Prevalence rising

In stress incontinence, any action that causes a rise in intra-abdominal pressure, including sneezing, heavy lifting, coughing and laughing, can cause leakage of urine. Lifting, for example, puts strain on the pelvic floor muscles, so should be avoided as much as possible. If lifting is unavoidable, such as picking up children or shopping bags, tightening the pelvic floor muscles before and during the lift will help.

Some drinks and foods can act as diuretics, stimulating the bladder and increasing urine volume. They include alcohol, caffeine, carbonated drinks/sparkling water, artificial sweeteners, chocolate, chilli peppers, foods that are high in spice, sugar or acid, especially citrus fruits. Caffeine and alcohol have a diuretic effect.

Restricted mobility may contribute to incontinence by making it difficult to get to the toilet in time. This is sometimes called functional incontinence. Needing to get from the bedroom to the bathroom at night, even over a short distance, can result not only in the passage of urine but also an increased risk of trips and falls when hurrying.

Constipation is a contributory factor because the rectum is located near the bladder and they share some nerves. Straining to pass hard, compacted stools can increase pressure on the bladder and cause overactivity in these nerves resulting in increased urinary frequency. 

Chronic colorectal distention from constipation and chronic straining may limit the extent of bladder distention and lead to the need to empty the bladder more often. Sometimes a prolapse around the rectal area, associated with weakened perineal tissue, may contribute to incontinence.

Any medicine that causes constipation can contribute to incontinence. Medicines used to treat urge incontinence are often antimuscarinics and constipation is a likely side-effect. 

Smoking can contribute to incontinence in several ways. Chemicals from tobacco smoke are excreted in the urine and are in contact with the bladder wall, where they can have an irritant effect that can cause urgency and OAB symptoms.   

A “smoker’s cough” increases intra-abdominal pressure on the pelvic floor muscles and increases the likelihood of stress incontinence. Nicotine also stimulates the detrusor muscle of the bladder.

Medicines that are associated with urinary incontinence include diuretics, ACE inhibitors and ARBs, and SSRIs. If the onset of symptoms coincides with starting one of these medicines, the patient can be referred. HRT (oral oestrogen) and vaginal oestrogen products may have been prescribed for vaginal atrophy or other menopause symptoms and if incontinence related to these has not been discussed with the prescriber, the patient should be advised to raise the matter with them.