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For any customer, asking a pharmacy team member for help with urinary incontinence or bladder weakness may require the building up of a certain amount of courage. So, it is crucial that pharmacy teams are clued up on symptoms and treatment options and also know how to make people feel comfortable when discussing their symptoms.
Incontinence is nothing to be embarrassed about, and pharmacy teams can play a significant part in helping to dispel stigma and misconceptions.
Incontinence or bladder weakness?
Firstly, pharmacy teams can clear up any confusion around the difference between ‘bladder weakness’ and ‘incontinence’. “Bladder weakness, I would say, is a general term used when people have a bladder issue, which could include reduced muscle strength of the pelvic floor, frequency or urgency, or passing urine with or without any loss of control causing leakage,” says Lydnsey Allen, specialist nurse at Bladder Health UK (bladderhealthuk.org). “Urinary incontinence is any actual involuntary leakage of urine, which can be due to different reasons and categorised into different types, such as stress, urge or functional.”
Lyndsey dismisses the notion that bladder problems are reserved for people of a certain age. “Anyone, at any age, or at any time in their life, can be affected by bladder weakness and/or incontinence, including men, women and children,” she says.
There are a few different types of incontinence, with varying causes:
- Stress incontinence leads to leakage when coughing, sneezing, lifting or straining. It’s usually due to weak pelvic floor muscles caused by childbirth, hormone changes at the menopause or getting older
- Urge incontinence happens when a sudden, urgent need to pass urine is triggered by bladder muscle spasms. Possible causes include urinary tract infection (UTI), drinking too much alcohol or caffeine, neurological conditions or certain medicines
- Overflow incontinence is when a person is unable to empty their bladder, possibly because of a physical blockage (e.g. enlarged prostate, bladder stones), nerve damage (which can occur with diabetes) or medication
- Functional incontinence is being unable to use the toilet in time due to poor mobility or a nerve-related condition
- Continuous incontinence is a rare condition in which the bladder cannot store any urine, causing a constant, ongoing leak.
How to help
Some types of incontinence can be treated by addressing the cause. For example, pelvic floor exercises may help someone who has a weak pelvic floor – perhaps because of the menopause or pregnancy.
A host of helpful management products are also available for you to recommend in the pharmacy. These include containment aids like incontinence pads and washable, leak-proof underwear; cleansing wipes; barrier creams that shield the skin from irritation and moisture; radar keys to open public toilets designated for disabled use, and non-irritating cleaning/cleansing products like soaps and body washes.
Pharmacy teams can also offer self-care advice, which includes:
- Avoiding constipation, as this can impact pelvic floor strength and bladder function
- Stopping smoking and vaping, as nicotine can irritate the bladder and coughing can weaken the pelvic floor
- Avoiding bladder irritants such as caffeine, artificial sweeteners, alcohol and fizzy drinks
- Reducing stress
- Bladder training to lengthen the time intervals between emptying the bladder.
“Pregnancy places the bladder and pelvic floor under sustained mechanical and hormonal strain”
Incontinence and men
Men are often tentative about addressing incontinence. “Men tend to be less likely to talk about these issues,” says Lyndsey Allen, Bladder health UK specialist nurse. “On our advice line, we have a higher percentage of female callers and when I speak to men, they often start their conversation by saying such things as ‘this is very embarrassing’ or ‘I feel awkward discussing this’. Very often they share that it is the first time they have spoken to anyone about such problems, including partners.”
Data shows that a considerable number of men have a certain degree of incontinence, but the lack of conversation about the issue makes them think they are alone in their struggle. This is one of the reasons why promoting awareness is so important.
“It is documented that up to 40 per cent of men over the age of 50 years have lower urinary tract symptoms which can include pain, flow issues, frequency, urgency and nighttime/sleep disturbance,” says Lyndsey.
“More specifically, it is reported that overactive bladder affects approximately 10 to 16 per cent of adult men; incontinence affects about 11 per cent of younger to middle-aged men – increasing to between 21 to 31 per cent in men over 65 years – and enlarged prostate affects around 50 per cent of men by age 50 and up to 90 per cent in the older decades.”
With statistics confirming that incontinence affects a considerable number of men across a range of ages, what can community pharmacy teams do to help? The answer is that there are lots of ways to offer support.
For instance, displaying information posters in the pharmacy, handing out leaflets and attaching fact sheets to prescriptions can increase awareness and prompt customers to seek help. These are all discreet ways to encourage more shy or nervous customers to engage with incontinence.
Lyndsey says that the most important thing pharmacy teams can do is educate themselves on bladder issues so they are confident addressing the topic with customers. Thereafter, Lyndsey says pharmacy teams should: “Give privacy when discussing these issues. Give time, listen actively, ask open ended questions, show kindness and understanding.
Explain that it’s most certainly not their own fault and that often these issues can be solved, treated or at least managed.”
Letting customers know that there are many others in similar situations can also help customers to relax and feel more at ease.
“Share that many men have bladder problems and ask gently and in language they will understand if this is something they are experiencing,” suggests Lyndsey. “Being the one to open the conversation shows that you are a person they can talk to about this. Perhaps also consider the use of paper questionnaire options for health screening that includes bladder issues.”
Other suggestions include:
- Seek to work with local NHS bladder and bowel continence services and let customers know how to access these
- Signpost patients to charities or advice lines for further support
- Advise customers to see their GP to ensure correct or necessary referrals can be made, if appropriate.
“Enlarged prostate affects around 50 per cent of men by age 50”
The impact of pregnancy and menopause
Many women, as well as their partners, may not be aware of the impact of pregnancy and menopause on bladder strength. Both events cause significant changes in a woman’s body, and if the bladder thought it was going to be left unscathed, well, it can think again.
A lot of people will be familiar with the comedic trope of a pregnant woman always needing the bathroom – this is not necessarily an exaggeration. Christien Bird, pelvic health physiotherapist, co-founder of the Menopause Movement and spokesperson of the Chartered Society of Physiotherapy (CSP), explains that pregnancy places the bladder and pelvic floor under sustained mechanical and hormonal strain.
“The hormone changes in pregnancy, like the production of relaxin, softens collagen and connective tissue throughout the pelvis to prepare the body for birth,” Christien says. “But this same softening reduces the support the bladder neck and urethra normally rely on. As the uterus grows, it adds direct weight and pressure onto the bladder, reducing its functional capacity and causing the frequency, urgency and nocturia so many pregnant women describe.” (Nocturia is the regular waking up in the night to empty the bladder.)
Christien adds that by the third trimester, “up to a third of women experience some degree of urinary incontinence, most commonly stress incontinence, as intra-abdominal pressure rises against a pelvic floor that is working harder to support increasing load with less connective tissue stiffness to help it”.
Women who are experiencing incontinence may ask in the pharmacy for product recommendations to help manage leaks. However, to avoid problems occurring in the first place, expectant mums can be encouraged to prepare their pelvic floor for the strain of pregnancy. Christien’s advice is:
- “Learn to contract correctly first. Many women ‘brace’ or use their glutes/inner thighs instead of the pelvic floor – ideally this would be checked by a pelvic health physiotherapist, but simple self-checks (stopping the flow of urine mid-stream once, as a test only, not a repeated exercise) can help with initial awareness
- Download the Squeezy app. It’s a great place to start
- Build quick ‘fast-twitch’ squeezes (for coughs/sneezes) and longer holds for postural support. In between, it is important to let go and release. The letting go matters as much as the lift
- Prevent constipation and straining on the toilet – consume adequate fibre and fluids, and use a footstool to achieve a more optimal defecation position
- Address a chronic cough early (stop smoking, treat reflux) since repetitive high-pressure loading can be a contributor
- Maintain healthy gestational weight gain where possible, as excess weight increases pelvic floor load
- See a pelvic health physiotherapist if any leaking, heaviness, or bulging is noticed. Early intervention in pregnancy is far more effective than waiting until postpartum. This is also important to prepare for the birth as pelvic floor muscle control and release as well as perineal massage have been shown to reduce the risk of pelvic floor injury during childbirth.”
Be ready to advise
Pharmacy teams should be prepared to pick up on symptoms in conversations with customers who might not raise these issues with their GP, and advise as appropriate.
Christien Bird, spokesperson for the Chartered Society of Physiotherapy, says there are a few key messages and recommendations:
- Normalise the conversation. “A simple, non-judgemental opening question like ‘Are you also noticing any bladder changes alongside your other menopause symptoms?’ can open a door many women haven’t felt able to walk through themselves”
- Encourage assessment. “Recurrent urinary tract infections (UTIs), new urgency, or leaking warrant a GP or continence service referral to rule out other contributing factors and confirm the type of incontinence (stress, urge, or mixed), since treatment differs”
- Signpost to pelvic floor muscle training with a pelvic health physiotherapist as a first-line, evidence-based treatment for both stress and urge incontinence
- Topical (local) vaginal oestrogen is a key, often under-utilised option pharmacy teams can discuss. “It’s a low, localised dose distinct from systemic hormone replacement therapy (HRT), with a strong safety profile for most women. Evidence shows it improves vaginal and urethral tissue quality – increasing collagen synthesis, vascularity and elasticity – and modestly reduces urinary frequency and urgency, particularly in women with combined bladder and vaginal atrophy symptoms”
- Combining topical vaginal oestrogen with pelvic floor muscle training appears to offer a synergistic benefit over either approach alone. “Restoring oestrogen locally
improves the visco-elastic properties and collagen quality of vaginal and urethral tissue, which gives pelvic floor training something more responsive and supportive to work with – early trial evidence in postmenopausal women with stress urinary incontinence supports better outcomes from the combined approach compared to vaginal oestrogen alone. This is a good example of ‘tissue health plus muscle training’ being more effective together than either intervention in isolation” - Practical, everyday advice pharmacy teams can share confidently: moderate caffeine and fizzy drink intake (rather than restricting fluids, which can increase urine concentration and irritate the bladder further); bladder training techniques for urgency; maintaining a healthy weight; treating constipation, and not being embarrassed to ask about continence products as a bridge – not a replacement – while proper treatment is sought.
“One of my favourite bladder re-training tips is mental maths,” says Christien. “If you feel an eye-watering urge to wee, start from 100 and count down in 7s. This will help to reduce the urgency and make it to the toilet in time.”
Additional advice for new mums
After giving birth, some people will want to do no exercise, while others might be eager to get moving again. Anyone who is returning to exercise after giving birth should do so at their own pace. “There’s no single ‘magic number’ of weeks – return to exercise should be guided by healing, symptoms and type of birth rather than the calendar alone,” says Christien.
However, she adds that current guidance can offer a useful structure:
- 0–2 weeks: Gentle walking, breathwork and pelvic floor/deep abdominal reconnection (regardless of birth type). This is about restoring the connection between breath, core and pelvic floor, not ‘exercising’ in the traditional sense
- 2–6 weeks: Gradually building walking duration/pace, continuing pelvic floor and core work, general mobility
- 6–12 weeks: After the GP or physiotherapy postnatal check, low-impact strength training can usually begin, progressing gradually
- Before returning to running, jumping or high-impact sport: Ideally a pelvic health physiotherapy assessment would be done first. A general guide is no earlier than three months postnatal, and only when the woman can meet functional criteria (e.g. single-leg squats, hopping, running on the spot without leaking, heaviness, or pain).”
Christien cautions that any leaking, dragging or heavy sensations, pelvic or lower back pain, or doming/coning along the abdominal midline are signals to scale back and seek individual assessment – not signs to ‘push through’.
“Recovery timelines also differ significantly between a straightforward vaginal birth, an instrumental delivery, and a caesarean birth,” she says. “So, individualised guidance always trumps generic timeframes.”
“Anyone, at any age, or at any time in their life, can be affected by bladder weakness”
The menopause: a transformational impact on the bladder
Women may experience issues with their pelvic floor during menopause. It is not something to worry about, says Christien, but neither is it something they should be told to simply accept.
The pelvic floor can be adversely affected by declining and fluctuating oestrogen levels during perimenopause and menopause. This directly impacts the bladder, urethra and vaginal tissues, says Christien. “This is part of what’s now termed Genitourinary Syndrome of Menopause (GSM). As oestrogen falls, the urethral and vaginal lining thins, loses collagen and elasticity, reducing the ‘seal’ the urethra normally provides,” she explains. “Vaginal pH rises, altering the local microbiome and increasing susceptibility to recurrent UTIs, which themselves can trigger or worsen urgency and leaking.”
Pelvic floor tissue is impacted by the loss of some of its collagen density, and can weaken further due to age-related loss of muscle mass, strength and physical function (sarcopenia). Christien says this then compounds any pre-existing weakness from pregnancy or birth, and overactive bladder symptoms like urge incontinence, needing to urinate frequently and urgency “commonly emerge or worsen, alongside stress incontinence”.
Signposting
There are organisations providing excellent support for healthcare professionals advising patients and for patients themselves. Christien’s top recommendations are:
- Pelvic, Obstetric and Gynaecological Physiotherapy: thepogp.co.uk
- The Menopause Movement: menopausemovement.co
- Positive Pause: positivepause.co.uk.
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