How common is urinary incontinence in women?
Very common. About 1 in 6 adult women has urinary incontinence, and in some studies nearly half of adult women report at least some stress leakage over the past year. The exact number depends on how a study defines leakage and which ages it includes. If you’re leaking, you have a lot of company, even if it doesn’t feel that way. Most women don’t talk about it.
The numbers
- About 17% of women over 20 have urinary incontinence, rising to 38% of women over 60
- Up to 77% of women living in nursing homes have it
- Half of young women who have never given birth report occasional leakage when they cough, sneeze, or exercise
- About 17% of women have overactive bladder, and more than 30% of women 65 and older. Overactive bladder means sudden, strong urges to go. About a third of women with it also leak.
- Only about 1 in 4 women with incontinence gets care for it, and fewer than half of those get treated
These numbers probably undercount the problem. The stigma of incontinence has been rated higher than that of depression or a cancer diagnosis, and that stigma keeps women quiet.
Types of leakage
Stress incontinence is leaking when you cough, sneeze, laugh, lift, or exercise. Urge incontinence is a sudden need to go, then leaking before you get to the bathroom. Mixed incontinence is both. The type matters because the treatments are different. With mixed incontinence, I treat whichever type bothers you more first.
You can read more about stress incontinence, urge incontinence, and mixed incontinence.
Why it’s so common
Pregnancy and birth put a lot of strain on the pelvic floor. About a third of first-time mothers start leaking with coughs or sneezes during pregnancy. For most, it goes away within a year of delivery. Women who are still leaking 3 months after birth, though, usually still leak 5 years later. Vaginal delivery stretches the pelvic floor muscles and can injure their nerves. About 20% of women have a visible tear in the main pelvic floor muscle, the levator ani, after a vaginal birth.
Childbirth matters most in younger women. After 60, the number of babies you’ve had no longer predicts who leaks. Age takes over: the urethra squeezes shut less firmly as you get older, and the tissue around it changes after menopause.
Extra weight raises the risk step by step. Compared with a BMI under 25, a BMI of 30 to 34 about triples the odds of stress leakage, and a BMI of 40 or more raises them about five times. Losing weight helps. In one trial, overweight women who lost about 8% of their body weight cut their stress leaks by 58%, compared with 33% in women who got education alone.
Common but not normal
A lot of women have incontinence, and it’s still a medical condition with good treatments. You don’t have to accept it because you’ve had kids or gotten older. More on that in is incontinence a normal part of aging?
I see women every week who waited years to come in because they thought nothing could be done. Most leakage can be treated, and many women can be cured.
How I approach it
You don’t need to wait until leaking gets bad. I start by working out which type of leakage you have and what bothers you most, and then we choose a treatment together.
For stress leakage, options include urethral bulking and a sling. For urge leakage, they include medications, Botox injections, and nerve stimulation. You don’t have to fail pills before moving to Botox or nerve stimulation. AUA guidelines don’t require it, though some insurance plans do. Pelvic floor physical therapy helps both types and works on strength, relaxation, coordination, and endurance. The pelvic floor physical therapists in my office can see you there. Lifestyle changes, including weight loss, fit alongside any of these.
If leaking changes how you live your day, I want to see you.
References
- Lukacz ES, Santiago-Lastra Y, Albo ME, et al. Urinary Incontinence in Women: A Review. JAMA. 2017. doi:10.1001/jama.2017.12137
- Wu JM. Stress Incontinence in Women. New England Journal of Medicine. 2021. doi:10.1056/NEJMcp1914037
- Nygaard IE, Heit M. Stress Urinary Incontinence. Obstetrics & Gynecology. 2004. doi:10.1097/01.AOG.0000137874.84862.94
- White N, Iglesia CB. Overactive Bladder. Obstetrics and Gynecology Clinics of North America. 2016. doi:10.1016/j.ogc.2015.10.002
- Sanses TVD, Zillioux J, High RA, et al. Evidence-Informed, Interdisciplinary, Multidimensional Action Plan to Advance Overactive Bladder Research and Treatment Initiatives: Directives From State-of-the-Science Conference on Overactive Bladder and Cognitive Impairment. Urogynecology. 2023. doi:10.1097/SPV.0000000000001274
- 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
- Lightner DJ, Gomelsky A, Souter L, et al. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline Amendment 2019. The Journal of Urology. 2019. doi:10.1097/JU.0000000000000309
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