Understanding Female Bladder Leakage: Causes, Types, and Management

Ever laughed too hard and had a little leak? It’s not just you, and no, it’s not something you just have to live with.

Bladder leakage is common. Also called female bladder incontinence and urinary incontinence, the condition affects nearly 80 million women in the United States, according to the National Association for Continence. What’s more:

• 1 in 2 women have some form of bladder incontinence
• Women experience about four leakage episodes per week on average
• 1 in 4 women take time off work due to bladder incontinence
• Women with severe bladder incontinence spend about $900 per year for their care

But as common as bladder incontinence is, only 25% of women talk to their doctors about it. Six years after their symptoms begin, women finally seek professional help. It can range from occasional leaks when you cough or sneeze to a sudden, intense urge to urinate that doesn't give you enough time to reach the bathroom.

Read on to learn more about the myths, causes, and treatments for bladder incontinence.

These are the most common types of bladder incontinence:

Stress incontinence: Urine leakage occurs when pressure is put on your bladder, like when you cough, sneeze, laugh, or lift something heavy. You might lose just a few drops or as much as a tablespoon or more. One in 3 women have this type.

Urge incontinence: You feel a strong, sudden urge to urinate, but you can’t hold it in. You may pee before reaching the bathroom. This affects about a third of women, and nearly half are over age 60.

Overflow incontinence: Your bladder doesn’t completely empty. This causes frequent or constant dribbling. It’s rare and happens more often in men than women.

Mixed incontinence: A combination of stress and urge incontinence. More than half of women with urge incontinence also have stress incontinence.

Bladder Incontinence by the Numbers

Bladder incontinence can affect women of all ages, but it becomes more common as women get older. While urinary incontinence is very common, the doctors that treat this problem want you to know that it should never be considered normal. You do not have to suffer in silence with this bothersome symptom.

Young Adults: Over one-third of women in their 20s experience some form of urinary incontinence.

Middle Age: The prevalence of urinary incontinence increases with age, with many women in their 40s and 50s noticing symptoms, often linked to childbirth and menopause.

Older Adults: Women over 50 have the highest incidence rates, with up to 75% of women over 65 reporting bladder leakage.

Studies show that women are twice as likely to experience urinary incontinence compared to men.

Urinary Incontinence Causes in Women

There’s rarely just one cause of urinary incontinence — it’s usually due to a few things. Here are some of the top contributors.

Pregnancy and Childbirth

• Weak pelvic floor muscles
• Nerve damage
• Pressure on the bladder
• Hormonal changes
• Physical trauma

Aging

• Weakened pelvic floor muscles
• Hormonal changes
• Nerve damage
• Chronic conditions
• Medications
• Small bladder capacity

Obesity

• Pelvic floor muscle weakening
• Increased pressure on the bladder
• Nerve damage
• Related health conditions
• Hormonal changes

Medical Conditions

• Urinary tract infections (UTIs)
• Constipation
• Chronic cough
• Diabetes
• Pelvic floor disorders
• Kidney stones or tumors
• Neurological disorders

Effective Solutions for Urinary Incontinence in Women

Whether your symptoms are mild or disruptive, you have real options for relief.

Lifestyle Changes

Bladder training: Train your bladder to hold urine longer by scheduling bathroom visits at set times and gradually increasing the intervals between trips.

Pelvic floor exercises (Kegels): Strengthen the pelvic floor muscles with regular Kegel exercises to help control urination and reduce symptoms.

Dietary adjustments: Focus on drinking 40–60 ounces of fluid a day. You can limit fluid after 6 p.m. to avoid waking up to go to the bathroom. Eat lean proteins, fiber-rich foods, non-acidic fruits, vegetables, nuts, and whole grains. Avoid drinks and foods that irritate the bladder, like coffee and tea, citrus, tomatoes and tomato-based foods, vinegar, spicy foods, artificial sweeteners, and alcohol.

Medications

Anticholinergic drugs: These medications help calm an overactive bladder by blocking chemical signals that trigger bladder contraction. This reduces sudden urges to urinate and helps you control when you go. Common examples: oxybutynin, tolterodine, and solifenacin.

Beta-3 agonists: This newer type of medication treats overactive bladder by relaxing a specific part of the bladder muscle, allowing it to hold more urine. These drugs tend to be easier on the body and are a good option for people who don’t do well on other medications. Common example: Mirabegron.

Low-dose vaginal estrogen therapy: After menopause, the skin around the urethra (the tube that carries urine out of the body) and the base of the bladder can become thinner and dryer. This can lead to frequent urination, urgency, pain while urinating, and a higher risk of urinary tract infections. Applying a low-dose estrogen cream to the vaginal area can help relieve these symptoms. Common example: estradiol.

Treatments

Dealing with urinary incontinence can be frustrating, but there are proven treatments that can help you take back control.

Botox injections: Botox blocks nerve signals to the bladder muscles so it can hold more urine. Injections are usually needed about every six weeks as the effect gradually wears off.

Neuromodulation: This treatment gently stimulates the nerves that supply the bladder. It’s designed to help restore normal communication between your brain and bladder. Approaches include:

• Tibial nerve stimulation sends signals through a nerve near your ankle that connects to the part of the spinal that controls your bladder. Percutanious tibial nerve stimulation (PTNS) is an in-office, weekly procedure, and it is the least invasive. Implantable tibial nerve stimulation (ITNS) is an at-home treatment that uses a small implant.

• Sacral neuromodulation provides constant, gentle simulation directly to the nerve that controls the bladder using a thin, flexible wire implanted near the base of the spine. An external stimulator worn on the body and a remote control allow you to monitor and adjust your therapy. The two common types are Axonics^® Therapy and the Medtronic InterStim™ system.

Vaginal pessaries: These soft, removable devices are placed in the vagina to support areas affected by pelvic organ prolapse (POP). They come in a variety of shapes and designs including rings, disks, cubes, or inflatable forms; each tailored to different types or stages of POP. Most are made of soft, nonabsorbent silicone and can often be inserted and removed without a doctor’s help.

Sling surgery: This common, minimally invasive procedure treats stress incontinence. A surgeon places a small sling made of mess or tissue under the urethra to support it and help prevent accidental leaks. One example is the Altis^® Single Incision Sling System.

Barriers to Treatment

There’s a stigma surrounding bladder incontinence and 77% of women surveyed by the National Association for Continence agree. About 42% feel too embarrassed to discuss it with family or friends. Many avoid bringing it up with their doctors, assuming it’s just a part of aging. Nearly a third of women keep their symptoms entirely to themselves, never seeking medical advice.

But help is out there. Incontinence is treatable.

Compassionate Help for Urinary Incontinence in Women

OU Health offers expert urogynecology care close to home.

A team of compassionate, highly trained women’s health specialists will take the time to listen to you and gather a detailed medical history. After a physical exam and any needed testing, they’ll work with you to create a personalized treatment plan tailored to your needs. The goal: to help women no longer suffer in silence.

“Sometimes, women can have the misconception that these problems are a normal part of aging and tend to not feel comfortable discussing these problems with their physician until they become very bothersome over time,” said Dr. Lieschen H. Quiroz, M.D., Chief of Female Pelvic Medicine and Reconstructive Surgery at OU Health.

Get the relief you deserve. Learn more about the treatments available or schedule a consultation with one of our OU Health urogynecologists in Oklahoma City or Tulsa.