What Causes Urinary Incontinence in Women?

Involuntary leakage is a common and treatable problem

Urinary incontinence symbol.

Involuntary leakage is a common and treatable problem

Anyone who has suffered from urinary incontinence knows that just laughing or even washing dishes can bring on the embarrassing symptom: urine leakage. Leaking urine is no laughing matter, however.

Women are most at risk to develop this very common and treatable problem. It’s a problem that many struggle to overcome without medical assistance.

In addition to one’s health, urinary incontinence can wreak havoc on all areas of life. Careers, relationships and self-esteem can suffer from the effects of losing bladder control.

Many women delay treatment because they feel uncomfortable discussing their condition. A video visit may be an option in some cases. The most important thing is to get the most accurate diagnosis and best treatment plan.

“The good news is that you are not alone and it’s ok to seek treatment. You do not have to live with something that can be treated,” says Varuna Raizada, MD, a urogynecologist at Scripps Clinic.

Treatment options vary from lifestyle changes to therapy, medicine, and surgery, based on the type and severity of incontinence. “Treatment depends on the cause and severity of the problem,” Dr. Raizada says. “The simplest and safest treatments are usually tried first.”

What causes urinary incontinence?

Urinary incontinence usually involves problems with the muscles and nerves that help the bladder hold or pass urine. “The bladder is a complex structure,” Dr. Raizada says.

Urinary incontinence affects twice as many women as men. It is more common as women advance in age and it is also due to multiple factors, including:


  • Family history
  • Pelvic floor issues after childbirth
  • Urinary tract infections (UTIs)
  • Lifestyle choices (including smoking)
  • Obesity


Many women get urinary incontinence during pregnancy, after childbirth and menopause. These life events that are unique to women may affect the bladder, urethra and other muscles that support these organs.

What are types of urinary incontinence?

There are two main types of incontinence: urge and stress. Women with both have mixed incontinence.

Urge incontinence

Urge incontinence, also known as overactive bladder, becomes more common with advancing age. It occurs when an overactive bladder abruptly contracts, causing a strong, sudden urge to urinate with little control. “Often, you’re running to the restroom and even before you get there, there is a loss of urine and you’re having accidents,” Dr. Raizada says.

Stress incontinence

Stress incontinence is the result of a weak bladder neck. Women lose urine with activities like laughing, coughing, sneezing or exercising. “It has nothing to do with mental stress, but it can cause mental stress,” Dr. Raizada says. “It has more to do with physical pressure or stress on the bladder.”

How is urinary incontinence diagnosed?

The main symptom of urinary incontinence is leakage of urine, and there are multiple treatment options.

“Your doctor should complete a thorough evaluation before planning treatment,” says Dr. Raizada. “The simplest and safest treatments are usually tried first.”

Questions asked by your doctor may include:

  • Do you leak urine when coughing, sneezing, exercising or moving suddenly? 
  • Do you have a sudden need to urinate? 
  • Do you have accidental leakage of urine? 
  • Do you experience pain when urinating? 
  • Do you suffer from frequent bladder infections?

If more tests are needed, you may be sent to a urologist or urogynecologist.

An evaluation may include:

  • Urine test to check for infection and other causes of incontinence
  • A post-void residual urine test to assess amount of urine left in bladder after urinating
  • Keeping a diary to track how often you urinate and leak
  • Ultrasound to take pictures of the kidneys, bladder and urethra
  • Bladder stress test, which involves coughing to examine loss of urine
  • Cystoscopy, which uses a thin tube with a tiny camera, to look for damaged tissue in the urinary tract
  • Urodynamics, which involves inserting a thin tube into bladder, filling it with water and checking how much fluid bladder can hold

What are treatments?

Your doctor may suggest some things you can do at home to help treat urinary incontinence, including:

  • Pelvic floor exercises (Kegel exercises)
  • Losing weight to reduce pressure on the bladder
  • Training your bladder by scheduling bathroom visits
  • Treating constipation by eating more fiber
  • Limiting drinks with caffeine, carbonation or alcohol
  • Quitting smoking

What are Kegel exercises?

Kegel exercises are exercises to strengthen your pelvic floor muscles and improve bladder control. Four in 10 women improve their symptoms after trying Kegels.

“Urinary incontinence is caused by weak muscles along the urinary tract. It’s important to know that you can improve those muscles,” Dr. Raizada says.


“They are easy to do,” says Dr. Raizada. “You lie down and squeeze the muscles you use to stop a stream of urine and then relax those muscles and repeat this exercise. A doctor, nurse, or pelvic floor physical therapist can help you with this proven technique.”

What are other treatments?

Your doctor may also recommend one or more of the following treatments if what you’re doing at home is not enough:

  • Medication to help relax bladder muscles and increase amount of urine bladder can hold
  • Botox injections in the bladder, also to relax bladder muscles and increase amount of urine bladder can hold
  • Biofeedback

In certain situations, and under proper doctor care, surgery is an option. It is generally not recommended if you plan to get pregnant in the future.

For symptoms of stress leakage, a mid-urethral sling can be a very effective surgery. “You go home the same day and if you have a desk job you can start work the following week,” Dr. Raizada says.

For symptoms of urge leakage, electrical stimulators can be used to restore bladder function. This surgery also goes by the name of sacral neuromodulation. It is a go-home the same day surgery as well. Posterior tibial nerve stimulation can treat urge incontinence as well.

Learn more about urinary incontinence and pelvic floor disorders

Watch the San Diego Health video with host San Diego host Susan Taylor and guest Dr. Raizada discussing treatments for bladder incontinence and other pelvic floor disorders. You may also listen to the podcast on what causes urinary incontinence in women.

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