Living with incontinence

Follow our tips on how to cope with the daily challenges of living with incontinence.

Enjoy good sex

Prepare for local trips

How to look after your skin

What to take on holiday

How to manage incontinence at work

Fight depression with talking therapy

Enjoy good sex despite incontinence

Worries about embarrassing leaks during sex can mean you avoid intimate contact. This puts strain on relationships and damages your self-esteem and self-confidence.

There's no reason why anyone with bladder or bowel weakness can't enjoy intimate relationships.

If you empty your bladder and bowel and don't drink too much fluid before having sex, any leak probably won't be serious. Sex involves all sorts of bodily fluids, so a small leak probably won't even be noticed.

It can give you peace of mind to protect the bed. Bed pads, which absorb moisture and have a stay-dry cover, may be the most comfortable choice.

Prepare for local trips

People with incontinence can worry so much about needing the toilet, even on quick trips to the local shops, that they become virtually housebound.

You can get a key from the disability network RADAR that allows you to use disabled toilets around the country under the National Key Scheme.

How to look after your skin

Constant dampness can make your skin irritated, but you can avoid this by following a simple routine.

Wash using a cotton cloth or disposable wipes (flannels and sponges can be too harsh). Use products that cleanse without drying. These are available as non-aerosol sprays, foams and disposable wipes.

Don't use soap as it makes the skin dry. And check that disposable wipes are alcohol-free to avoid skin irritation.

After cleansing, always moisturise and use a non-greasy barrier cream. This forms a protective layer to block out unwanted moisture.

What to take on holiday

Incontinence shouldn’t stop you going on holiday or staying with friends. The key is to plan ahead.

Take enough of all the products you use with you. Include a small bag containing your clean-up kit. This could contain a change of clothes, pads, handwash, wet wipes and plastic bags.

If you intend to do your own laundry, find out where you can wash and dry items in private, if necessary. A portable washing line and pegs can be useful.

If you're flying, pre-book an aisle seat near the toilet and wear loose-fitting clothes, as they're more comfortable and make changing easier.

Finally, pack a deodorising spray, which will remove odours, rather than just masking them.

How to manage incontinence at work

A study by the charity Bladder and Bowel UK (formerly PromoCon), which provides information and advice about incontinence products and services, found that coping with incontinence symptoms at work is a big source of anxiety for people with bladder and bowel problems, especially men.

Some people who told their colleagues or employer about their continence problems reported a negative response, while others found their boss supportive and understanding.

Contact the Bladder and Bowel UK confidential helpline on 0161 607 8219 (Mon-Fri 9am-4.30pm) or email bladderandboweluk@disabledliving.co.uk for advice on whether, and how, to tell your employer about your continence difficulties. The helpline can also suggest incontinence products that can help at work.

Fight depression with talking therapy

Incontinence can affect you mentally as well as physically. The negative effect on your self-esteem, dignity and independence can lead to isolation, distress and depression.

According to continence nurses, up to 70% of people with incontinence are affected by depressive illnesses.

It helps to talk to people you trust, so tell your friends and family how you're feeling.

Or ask your GP to refer you for counselling or other talking therapy.

For more tips, read 10 ways to stop the leaks.

10 ways to stop leaks

For many people with incontinence, the following self-help tips and lifestyle changes are enough to relieve symptoms.

Do daily pelvic floor exercises

Pelvic floor exercises can be really effective at reducing leakage, but it's important to do them properly. Find out how to do pelvic floor exercises.

You may have to do pelvic floor exercises for three months before you see any benefits.

Quit smoking

If you smoke, you put yourself at risk of incontinence, because coughing puts strain on your pelvic floor muscles.

Advice to help you stop smoking is available from your GP or pharmacist.

If you want to go direct, find your nearest NHS Stop Smoking Service from the NHS Smokefree website, or call the Smokefree National Helpline to speak to a trained adviser on 0300 123 1044.

Read more about how to stop smoking.

Do the right exercises

High-impact exercise puts pressure on your pelvic floor muscles and can increase leakage. Sit-ups can also make you leak by straining your pelvic floor muscles.

If you want to strengthen your pelvic floor to relieve symptoms, replace jogging and aerobics classes with pilates. This gentle method of stretching and strengthening core muscles has become more popular as a treatment for stress incontinence.

Avoid lifting

Lifting puts strain on your pelvic floor muscles, so avoid it wherever you can.

When you do need to lift something, like picking up children or shopping bags, tighten your pelvic floor muscles before and during the lift.

Fight incontinence by losing weight

Being overweight can weaken your pelvic floor muscles and can cause incontinence, because of the pressure of fatty tissue on the bladder.

Your symptoms may improve, and could clear up completely, if you lose the excess weight.

To check whether you're a healthy weight, use our healthy weight calculator. Your body mass index (BMI) is a measure of whether you're a healthy weight for your height.

Read more about how to lose weight.

Treat constipation promptly

Straining to empty your bowels weakens your pelvic floor muscles and makes leakage worse.

Never delay the urge to empty your bowels. If you have constipation, it may help to change your diet and lifestyle.

Eating more fibre and taking more exercise can help. It may also help if you change the way you sit and use your muscles to empty your bowels. A specialist physiotherapist can advise you on this.

Read more about food and diet.

Cut down on caffeine

Caffeine irritates the bladder and can make incontinence worse.

Coffee has the biggest effect, so stop drinking it or switch to decaffeinated.

Fizzy drinks, tea, green tea, energy drinks and hot chocolate also contain caffeine, so cut down on these too and replace them with water and herbal or fruit teas.

Cut down on alcohol to improve incontinence

Alcohol is a diuretic, which makes you urinate more often. Cutting down may help your incontinence symptoms.

Read more on how to cut down on your drinking.

Drink plenty of water

Drink six to eight glasses of fluid a day (but no more) unless your doctor advises you otherwise.

Many people with urinary incontinence avoid drinking fluids, as they feel it causes more problems. However, limiting your fluid intake makes incontinence worse, because it reduces your bladder's capacity.

Too little fluid can also cause or worsen constipation.

Find out which are the healthiest drinks.

Eat the right foods

Avoid spicy and acidic foods, such as curries and citrus fruits, as they can irritate the bladder and make leaks and other incontinence symptoms worse.

For more tips, see living with incontinence.

Incontinence products

Incontinence pads and other products and devices can make life easier for you if you're waiting for a diagnosis or for a treatment to work.

This page covers:

Pads and pull-ups

Avoid sanitary pads

Stop stress incontinence leaks

Appliances and bedding

Can I get incontinence products on the NHS?

Where to buy incontinence products

A wide range of products and devices are available for bladder and bowel incontinence.

They include:

• pads and pants
• bed and chair protection
• catheters and penile sheaths
• skin care and hygiene products
• specially adapted clothing and swimwear are also available

Pads and pull-ups for incontinence

The most popular incontinence products are pads that are worn inside underwear to mop up urine leaks.

There's a wide choice of absorbent pads and pull-ups for men and women with all types of incontinence.

They use the same technology as nappies and have a "hydrophobic" layer which draws urine away from the surface of the pad, so your skin stays dry.

"I wouldn't recommend that people with urinary incontinence or bowel incontinence use pads without advice from a doctor or continence adviser," says Karen Logan, consultant continence nurse at Gwent Healthcare NHS Trust.

"But as a temporary measure, they can really improve your quality of life and save you from being housebound or spending all your time in the toilet."

Avoid sanitary pads for incontinence

"Many women use sanitary pads instead of incontinence pads because they're cheaper, but they don't have the same technology. They stay damp and they can make skin sore," says Logan.

"I recommend paying the extra for incontinence pads as they're much more effective and comfortable."

For people with severe leakage, continence clinics and district nurses can supply pads on the NHS, though they tend to be big and bulky.

"Women with mild to moderate incontinence want the thin, discrete pads you attach to your underwear. You pay for these yourself.

"They're on sale at most supermarkets, chemists and online. It doesn't really matter what brand you buy as they're all good quality," says Logan.

Stop stress incontinence leaks with tampons

Some women with stress incontinence use super-sized tampons to prevent sudden leaks. Wearing a tampon in the vagina puts pressure on the bladder neck to stop leakage on exertion.

According to the National Institute for health and Care Excellence (NICE) guidelines on urinary incontinence in women, tampons aren't recommended for the routine management of urinary incontinence in women.

However, tampons can be used occasionally when necessary to prevent leakage, for example, during exercise.

Appliances and bedding for incontinence

Other useful incontinence products for more serious leakage include sheaths and drainage systems for men and urinals (urine collection devices) for men and women.

A variety of incontinence bedding is available, such as washable bed pads, which sit on top of the mattress and soak up any overnight leakage. The pads stay dry to the touch and they can be useful for trips away from home.

Can I get incontinence products on the NHS?

You may be able to get incontinence products on the NHS; it depends on your local clinical commissioning group. To qualify for NHS products you may need to be assessed by a healthcare professional.

Here's more information about how to get incontinence products on the NHS.

Where to buy incontinence products

The charity Bladder and Bowel UK (formerly PromoCon) gives independent advice on products that can help manage bladder and bowel problems.

For more information on products and mail order, call their confidential helpline on 0161 607 8219 or visit the Bladder and Bowel UK website.

The Continence Product Advisor gives independent and evidence-based advice on how to choose and use suitable incontinence products.

Read more tips for living with incontinence

How to get NHS help for incontinence

If you have incontinence, don't be embarrassed about getting medical help. The symptoms can be improved, and sometimes cured, with simple methods.

Almost half (45%) of all people with incontinence wait at least five years before they get help, according to Karen Logan, a consultant continence nurse at Gwent Healthcare NHS Trust.

"There's a huge stigma around incontinence, despite it being so common," she says. "I would urge anyone with symptoms to come forward, as it's more than likely that we can sort out the problem and really improve their quality of life."

You should get help if you've had incontinence problems for more than a few weeks to rule out conditions such as diabetes.

Incontinence help from your GP

Your GP can assess whether you have incontinence and decide which type of incontinence you have.

They can also:

• give general advice on controlling symptoms of incontinence
• provide information on pelvic floor exercises and bladder retraining
• provide treatment for incontinence with prescribed medicines.

If lifestyle changes and treatments don't solve the problem, your GP can refer you to a continence adviser or specialist.

Continence clinics

Continence clinics can be based in a hospital or in the community, often attached to a health centre. They have specialist teams providing support and medical advice for people with bladder or bowel incontinence.

You don't need to be referred by your GP and can phone them directly to make an appointment.

"If you prefer not to see your GP, these are an excellent alternative first stop for diagnosis and treatment," says Logan. "We can significantly improve life for 75-80% of the people who come to us with incontinence problems."

On your first visit, a continence adviser, usually a nurse who specialises in bowel and bladder problems, will assess you and explain your incontinence treatment options.

Continence advisers, and the incontinence physiotherapists who work alongside them, are particularly good at teaching pelvic floor exercises to women with sudden leaks (stress incontinence).

For women with regular urges to use the toilet (urge incontinence), they can provide bladder training.

They can also supply pelvic floor-strengthening devices – such as vaginal cones, and continence pads and products – and explain how to use them.

Call your local hospital for details of your nearest NHS continence clinic.

The hospital incontinence specialist

If the help offered by your GP or local continence clinic doesn't work, you can be referred to a hospital urologist or urogynaecologist for tests and possible incontinence surgery.

If you have bowel incontinence, you may be referred to a colorectal surgeon or gastroenterologist.

According to Karen Logan, only 10-15% of patients who attend continence clinics have to be referred for surgery.

If you decide to have surgery, it's important that your surgeon has the necessary skills and training.

Check that they're trained in surgery for incontinence and have done these operations often enough to keep their skills up-to-date.

Get tips on living with incontinence.

Prostate cancer treatment stories

Treatment for prostate cancer can have serious side effects. Here, male patients describe how it affected them.

• prostatectomy involves the surgical removal of the prostate gland
• brachytherapy is a form of radiotherapy where a number of tiny radioactive seeds are surgically implanted into the tumour

While the side effects from the prostate cancer treatments below are the most common ones, not all men will experience them.

Some men will have short-term discomfort and make a good recovery, while others may experience longer-term symptoms which may require lifestyle changes.

The men's names have been changed to protect their privacy.

Incontinence

If your urinary incontinence is mild, you may be able to control it by learning some simple exercises. Pelvic floor exercises can strengthen your control over your bladder. For more severe cases, surgery may be necessary.

Bill had radical prostatectomy (prostate removal) after he was diagnosed with prostate cancer aged 66

Bill was incontinent for six months after the surgery and says during that time his life had to be divided into 40-minute slots. "The sort of nappy-type pads that I wore had a 40-minute lifespan," he says. "If I was going to go to the cinema or anything of that sort, everything had to be worked out in 40 minutes.

"I was still very pleased I'd had the surgery. I would never have not had the surgery because of it." Bill was considering changing his lifestyle as a result, but then he started getting better.

Anthony had brachytherapy (a form of radiotherapy) after he was diagnosed aged 59

After the treatment, Anthony experienced bladder pain and had trouble passing water. He says: "[I was also] passing water far too often to get involved in doing anything else. This obviously leads to a lack of confidence and you don't feel like leaving the house." He says his condition has gradually improved and as a result so has his confidence. "I can go out of the house and travel about now and it's getting back to normal," he says.

Simon was 54 when he was diagnosed and had a radical prostatectomy

Simon was given male incontinence pads after his treatment to deal with what he calls "dripping". He says not many chemists stocked them and he would often run out. He says: "I'd advise anybody to make sure their local chemist has got them in for you, as our local chemist only had one pack."

He says the pads are not uncomfortable but he found the drip sensation annoying. He has since been able to return to work as a builder. "I haven't worn pads now for the last four or five months," he says. "I get a drip now and again but it's mostly if I put my legs wide apart."

Impotence

There are a number of treatments available for erectile dysfunction, including drugs to increase blood flow, such as Viagra, injections to produce an erection, vacuum pumps and surgical implants.

Nigel had radical prostatectomy after he was diagnosed aged 56

Nigel says his sex drive has gradually diminished since his treatment. "It became very limited," he says. He is unable to have or maintain an erection. "That isn't a huge problem to me and my wife," he says. "We've learnt to come to terms with it. It was something we didn't want and we would've preferred not to have had, but it's secondary to everything else. Both of us are here and we get on with our life."

Angus was diagnosed aged 68 and had surgery and hormone therapy

Angus didn't find it too hard to come to terms with impotency. "At 70 I'm not that worried," he says. "It hasn't altered my relationship with my wife. By the time we reached 70, it wasn't the end of the world. It just doesn't happen any more. I think our relationship is fine, we're as affectionate as we always were but there isn't any sexual activity."

Charles had hormone treatment after he was diagnosed aged 66

Charles says he and his wife are not that bothered about his impotence. "In a younger man I think the impotence would worry them because it might affect their married life. It depends how the relationship between the husband and wife is. In my case, we've got three grown-up daughters now and my wife isn't bothered in any way. It doesn't interest her any more so we get along well together."

In fact, Charles' wife tells him that the hormone therapy has made him more even-tempered. "She says I'm more relaxed now than I've been in all the years she's known me," says Charles.

Bowel and bladder problems

Bowel dysfunction is mainly a side effect of radiotherapy. Short of treating individual symptoms as needed, there are few, if any, treatment options for bowel dysfunction after radiotherapy.

Frank was diagnosed aged 66 and had radical prostatectomy

On top of urinary incontinence and impotence, Frank developed symptoms of a dilated colon, called a mega-colon. "It becomes almost like a reservoir, so instead of being a muscular tube which is going to propel the faeces along, it becomes a collecting tank for faeces," he says. It was a condition Frank found particularly difficult, especially as he had a weak pelvic floor that weakened his bowel control even further.

Tim had radiotherapy after he was diagnosed at the age of 67

Following treatment, Tim had severe diarrhoea which lasted for about three weeks. He was warned beforehand that his rectum would probably be injured as a consequence of the radiotherapy. He says: "That was all explained to me, but you don't know what it means until you get it. We were all prepared for it so coped with the consequences, which lasted about three weeks after the treatment. It's gradually got better since."

George had radiotherapy after he was diagnosed aged 66

The radiotherapy caused damage to George's rectum, called proctitis, an inflammation of the anus. He says: "The result is that you have to keep your bowels as regular as you possibly can, because if you don't you'll just aggravate it and make it worse. And also the frequency is increased. Instead of possibly just going once or twice a day, you know at the extreme you might have to go three times a day, but the plus side is you do go as soon as you wake up."