Understanding Urinary Leaking: Is It Stress or Urge Incontinence?

All you know is that you’re leaking. Quickly searching online yields a lot of confusing results, but you gather that you probably have a weak pelvic floor. So what should you actually do?

It’s time to pause and get some real answers. Not all urinary leaking is the same, and pelvic floor strength is not always the root cause. Describing and defining your symptoms lets you confidently follow the right plan. So what is causing your leaking and what can you do about it?

Types of Urinary Incontinence

Stress Urinary Incontinence (SUI)

Involuntary urinary leakage with exertion and/or change in intra-abdominal pressure—activities such as coughing, sneezing, laughing, jumping, lifting, running

SUI affects around one-third of women at any age, with similar prevalence after menopause.

Why SUI happens

SUI occurs occurs when pressure downwards is greater than the body’s ability to generate resistance upwards. If you’re concerned about sneezing, laughing, exercise class or jogging to catch the bus, you probably have SUI.

Support against downward pressure comes from active and passive support mechanisms:

Active support: Pelvic floor muscles and urethral sphincters
Passive support: Connective tissue suspending the bladder and urethra against gravity and pressure

How to treat SUI

The goal of SUI treatment is to increase the amount of active and/or passive resistance against pressure. There are several ways to approach this, depending on your symptoms and history.

Pelvic floor muscle training (Kegel program)

The gold standard treatment for SUI. Check out the article linked below for more about Kegels and how to design a pelvic floor training program.

The “knack”

Perform a pelvic floor contraction (Kegel) prior to the situation where leaking occurs (cough, sneeze, lifting, etc.)

Pessary

A medical-grade silicone device that you manually insert into the vagina. It augments passive support to the bladder/urethra and reduces the effect of pressure changes. You can be fit for a pessary by a urogynecologist or gynecologist. It may require several tries to find the right size.
Pessaries are removable and can be worn anytime you find it beneficial (just for exercise, all day, etc.). A pessary works immediately, but only when you’re wearing it.
Over-the-counter products such as Revive and Poise Impressa act similarly to a pessary and are easy options for many to try.

Avoid constipation

Chronic straining and hard stools is one of the biggest risk factors for SUI for people of any gender or age.
If you’re constipated, improving your bowel movements is one of the most powerful ways that you can improve your pelvic floor health and reduce SUI. Check out the article linked below for more on how to treat constipation.

Incontinence surgery

Incontinence surgery aims to reinforce passive support to the urethra against downward pressure.
Incontinence surgery is performed by a urologist or urogynecologist, and only after individual evaluation of your anatomy, risks and benefits.

Urge Urinary Incontinence (UUI)

Urinary leakage that comes with a strong, uncontrollable urge.

UUI is often something that only happens in certain situations. Examples include when you put your key in the door, when you hear running water or when you’re going to the toilet with a full bladder.

Studies estimate that 5-20% of women of any age experience UUI, with around 11% of postmenopausal women reporting symptoms.

Why UUI happens

Being able to control your bladder depends on both involuntary and voluntary processes. Essentially, UUI occurs when the bladder is triggered to contract and it’s too strong for you to override. If you feel like your bladder is running the show, you probably have UUI.

How to treat UUI

The goal of UUI treatment is to put you back in control of when and where you go and reduce anxiety around feeling urinary urge.

Bladder training

Bladder training puts you back in the driver’s seat instead of letting your bladder and nervous system run the show. Read more about bladder training in the linked article below about urinary urgency and frequency.

Urge deferral

Especially if you have specific triggers for leaking (like hearing running water), it’s important to break the association between the trigger and leaking. This means practicing not giving in to the urge to pee when you encounter the trigger.
It may take some practice to find the urge deferral technique that works best for you. Quick Kegels, paced breathing, distraction, counting backwards by sevens and pressure on the clitoris have all worked for different people.
With consistency, this practice can “disconnect” a trigger with leaking.

Pelvic floor muscle training (Kegel program)

Training the pelvic floor muscles is never a bad idea, but it may not be that helpful for many people with UUI. SUI is frequently a strength issue, while UUI is seen in a wide range of people with varying levels of pelvic floor strength.

Improve coping skills and reduce stress

Many people with UUI and/or urinary urgency have more symptoms when they’re more stressed or anxious.
The body’s “fight or flight” response can also be described as “pee and run away”—so it’s actually common to feel urinary urge that’s more related to your state of mind than anything else.

Get enough water and avoid bladder irritants

Read more about dietary recommendations in the article linked below.

Medication

Medication can be a good option for UUI but may have significant side effects especially with long-term use. Give the above strategies a few months of effort before trying medication.
We recommend consulting with an expert in bladder function, such as a urogynecologist, to weigh risks and benefits.

Mixed Urinary Incontinence (MUI)

Experiencing symptoms of both SUI and UUI.

An estimated 9% of women of any age experience MUI.

MUI is treated by using strategies for SUI and UUI simultaneously or in sequence if one set of symptoms is more severe and bothersome.

Post-Void Dribble (PVD) and Overflow Incontinence (OI)

PVD is when a few drops of urine leak immediately after emptying your bladder and rising from the toilet.

OI is when a few drops of urine leak out at some other point in the day, not related to SUI or UUI.

PVD is poorly researched but reported by many women, including those with other types of urinary incontinence. PVD and OI are thought to be a similar issue that occurs at different times.

Why PVD and OI happen

Our current best guess is that urine gets trapped in the urethra like a “kinked hose” and then leaks out when movement shifts the position of the bladder and urethra.

How to treat PVD and OI

There is no identifiable research available on the treatment for either of these symptoms in female anatomy. Experts recommend the following strategies:

After emptying the bladder but before rising from the toilet:

Pause and do a few quick Kegels and/or
Do a few pelvic tilts/pelvic circles

Pelvic floor muscle training (Kegel program)

Learn about pelvic floor muscle training and how to start a strengthening routine.

Self Care for Leaking

Urinary leaking can be anything from mildly annoying to life-changing. Many of the treatment strategies outlined above take time and require a commitment that many people aren’t able to give.

In terms of products, choose those specifically for urinary leaking to keep the skin of your vulva healthy, minimize odor and live your life with less limitation. When it comes down to it, being active with leaking is better than limiting your life to prevent it.

Regardless of the brand you choose, we recommend picking products specifically made for urinary leaking—not menstrual products—so they’re made with the right materials for your needs.