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IF YOU have any involuntary loss of urine which is a social or hygienic problem, you should contact your GP for further advice in the first instance. Incontinence can be divided broadly into the following types, but most patients suffer from stress and/or urgency incontinence: Stress incontinence: leakage during periods of abdominal pressure (coughing, sneezing, lifting, straining).

Urge incontinence: leakage following an irresistible urge to pass urine.

Mixed incontinence: combined stress and urge incontinence.

Overflow incontinence: inability to empty bladder, resulting in overflow.

Other types include functional, continuous and post-void dribble.

There may be as many as 3 million people in the UK with urinary incontinence — 60 to 80 per cent of these have never sought medical advice for their condition and 35 per cent view it simply as part of the ageing process.

Conservative treatment can be successful in improving most forms of incontinence and surgery is effective if conservative measures do not work.

STRESS INCONTINENCE

This is usually the result of sphincter weakness caused by childbirth, decrease in hormone support due to menopause, hysterectomy or increasing age. It is made worse by obesity.

URGE INCONTINENCE

This is due to bladder muscle overactivity. In most patients, the underlying cause is unknown. Urinary infections, bladder stones, bladder cancer, neurological disease (eg stroke, Parkinson’s disease) and obstruction (usually prostatic enlargement) can all cause urge incontinence.

OVERFLOW INCONTINENCE This is usually due to chronic retention of urine (in men) but may also be caused by a congenital abnormality of the bladder or by spinal cord injury.

CONTINUOUS INCONTINENCE

This is usually due to an inherited problem, injury to the pelvis, an acquired false opening from the vagina into the bladder or a complication of surgery.

POST-VOID DRIBBLE

A cause is rarely found for this type of incontinence. In a small proportion of patients, it may be due to to a pouch in the water passage or a narrowing of the water passage.

TREATMENT

There are several reasons why your GP may arrange a referral to a urologist to exclude more complex problems and start management, these include: an enlarged bladder blood in your urine a mass arising from your pelvis or urinary tract if you are suffering from pain if you previously had radiotherapy or surgery to your bladder region.

For most types of incontinence, lifestyle changes and modification of diet will suffice. Urgency incontinence can be treated with drugs, botox to the bladder or implanting a pacemaker in the buttocks to control bladder contractions. Stress incontinence is treated with surgery, which can be minimally invasive such as peri-urethral bulking agents or more complex such as colposuspension or a rectus facial sling.

Mr Shahzad Shah is a leading urologist a Spire Bushey Hospital, 020 8901 5505