Urinary incontinence is the involuntary leakage of urine, and it is far more common than most people realise. In my clinic, I see it in women in their thirties who have just had children, women in their fifties going through the menopause, and older men after prostate surgery. It is one of those conditions patients apologise for mentioning, when really it should be as unremarkable as discussing a bad back.
The severity varies enormously. For some, it is the odd dribble when laughing, coughing or sneezing. For others, it is a sudden, overwhelming urge to go that doesn’t give them time to reach a toilet. Either way, it can quietly shrink a person’s world. I have had patients turn down holidays, avoid the gym and stop trampolining with their grandchildren because of it.
It is worth saying plainly: incontinence is common with age, but it is not something you simply have to put up with. There is a great deal that can be done, and much of it doesn’t involve surgery.
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There isn’t one single cause. In my experience, it usually comes down to a combination of the following.
Stress incontinence happens when the muscles that hold urine in, chiefly the pelvic floor and the urethral sphincter, have weakened or been damaged. This is the type I see most often, and it is very strongly linked to pregnancy and vaginal delivery. Carrying a baby to term, and the birth itself, put a significant strain on the pelvic floor that many women underestimate until years later.
Urge incontinence is different. It is caused by overactivity of the detrusor muscle, the muscle that controls bladder contraction, so the bladder squeezes at the wrong moment and gives you very little warning.
Several factors make incontinence more likely:
My honest view is sooner rather than later. Patients often wait years, sometimes decades, before they mention it to anyone, by which point the muscles have weakened further and their confidence has taken a real knock. If leakage is affecting how you exercise, socialise, work or sleep, that is reason enough to seek an opinion. You do not need to wait until it becomes severe.
pregnancy and vaginal birth
obesity
a family history of incontinence
increasing age – although incontinence is not an inevitable part of ageing
Our consultations are in-depth and tailored to you, creating a bespoke treatment plan catering to all of your concerns.
ConsultationEvery patient who comes to see me about incontinence gets a proper, unhurried consultation. I want to understand the pattern of leakage, what triggers it, your obstetric or surgical history, and what matters most to you, whether that is getting back to running, feeling confident in social situations, or simply sleeping through the night. From there we build a treatment plan around you.
Emsella Chair
This is the treatment I reach for most often, and it has genuinely changed how I manage incontinence in clinic. You sit on the chair, fully clothed, for around 28 minutes while it delivers high-intensity electromagnetic energy to the pelvic floor. Each session generates thousands of supramaximal contractions, far more than you could ever achieve doing Kegel exercises on your own, however diligent you are. Most patients need a course of sessions rather than a single visit.
The results speak for themselves. In clinical studies, 95% of patients reported a significant improvement in their day to day symptoms, and 85% noted an improvement in intimate satisfaction as a welcome secondary benefit. I would rather set expectations honestly: it is not a miracle cure and it works best as part of a broader plan that may include physiotherapy, weight management and lifestyle changes where relevant.
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