Bladder Up: The Ultimate Guide to Urinary Incontinence

If you’ve ever experienced an accidental bladder leak, you know it’s enough to make you think twice before taking your turn on the backyard trampoline or doing jumping jacks during boot camp. It can start to feel hard to trust your bladder and you may even wonder if you have urinary incontinence.

Urinary incontinence, in the simplest form, is any type of urine leakage, whether that be drops, dribbles, or a full drainage. We’ll get more into the details of what that all looks like in a bit, but rest assured, wearing panty liners, avoiding high-impact exercise, and panicking at every sneeze doesn’t have to be your regular way of life.

Keep reading to find out how to tell if you have urinary incontinence, what a diagnosis looks like, and how pelvic floor therapy can help stop leaking for good.

What is urinary incontinence?

Urinary incontinence (UI) is the involuntary leakage of urine from your bladder. That means any amount — from a single drop to a bladder full. It’s incontinence if leaks happen all the time or hardly ever. UI tends to affect people assigned female at birth more often and can occur at any age.

There are different types of urinary incontinence and each is defined by the circumstances surrounding why the leakage happened, as well as the problem causing the bladder dysfunction. The most common types of incontinence treated by pelvic floor physical therapists are stress, urge, and mixed urinary incontinence.

Stress Urinary Incontinence

“This type of leakage is what most people think of when they have incontinence,” says Origin Pelvic Floor Physical Therapist Dr. Ashley Rawlins, PT, DPT. “Stress urinary incontinence (SUI) is when your leakage occurs after mechanical pressure is put on your bladder.” Common triggers for stress urinary incontinence are coughing, laughing, or sneezing. “These are examples of activities that increase intra-abdominal pressure,” Rawlins explains. “When we cough, laugh or sneeze the pressure in our abdominal area increases, and that pressure compresses the bladder, essentially pushing urine out.”

Common triggers for stress urinary incontinence are coughing, laughing, or sneezing.

Beyond coughing and sneezing, other stress events can include certain exercises and physical activities, like jumping rope, high-impact cardio, and heavy lifting. When your pelvic floor muscles aren't strong or coordinated enough to counteract the pressure these activities put on your bladder, you're likely to spring a leak.

According to the National Association for Continence, 1 in 3 people assigned female at birth experience stress urinary incontinence, but that number increases to one in two for those over the age of 65. Some of the more common risk factors for developing stress urinary incontinence are pregnancy and vaginal childbirth, menopause, having had a hysterectomy, or frequently engaging in high-impact activities.

Urge Urinary Incontinence

This type of incontinence is leakage of a much different tune, occurring after you have a sudden and intense urge to urinate. A common example of urge urinary incontinence (UUI) is when you desperately need to pee just as you arrive home and put your keys in the door, and you're unable to hold it long enough to make it to the bathroom.

Urge urinary incontinence is commonly a result of overactivity in the muscle that controls the bladder, but may also be caused by trigger points in a neighboring muscle, which can lead to a feeling of urgency.

Mixed Urinary Incontinence

Last comes mixed urinary incontinence (MUI), which is exactly what it sounds like: You have a mixture of leakage as a result of both urgency and stress. The factors that cause this kind of leakage can be a combination of those that lead to stress urinary incontinence and urge urinary incontinence.

How do I know if I have urinary incontinence?

“Technically any amount of leakage of urine is incontinence,” says Rawlins. “Whether you sometimes leak a drop of urine when you bust out laughing, or you leak a lot an often.”

Sometimes, it can be hard to determine if you're really losing urine. You may think that some pee came out, but be unable to distinguish between urine, sweat, or discharge when you check you underwear. If you’re not sure what’s coming out, don’t hesitate to talk to a pelvic floor PT — they’re used to decoding discharge and can assess your pelvic floor for symptoms consistent with incontinence.

Do I have to treat urinary incontinence?

It's common to brush off small or infrequent bladder leaks as no big deal, but any urinary incontinence is a sign of pelvic floor muscle dysfunction. "It can be a sign of pelvic floor weakness, lack of coordination, or another issue that's affecting your bladder or urethra," says Rawlins. And, if left untreated, urinary incontinence is likely to get worse.

If left untreated, urinary incontinence is likely to get worse.

"Small leaks tend to become bigger problems with each pregnancy and delivery (belly or vaginal), with continued high-impact activity or heavy lifting, and as we age,” says Rawlins. "Changes that occur with menopause can also exacerbate incontinence."

While it's never too late to treat incontinence, it's better to address it earlier rather than later.

Diagnosing & treating urinary incontinence

If you have bladder leaks, it is important to figure out why you are leaking. Understanding which type of incontinence you have will help to determine the steps needed to help make you dry again. Not everyone with urinary incontinence will get better with kegels, but you can get better with treatment that is specific to your needs. Talk to your primary care physician, gynecologist, or OB. They’ll be able to determine if it’s stress induced, urgency, or mixed, and ideally, recommend a pelvic physical therapist who can help determine how the muscles are impacting your bladder function.

Not everyone with urinary incontinence will get better with kegels.

And please, don’t be embarrassed! Rawlins often sees lack of education and shame as a major barrier to folks getting pelvic floor PT help. “People first need to know that UI isn't something they have to put up with,” she says, “and then they need to know that not only are they in wonderful company, since it's so common and leakage isn't something to be ashamed about, but there are also highly trained pelvic PTs out there with all of the tools that are needed to help.”

Other options for working with UI include certain medications and surgery. Rawlins stresses, though, that pevlic floor physical therapy should be the first line of defense. “It's safe, effective, and has little to no side effects, and is well tolerated by most,” she says. One 2017 study found that for female patients with mixed urinary incontinence and overactive bladders, pelvic floor muscle training significantly improved patients symptoms in almost all areas — urinary loss, overactive bladder symptoms, and self-reported overall quality of life.

How can pelvic PT help with urinary incontinence?

If the leakage is related to pelvic floor muscle dysfunction (not neurological, such as related to MS or another disease), pelvic floor PT can help remedy the muscular imbalance in the pelvis and work with you to find better habits and strategies to support your bladder function.

Perhaps your muscles aren’t contracting and supporting at the right time? Then your PT will work with you on optimizing the coordination and function of your pelvic floor. If the muscles are too underused and weakened, we work on strengthening.

Pretty commonly, people think of treating urinary incontinence with kegels, which is a pelvic floor exercise — think resistance training for your pelvic floor where you contract and relax it. That’s great for folks who have underused or under active pelvic floor muscles, but in some cases, like younger athletes affected by urinary incontinence, their muscles are so overactive that they need to improve their pelvic floor muscle range of motion, and not constantly be contracted to then restore strength and function.

What can I expect from a pelvic PT appointment?

Rest assured, Rawlins says, pelvic physical therapists are in your corner. “We are dedicated to helping those with bladder, bowel, and sexual dysfunction, and hope that embarrassment or shame isn’t getting in your way of seeking help,” she says. “It can be really hard to feel heard and understood when you have pelvic floor symptoms, let alone find effective treatment.” Thankfully, there are physical therapists, like those at Origin, who have gone the extra step to get trained in how to work with the pelvic floor and get you back to your fully-functioning self.

At a pelvic floor PT session, it’s never about seeing the anatomy; it’s about examining someone’s muscles based on their symptoms. The first step to checking out the pelvic floor muscles, which can be done through the vagina or anus. Alternately, there are external approaches to evaluating muscle dysfunction, or your PT can teach you how to examine your own muscles through anatomic models and drawings. Origin uses this last practice during their virtual appointments and patients can find self-evaluations to be very empowering. You'll then work with your PT to come up with a treatment plan and goals that work for you.

Beyond kegels, some pelvic floor PT exercises include core, hip, and back strengthening exercises, breathing techniques, yoga stretches, and manual therapy.

3 bathroom habits that contribute to urinary incontinence

Other ways PT can help with urinary incontinence is by breaking any bad habits you may have garnered over the years, like pushing to pee (guilty!) or purposefully limiting water intake. “We develop all these habits and tricks that we think are helping, or are maybe helping just a bit, but are actually sabotaging our bladder health,” says Rawlins.

Cutting water intake

You may think that drinking less water will limit the amount of leakage you have, but it may actually be making leakage worse. When you drink less, your urine becomes more concentrated, which may be more irritating to your bladder, which can lead to leakage.

Pushing to pee

Another habit that has trained your bladder in a negative way is forcing yourself to pee or pushing the pee out, rather than relaxing your pelvic floor muscles and peeing properly. Pushing may make it more difficult to fully empty your bladder, and pushing may even strain your pelvic floor.

Going “just in case”

This is when you make yourself go, just in case you get busy or don’t know where the next clean bathroom will be (zoom meetings, going to a store, etc.). With this habit, you are impacting your bladder’s flexibility and training your brain to empty your bladder more often.

Your bladder is like a balloon and its only job is to expand and empty. If you aren't letting it expand, you’ll have to go more often. Rawlins does point out that yes, there are times when you need to try to pee even if you don’t actually have to! Hitting the toilet on a road trip when the next bathroom is miles and miles away? Please go, just don’t make the “just in case” peeing a daily habit.

Get Relief From Urinary Incontinence

Ready to take action with your bladder? At Origin, PT for urinary incontinence can be done virtually and privately (no showing of parts on Zoom!). You’ll work with licensed PTs to start creating a plan to get your life back on track and help you become free of leaks once again.