Leaking urine is one of the most common health problems women face and one of the least talked about. Up to 1 in 3 women experience it at some point. Many put up with it for years because they assume it comes with having children or getting older, when in fact it is very treatable.
The Main Types
Stress incontinence. This means leaking when pressure in your tummy rises, for example when you cough, sneeze, laugh, run or jump. It happens when the pelvic floor and the muscles around the urethra, the tube that carries urine out of the body, cannot hold against the extra pressure. It is common after childbirth and in women who do high-impact sport.
Urge incontinence. This is a sudden, strong need to pass urine that is hard to hold, sometimes leading to a leak before you reach the toilet. It is often part of overactive bladder, where the bladder muscle squeezes when it should not. You may also need to go often, including at night.
Mixed incontinence. Many women have both types.
Things That Can Make Leaks Worse
Constipation, which puts pressure on the bladder and pelvic floor
Caffeine and alcohol, which can irritate the bladder
Drinking too little, which concentrates urine and can make urgency worse. Around 1.5 to 2 litres of fluid a day suits most women
Extra body weight, which increases pressure on the pelvic floor. Even modest weight loss can reduce leaks
The drop in oestrogen at menopause
A long-term cough, for example from smoking
Treatments That Work
Pelvic floor muscle training. For stress and mixed incontinence, supervised pelvic floor training for at least three months is the first recommended treatment, with strong evidence behind it. Working with a pelvic health physiotherapist makes it more effective than following a leaflet on your own.
Bladder training. For urge incontinence, bladder training gradually increases the time between toilet visits, which teaches the bladder to hold more. It usually takes six weeks or longer to work.
Vaginal oestrogen. After menopause, low-dose vaginal oestrogen can ease urgency and help prevent urinary infections. Our article on vaginal dryness after menopause explains how it works.
Medicines. If bladder training is not enough for urge symptoms, medicines that calm the bladder muscle can help. Some older types can affect memory in older women, so ask your doctor about the options.
Devices and surgery. A pessary, a small device placed in the vagina, can support the bladder during exercise. Surgery is an option for stress incontinence when other treatments have not worked. Vaginal mesh procedures have been restricted in some countries because of serious complications, so ask your surgeon about all the alternatives and their risks.
When to See a Doctor
See your doctor if leaks are affecting your daily life, or sooner if you see blood in your urine or have pain when you pass urine.
Most women improve with simple, low-risk treatments, so it is worth asking for help rather than buying ever-larger pads.