Urinary incontinence

If you pee or leak urine when you do not mean to, this is called urinary incontinence. It is a common problem and probably affects millions of people around the world.

Urinary incontinence can make you more likely to have a fall. Up to 1 in 2 falls are connected with this health problem.

Types of urinary incontinence

Urinary incontinence can happen in different ways.

• Stress incontinence. If you have stress incontinence, urine leaks out when you cough, sneeze, laugh or exercise. This is caused by weak muscles that control the flow of urine out of your bladder and weak pelvic floor muscles.
• Urge incontinence. This is when you have a sudden and urgent need to pee. As you get older, your bladder becomes more unpredictable. You have less warning when you need to pee and pee more often. Sometimes, this can become a problem and start to cause incontinence.
• Overflow incontinence. This is when your bladder does not empty completely. It causes urine to build up and possibly leak out.
• Nocturia. This is when you wake up more than 2 times each night to pee. It disturbs your sleeping patterns and makes you feel tired during the day.

How urinary incontinence causes falls

Urinary incontinence can cause falls in different ways.

• You might rush to the toilet in fear of not reaching it in time. This is particularly risky when you get out of bed at night, it is dark and you feel sleepy.
• You might feel sleepy (drowsy) during the day because you wake up to pee during the night. This can make you more likely to fall.
• Some medicines used to treat urinary incontinence can cause low blood pressure when you stand up (postural hypotension). These can include antidepressants (Cymbalta and Tofranil) and anticholinergic medicines (Ditropan, Oxytrol and Detrol).
• If you drink less fluids to avoid leaking urine, you can get dehydrated. Your urine becomes dark and concentrated. This irritates the bladder and can make the symptoms of urinary incontinence worse, such as the need to pee urgently. You are then more likely to fall.
• If you leak urine on the floor, there is a risk of slipping.
• If you focus on needing to reach the toilet, this can distract you when walking or doing a task.
• If you are worried about leaking urine by accident, you might cross your legs or try unfamiliar walking patterns.
• If you are worried about leaking urine by accident, you might avoid going out into the community. You might become isolated and stop doing some daily activities. By restricting your lifestyle, you can lose body strength, balance and stamina. This can contribute to falling.

Managing incontinence to reduce the risk of falling

There are various ways to manage urinary incontinence. In many cases, it is possible to improve or even cure this condition.

Getting professional support

If you leak urine by accident, speak to your GP, district nurse or healthcare professional. They can help to find and treat the cause of your incontinence, and explain what services are available to help you.

You can refer yourself directly to a local continence clinic.

Exercises

You can do exercises to:

• strengthen your pelvic floor muscles
• improve your balance and walking
• practise moving from one position to another (this type of exercise can help you to get in and out of bed or on and off the toilet safely)

Peeing habits

It's usual to:

• pee between 5 and 7 times each day
• pee between 1 and 3 times each night (this number increases as you get older)
• leave 2 to 3 hours between each pee

Avoid going to the toilet because you're worried about needing to pee again later (perhaps if you go out). This can weaken your pelvic floor muscles.

It is best to sit down while you pee to make sure that your bladder is empty.

Drinks

You need to drink between 5 and 8 cups or glasses of fluid each day. Try to spread these drinks evenly throughout the day.

If you keep needing to go to the toilet suddenly and urgently, avoid drinks with caffeine, citrus, caffeine, fizz or alcohol.

Home environment and daily life

A personal alarm can help you to stay safe at home, particularly if you wake up in the night to pee. You can press the alarm to get emergency help at any time of the day or night if you fall.

Another option is to have a fall detector or bed sensor fitted at home. This senses if you have a fall or get out of bed and do not return within a set time. The sensor automatically calls for help. You do not need to press a button.

It may help to put a commode or urinal beside your bed if the toilet is not close to your bedroom.

• Commode. A commode is a toilet that can be easily carried or moved. Speak with a GP, district nurse or occupational therapist if you need a commode to reduce your risk of nighttime falls.
• Urinal. A urinal is a container for peeing. You can buy this device from your local pharmacy or online.

It is a good idea to wear clothes that you can easily remove or undo. Examples are loose-fitting trousers and clothes with Velcro fastenings.

It's important to think about hazards in your home and how you can remove them. Read more about staying safe at home.

Bladder and bowel community clinics

Your GP, nurse or other healthcare professional can refer you to our bladder and bowel community clinics if you live in Lambeth or Southwark. You can also refer yourself by calling 020 3049 4020 (Monday to Friday, 9am and 5pm).

More information and support

You can visit these websites for more information on urinary incontinence and support to manage the condition:

• Bladder and Bowel UK: www.bbuk.org.uk
• Age UK Incontinence: www.ageukincontinence.co.uk