Can urinary incontinence get worse over time?
Yes, it often does. Without treatment, urinary incontinence tends to progress gradually. What starts as an occasional leak during a hard sneeze can slowly become more frequent leaking during lighter activities like walking, standing up, or bending over. It doesn’t have to go that way, but it often does when nobody treats the underlying causes.
Why it progresses
The factors that cause incontinence don’t usually stop on their own:
- Pelvic floor muscles continue to weaken without targeted exercise
- Hormonal changes during and after menopause thin the tissues of the urethra and bladder; unlike hot flashes, these genitourinary changes tend to be progressive and don’t improve without treatment
- Weight gain adds more chronic pressure to the pelvic floor, and higher body weight is linked to a stepwise increase in the risk of stress leakage
- Chronic coughing from allergies or asthma adds ongoing strain
- Natural aging reduces muscle mass and connective tissue strength
“I think of pelvic floor health like any other aspect of fitness. Without attention, things tend to decline over time. The good news is that with the right interventions, we can not only stop the decline but actually reverse it in many cases.”
The cost of waiting
On average, women wait 6-8 years before seeking treatment for incontinence. During that time, symptoms typically worsen, treatment options may become more involved, and coping strategies like limiting fluids, avoiding activities, and wearing pads become ingrained habits.
What you can do now
- Start pelvic floor exercises, ideally with guidance from a physical therapist. Behavioral therapy and pelvic floor muscle training are recommended first-line, noninvasive treatments and can meaningfully reduce leakage.
- Maintain a healthy weight; even modest weight loss (about 5-10% of body weight) can reduce leakage episodes
- Address chronic cough or constipation to reduce repeated strain on the pelvic floor
- See a specialist. A urogynecologist can establish a baseline and create a plan.
“Early treatment almost always means simpler treatment. I’d rather see a patient when their symptoms are mild and we can make a big impact with physical therapy, than years later when we’re discussing surgical options.”
References
- ACOG Committee on Practice Bulletins—Gynecology, American Urogynecologic Society, Kenton KS, et al. Urinary incontinence in women (ACOG Practice Bulletin No. 155). Obstetrics & Gynecology. 2015. doi:10.1097/AOG.0000000000001148
- Faubion SS, Kingsberg SA, Clark AL, et al. The 2020 genitourinary syndrome of menopause position statement of The North American Menopause Society. Menopause. 2020. doi:10.1097/GME.0000000000001609
- Nygaard IE, Heit M. Stress urinary incontinence. Obstetrics & Gynecology. 2004. doi:10.1097/01.AOG.0000137874.84862.94
- Subak LL, Wing R, West DS, et al. Weight loss to treat urinary incontinence in overweight and obese women. New England Journal of Medicine. 2009. doi:10.1056/NEJMoa0806375
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