Urinary Incontinence: Understanding the Different Types and Treatment Options

Urinary incontinence (UI) is any involuntary loss of urine and a common symptom that affects 1 in 4 women regardless of their stage of life and may have major impacts on quality of life. Women are at higher risk than men of developing incontinence, affecting 40% of postpartum women and up to 75% of women above 65 years old. It also occurs in active women, with or without having had children. This article covers the most common types of UI, their treatments and offers practical recommendations for bladder and pelvic health.

Despite the high prevalence of UI, only 45% of women discuss it with their healthcare provider. Some may feel embarrassed and ashamed or feel as if it is an inevitable part of aging, working out or having children. Although UI is common, it is not normal. Treatment and preventative options are available and effective. This is why I love what I do. As a pelvic health physiotherapist, I guide women to eradicate incontinence, build confidence in their pelvic floor and reconnect to their bodies. We are in this together! 

The two most common types of UI are stress UI and urge UI. Both may occur simultaneously, which we call mixed UI. Other types of UI are overflow (constant dribbling of urine) and functional incontinence. If you are unsure whether the nature of leakage is urine or other vaginal discharge, you can put aside your underwear to let dry for a few days. The smell of urine will intensify, whereas vaginal discharge will not.

Stress urinary incontinence 

Stress UI occurs with coughing, laughing, sneezing, sexual relations, lifting heavy objects, jumping, walking, etc. The “stress” represents any activity that increases the intra abdominal pressure and thus pressure on the perineum. Many active women who experience stress UI stop their sports and adopt a less active lifestyle. 

Urge urinary incontinence 

This type of UI occurs when women experience a sudden urge to void and do not make it to the bathroom on time, resulting in urine leakage. It accompanies overactive bladder syndrome, a frequent (more than 5-8 times during the day) and urgent need to urinate. This may be distressing socially with some women “toilet mapping” in social contexts, peeing multiple times before leaving the house or limiting outings out of fear of discomfort or embarrassment. 

Treatment options

One of the pelvic floor’s main functions is to support the bladder and close off the urethra when needed, giving us continence. Read “Why Your Pelvic Floor is not a Floor” to learn the plethora of functions the pelvic floor has in your body. If the muscles (there are about 16 total) are weak and cannot function adequately, leaking may occur. If left untreated, UI may deteriorate and other pelvic symptoms may appear such as fecal incontinence and pelvic organ prolapse. The World Health Organization and International Continence Society recommend pelvic floor muscle training to treat UI in women. I refer to this firstline, effective and safe treatment option as the “Pelvic floor Olympics”, including strength, coordination, power, speed, and endurance exercises. In a recent study, researchers found that “Women undergoing pelvic floor muscle training are believed to be 7 times more likely to be cured of urinary incontinence than those with no treatment.” However, simply doing “kegels” (pelvic floor contractions) to treat incontinence, without an assessment of perineal function or a personalized treatment plan is not recommended. We highly recommend you consult with a pelvic health physiotherapist who can build a holistic treatment plan to address meaningful activities in your life. Reach out to us if you need help finding one near you. 

For some women (those who experience urge UI), a bladder reeducation is indicated in addition to pelvic floor muscle training. The walls of the bladder are formed by a muscle and like any other, it is important to train. Bladder reeducation involves training the bladder into a “normal” peeing schedule, which is considered to be every 2.5-3 hours and gaining confidence in your ability to retain urine when needed. 

Healthy bladder and perineal habits

Here are a few lifestyle habits to harmonize perineal and bladder health, to help prevent UI or to do in conjunction with treating UI: 

• Observe urinary and leaking frequency. For 3 days, track the number of times and when you pee/leak in addition to the circumstances of leakage, if any. A healthy frequency is considered to be every 2.5-3h during the day and none (or once, depending on age) during the night. This is a healthy exercise for anyone, with or without incontinence.  If you wake up during the night to pee, try stopping liquid intake 2 hours prior to bedtime.
• Sip your water throughout the day and establish a consistent daily liquid intake. This should be half your weight (in lbs) in ounces of water or decaffeinated beverages. A common misconception is that drinking less will decrease leaking. This is false! You need to train your bladder to be able to expand and hold liquid in a healthy way. Additionally, drinking water helps prevent constipation and urinary tract infection, which may both exacerbate UI. 
• Avoid excessive intake of bladder irritants such as caffeine, carbonated beverages and alcohol. 
• Do not push down on your perineum when peeing. Some have a tendency to do this to make pee go faster or get the last drops out.
• Do not smoke and maintain a healthy weight. Both smoking and excessive weight gain increase risk of incontinence. This is one of the reasons why we recommend all pregnant women (starting mid second trimester if no symptoms) to consult with a pelvic health physiotherapist to help prevent UI. 

If symptoms still persist after completing a guided pelvic floor muscle training program, other treatments exist such as intravaginal devices, pharmacological and surgical options. We highly recommend consulting with your health care provider to explore the best treatment options. In all cases, conservative management for UI is firstline and should be considered prior to more invasive options.