Bladder problems typically take the form of urinary retention (inability to empty the bladder) or urinary leakage (incontinence) and arise from neurogenic disorders such as spinal cord injury, multiple sclerosis and spinal bifida. Urinary problems can be age related or result from an underlying physical disease, caused by a dysfunction in the bladder. Learn how the bladder works.

Urinary incontinence

There are different types of urinary incontinence, each with different symptoms and causes. The most common types of urinary incontinence are stress urinary incontinence (SUI), urge urinary incontinence and mixed urinary incontinence.

• Stress urinary incontinence (SUI) occurs when the muscles in the pelvic floor, under sudden, increased pressure (stress), are too weak to hold the urethral sphincters closed. The result is an involuntary leakage of urine during everyday activities such as sneezing, coughing, laughing or exercising.
• Urge urinary incontinence (unstable or overactive bladder) is caused by involuntary, uncontrolled contractions of the muscle in the bladder. This results in a sudden urge to go to the toilet, and involuntary urine leakage before reaching the toilet.
• Mixed urinary incontinence is a combination of stress urinary incontinence and urge urinary incontinence.
• Overflow incontinence (a frequent or constant dribble of urine) results from an inability to empty the bladder and occur in people with a damaged bladder, blocked urethra or neurological damage. With overflow incontinence you may feel as if you never completely empty your bladder. When you try to urinate, you may produce only a weak stream of urine.

Urinary Retention

Urinary retention can be caused by an obstruction in the urinary tract, a bladder muscle weakness or by a neurogenic condition e.g. multiple sclerosis, spinal cord injury or spina bifida all of which interfere with signals between the brain and the bladder, resulting in a dysfunction in the urinary system.

Urinary tract infections

When your bladder is not emptying properly there is a risk that the residual urine in the bladder will become infected. This could cause further complications (for example urinary tract infections) and problems if it is not removed regularly. It is important to seek help if you experience symptoms of urinary retention.

Symptoms of urinary problems are different depending on whether you suffer from urinary incontinence or urinary retention. Causes of urinary problems are many and can be related to a number of medical conditions including both neurogenic and non-neurogenic disorders. Read more about causes and symptoms of bladder problems and how to take care of your bladder.

Urine is produced in the kidneys, and flows from the kidneys into the bladder via the ureters. The bladder stores urine until the urethra carries it out of the body. This flow, from the bladder to the urethra, is controlled by the urethral sphincters, which open and close the bladder outlet. The sphincters, in turn, are controlled by the pelvic floor muscles. The healthy bladder expels urine in a controlled, usually voluntary fashion, and the average person urinates 4-8 times a day. Watch a video demonstration of how the bladder works.

Bladder activity is regulated by the central and peripheral nervous systems. You feel the need to urinate when the stretch receptors in the bladder tell the brain that the bladder is full. However, with bladder dysfunction, you may not be able to inhibit the urge to pass urine. Problems with the bladder may result in urinary incontinence or urine retention.

Urinary incontinence

Urine incontinence is the involuntary leakage of urine. There are different types of urinary incontinence, each with different symptoms and causes.

Urinary retention

Urinary retention can be caused by an obstruction in the urinary tract, a bladder muscle weakness or by a neurogenic condition e.g. multiple sclerosis, spinal cord injury or spina bifida all of which interfere with signals between the brain and the bladder, resulting in a dysfunction in the urinary system.

Neurogenic bladder

Neurological conditions can cause damage to the nervous system affecting the bladder and resulting in urinary retention (see above) or an overactive bladder which has symptoms of both urge incontinence and leakage. 

Find out more

Learn more about neurogenic bladder, symptoms and causes of urinary retention and urinary incontinence.

Symptoms will vary depending on the underlying cause. The basic function of your urinary system is to store urine in your bladder and empty it through your urethra.

Typical symptoms of urinary incontinence

• Urinary leakage
• Small or large amounts of urine leaking without warning or without feeling the urge to go to the toilet
• Involuntarily leakage when sneezing, coughing, laughing or exercising
• A sudden urge to rush to the toilet to urinate
• The need to get up to pass urine two or more times a night (nocturia)

Typical symptoms of urinary retention

• Discomfort 
• Urgent sense to urinate but inability to start the urine flow
• Frequent visits to toilet
• Dribble due to overflow incontinence
• Weak flow
• Bloated lower abdomen

When to get in contact with your healthcare professional

Many people who experience bladder issues are hesitant to see their healthcare professional, because they find it embarrassing. In order to clarify what is causing the symptoms and to rule out anything potentially serious, it is important to consult a healthcare professional.

Causes of urinary problems are many and can be related to a number of medical conditions including both neurogenic and non-neurogenic disorders. 

Medical conditions causing your urinary problems are generally categorised either as neurogenic or non-neurogenic. Some conditions can cause urinary retention or may completely prevent the bladder from emptying and require catheterisation. Some conditions can cause urinary incontinence in which case a collecting device (urisheath and bag) offers a comfortable solution for men.

Neurogenic conditions causing urinary problems

Conditions causing damage to the nervous system include: 

• Spinal cord injury
• Multiple sclerosis
• Spina bifida
• Diabetes mellitus
• Stroke

 Urinary symptoms vary depending on where the neurological damage occurs and how severe it is.

Other medical conditions causing urinary problems

An example of a non-neurogenic medical condition causing urinary problems is BPH. Men diagnosed with BPH have an enlarged prostate which can have an impact on their daily life as urinary symptoms may appear as the prostate grows. Urinary symptoms can become very bothersome and if severe, an intermittent catheter, medicine or an operation may be needed.  

• Weakening of the pelvic floor due to age or childbirth
• BPH (enlarged prostate)
• Prostate or bladder surgery
• Bladder cancer
• Botox injections of the bladder to manage urinary incontinence
• Aging

Find out more

Read more about neurogenic bladder and how to take care of your bladder.

The result of having lost proper control from the central nervous system due to a neurological disorder is called a neurogenic bladder.

Neurogenic bladder may occur as a consequence of:

• Spinal cord injury
• Multiple sclerosis
• Spina bifida
• Type 2 diabetes
• Parkinson 
• Stroke
• Brain tumours 

A neurogenic bladder means that the normal process of filling and emptying the bladder is not working properly, so the bladder either fills without proper emptying or it empties unexpectedly. Symptoms vary depending on where the neurological damage occurs and how severe it is.

Different types of neurogenic bladder

A neurogenic bladder may be retentive, meaning it retains urine which could cause infection or other serious problems, or it may be overactive. An overactive bladder is typically caused by spasms of the muscles of the bladder and mainly associated with symptoms of urge incontinence.

Find out more

The symptoms of a neurogenic bladder must be properly managed. If the bladder has lost its inherent ability to empty the most reliable method is catheterisation. If an appropriate collecting device is not in place, this will lead to wetting. Read more about symptoms and how to take care of your bladder.

This FAQ is intended as a guide to commonly asked questions. Please always consult your healthcare professional regarding urinary problems. 

What is incontinence?

Urinary incontinence is the medical term for being unable to control the release of urine. 

What is neurogenic bladder? 

Neurogenic bladder refers to a condition where neurological damage has led to bladder dysfunction.

What are the signs and symptoms of urinary incontinence?

Some typical signs and symptoms include:

• Involuntary leakage of urine without warning or without feeling the need to go to the toilet
• Involuntary leakage of urine when sneezing, coughing, laughing or exercising
• A sudden urge to rush to the toilet either before or when leaking urine
• The need to get up to pass urine two or more times a night (nocturia)

What causes incontinence?

Potential causes include:

• Damage or weakness to the muscles in the pelvic floor (most commonly due to pregnancy and childbirth)
• Problems with the control of the bladder muscle (bladder overactivity and bladder underactivity)
• Neurogenic conditions that affect the voluntary release of urine (e.g. spinal cord injury, multiple sclerosis or  spina bifida)
• Enlarged prostate gland 
• Urinary tract infection
• Type 2 diabetes

Is incontinence a natural part of aging?

Although incontinence becomes more common with advancing age, it is not just older people who are affected. Effective solutions are available, so it should not stop you from living a full and active life, whatever your age. 

Can I still have a social life with incontinence?

It is possible to manage incontinence effectively. A doctor or nurse should be able to help find a solution that makes it possible to continue a social life and everyday activities. 

Can incontinence be treated?

Most types of incontinence can be treated or improved through lifestyle changes, pelvic floor exercises, bladder training, medication or surgery. If a cure is not possible,or a temporary solution is required, products such as catheters, urisheaths (for men) or absorbent products can be very helpful. 

What is a catheter?

A catheter can be used to ensure the bladder is completely emptied. It is a slim, flexible tube that is inserted into the bladder through the urethra enabling the urine to drain.

Why is it important to empty my bladder?

If your bladder is not emptied regularly, it can cause urinary tract infections. These start in the bladder but can move back to the kidneys and cause serious renal damage. Even small amounts of urine left in the bladder can cause infections. 

Can I drink less so that I do not have to empty my bladder so often?

No. It is very important that you drink enough to keep the urinary system healthy. An adult should drink approximately 1500 ml per day and take in a total of about 3 litres including liquids in the daily diet.

How can I tell if I have an urinary tract infection?

Symptoms of a urinary tract infection vary and may be subtle. They include:

• Dark-coloured and strong-smelling urine
• Blood in the urine
• Cloudy urine
• Fever/sweating
• Bladder spasms
• Increased muscle contractions in your leg

If you have any of the above symptoms, talk to your doctor or nurse. 

What if I get frequent urinary tract infections?

Using an intermittent catheter increases the risk of urinary tract infections. However, compared to other catheter types such as permanent (indwelling) catheters, intermittent catheters are less likely to cause urinary tract infections.

How can I prevent catheter related urinary tract infections?

There are ways to reduce the risk of urinary tract infections from catheters:

• Ensure you have clean hands and equipment when catheterising
• Drink sufficient amount of fluid during the day to wash out the urinary tract
• Make sure that the bladder is fully emptied every time you catheterise
• Speak to your healthcare professional about your catheterisation frequency and technique

Find out more

View our guide of how to catheterise.