What Causes Urinary Incontinence in Women?

Urinary incontinence occurs when the muscles and nerves that control urination do not function properly. When these systems are weak or disturbed, the bladder may release urine unexpectedly.

Many factors can raise the risk of urinary incontinence, such as:

• Family history
• Pelvic floor issues after childbirth
• Urinary tract infections (UTIs)
• Smoking and other lifestyle habits
• Obesity, which increases pressure on the bladder
• Hormonal changes during menopause
• Aging, which can reduce bladder flexibility and weaken nerve signals

There are several types of urinary incontinence. In women, the most common are urge incontinence and stress incontinence. Some women experience mixed incontinence, which combines features of both, while others may have overflow incontinence, which is less common.

Urge incontinence, also called overactive bladder, is more common with older adults but can affect women of any age. It occurs when the bladder muscles contract too often or too strongly, creating a sudden, urgent need to urinate.

“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 happens when the muscles and tissues that support the bladder and urethra weaken, often due to pregnancy, childbirth or hormonal changes during menopause. As a result, leakage can happen whenever pressure is placed on the bladder, such as when 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.”

Diagnosing urinary incontinence begins with identifying the type and severity of symptoms. The main symptom is involuntary urine leakage.

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

During diagnosis, your doctor will ask about your symptoms, review your medical history and may perform a physical exam. Keeping a bladder diary is often helpful for tracking patterns of leakage and fluid intake. You may be referred to a urologist or urogynecologist for specialized care.

Common questions your doctor may ask 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?

Diagnostic tests may include:

• Urine test to check for infection and other causes
• A post-void residual urine test to measure leftover urine after urination
• Ultrasound to take view the kidneys, bladder and urethra
• Bladder stress test, which involves coughing with a full bladder to check for leakage
• Cystoscopy, which uses a thin tube with a tiny camera to examine the urinary tract
• Urodynamics, which uses a thin tube to fill the bladder with water and measure how well it holds and empties

Most women improve with simple, non-surgical treatments. Doctors usually begin with the least invasive options, such as:

• Pelvic floor (Kegel) exercises to strengthen muscles
• Maintaining a healthy weight to reduce pressure on the bladder
• Bladder training by scheduling bathroom visits
• Managing constipation with fiber and hydration
• Limiting caffeine, alcohol and carbonated drinks
• Quitting smoking

Kegel exercises strengthen pelvic floor muscles and improve bladder control. Four in 10 women improve their symptoms with regular practice.

“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.

“Kegel exercises are easy to do,” she adds. “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.”

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

• Medication to relax bladder muscles and increase capacity
• Botox injections to reduce overactivity
• Biofeedback therapy to improve pelvic floor control
• Surgery, though not recommended if you plan to get pregnant in the future

For stress incontinence, a mid-urethral sling procedure can be a highly effective treatment option.

This minimally invasive surgery involves placing a narrow strip of synthetic mesh under the middle portion of the urethra to provide support and prevent leakage during moments of increased abdominal pressure. “You go home the same day and if you have a desk job you can start work the following week,” Dr. Raizada says.

For urge incontinence, electrical stimulation therapies can help improve bladder function. They work by sending gentle pulses to the nerves that control urination. Two common options are:

• Sacral neuromodulation (SNM): An outpatient procedure where a small, implanted device stimulates the sacral nerves in the lower back to help restore bladder-brain communication
• Posterior tibial nerve stimulation (PTNS): A non-surgical treatment using a thin needle near the ankle to deliver mild electrical impulses over a series of office visits to gradually improve bladder control

Early treatment can make a significant difference. If lifestyle changes do not help enough, consult with your doctor. They can discuss advanced therapies or simple procedures that may help you feel better.

Watch the San Diego Health video with host San Diego host Susan Taylor and 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.