Imagine how much less alone we’d feel if we let go of embarrassment around common conditions. Bladder leakage—also known as urinary incontinence—isn’t a normal part of life, but it’s also not uncommon. Approximately 35% of women are affected by urinary incontinence.

Because of the stigma around bladder and bowel health, along with misconceptions that incontinence is simply an expected part of aging or life transitions, too many people avoid seeking help. In reality, there are effective options to treat and manage symptoms, especially for the two most common types of incontinence: stress and urge.

Why am I leaking urine?

The two most common types of urinary incontinence:

  • Stress incontinence: leakage with exertion, exercise, or a change in pelvic pressure from a cough, laugh, or sneeze.
  • Urge incontinence: urinary frequency with a sudden, intense urge to urinate, which may or may not be followed by leakage. This is often a symptom of an overactive bladder.

It’s also possible to experience a mix of symptoms or less common forms:

  • Mixed incontinence: a combination of stress and urge incontinence.
  • Overflow incontinence: when the bladder doesn’t empty completely, leading to leakage or dribbling.
  • Functional incontinence: when a physical or mental impairment prevents reaching the bathroom in time, even though bladder function is normal.

This article will focus on stress and urge incontinence. They’re the most common types, and their treatments often form the foundation for managing mixed incontinence.

Getting a diagnosis

Talking to your provider is the first step. If you are seeing your primary care provider, ask for a referral to a gynecologist, or better yet, a urogynecologist. They’ll likely start with your symptoms and health history, may perform a pelvic exam, and sometimes ask you to keep a “bladder diary” to track habits and leakage. This information helps determine the type of incontinence you have and can rule out other issues, such as a urinary tract infection.

Causes of stress incontinence

For women and others with female anatomy, stress incontinence is more common. Normally, urine leaves the body only when you intentionally empty your bladder. With stress incontinence, leakage happens during everyday activities—like sneezing or laughing—because the bladder outlet (the urethra) is not strong enough to stay closed when pressure increases.

This often happens due to weakening of the pelvic floor muscles or loss of connective tissue support. The pelvic floor muscles act like a sling, supporting the bladder and other organs. When weakened—often from childbirth or aging—they may not provide enough support to keep the urethra closed.

While not something to be embarrassed about, it also isn’t something you need to accept as “normal.” Symptoms may progress over time, affecting your activities or desire to exercise, making treatment important.

Effective treatments for stress incontinence

Whether to treat stress incontinence is a personal decision. Some people with occasional leakage may decide it isn’t bothersome. For others, treatment can provide meaningful relief and prevent worsening symptoms.

First-line treatments for mild stress incontinence include:

  • Pelvic floor (Kegel) exercises: strengthening these muscles can improve bladder control. Your provider can ensure you’re doing them correctly.
  • Healthy weight management: extra weight adds pressure on the bladder and pelvic floor.
  • Reducing pelvic floor strain: avoid constipation with a high-fiber diet and hydration; use proper lifting techniques; treat chronic coughing.

If symptoms are more bothersome, your provider may recommend:

  • Pelvic floor physical therapy: targeted exercises to strengthen and coordinate pelvic floor muscles.
  • Vaginal pessary: a small, removable device placed in the vagina to support the urethra during activity.
  • Urethral bulking: a minimally invasive injection that helps the urethra close more effectively.
  • Surgery: Minimally invasive procedures are available that provide lasting support to the urethra.

It’s important not to limit healthy activities—like running or jumping—just to avoid leaks. Staying active supports your overall health and well-being.

Causes of urge incontinence

Urge incontinence can result from:

  • Overactive bladder (bladder muscles squeeze more often than they should)
  • Menopausal genital atrophy
  • Dietary irritants
  • Urinary tract infections
  • Constipation
  • Nerve damage from conditions such as multiple sclerosis, diabetes or Parkinson’s disease
  • Pelvic organ prolapse

Effective treatments for urge incontinence

Current treatments can cure or greatly improve symptoms for more than 80% of people. Options include:

  • Lifestyle changes, such as managing fluid intake and avoiding bladder and dietary irritants such as caffeine and certain foods
  • Pelvic floor exercises
  • Bladder training by gradually increasing time between bathroom visits to retrain the bladder
  • Medications like vaginal estrogen cream, if menopausal
  • Advanced therapies including Botox injections to relax bladder muscles or nerve stimulation devices that regulate bladder signals

How pregnancy affects the bladder

Frequent urination and occasional leakage are common in pregnancy, usually due to bladder pressure from the growing uterus and hormonal changes that relax bladder muscles.

As pregnancy progresses, the pelvic floor may weaken, and after childbirth this can contribute to stress incontinence. Postpartum recovery, including targeted pelvic floor exercises or physical therapy, can help restore strength and prevent longer-term issues. If you have stress incontinence after delivery and it has not resolved on its own by the time you have stopped breast feeding, or within six months if not breast feeding, let your provider know.

Taking back control

Bladder leakage doesn’t have to be part of your life. Effective, judgment-free treatment is available, and most people find real relief. If you’re experiencing symptoms, seek help from a gynecologist or urogynecologist. You deserve to feel confident, healthy and in control.

Learn more about urogynecology services at WHA.