Ryan Stewart, DO
Fellowship-Trained Urogynecologist
Urogynecology & Reconstructive Pelvic Surgery
Green Bay, Wisconsin
✓ Medically reviewed March 2026

Urinary Incontinence

Urinary incontinence, the involuntary leakage of urine, is one of the most common reasons women come to see me. It affects millions of women, and yet many wait years before bringing it up with a doctor. Some assume it’s just a normal part of aging or something they have to live with after having children. It isn’t, and they don’t.

The first step is understanding what type of incontinence you’re dealing with, because the type drives everything that comes after: the workup, the treatment options, and what to expect.

Types of Urinary Incontinence

I think about urinary incontinence in a few main categories:

Stress incontinence. Leaking with physical activity that puts pressure on the bladder: coughing, sneezing, laughing, lifting, or exercise. This is the most common type I see in younger women and after childbirth.
Urge incontinence. A sudden, strong urge to urinate that you can’t suppress, followed by leakage. This is the hallmark of overactive bladder.
Mixed incontinence. A combination of stress and urge incontinence. Many women have elements of both.
Overflow incontinence. The bladder doesn’t empty completely, leading to frequent dribbling. Less common in women but it does happen.
Functional incontinence. Physical or cognitive limitations prevent getting to the bathroom in time. The bladder itself may be working fine.

What Causes It?

There’s rarely a single cause. Most of the time, multiple factors are contributing:

Pelvic floor muscle weakness, whether from pregnancy, childbirth, or aging
Pregnancy and vaginal delivery, especially with larger babies or prolonged pushing
Menopause. Declining estrogen affects the tissues of the urethra and vagina.
Neurological conditions. Stroke, MS, Parkinson’s, and others can disrupt bladder control.
Urinary tract infections, which can cause temporary urgency and leakage
Medications. Diuretics, sedatives, and some blood pressure medications can contribute.
Obesity. Extra weight increases pressure on the pelvic floor.
Chronic coughing, whether from smoking, asthma, or other lung conditions

Symptoms

What you experience depends on the type of incontinence:

Leaking urine when you cough, sneeze, laugh, or exercise
A sudden, intense urge to urinate that’s hard to control
Going to the bathroom more than 8 times in 24 hours
Waking up at night to urinate (nocturia)
Constant dribbling or a sense of incomplete emptying

If any of this sounds familiar, it’s worth bringing up, even if it seems minor. Many of the women I see wish they had come in sooner.

How We Diagnose It

The evaluation is straightforward and starts with a conversation:

Your history. I’ll ask about your symptoms, when they started, what makes them better or worse, and how they’re affecting your daily life.
Physical exam. A focused pelvic exam to assess pelvic floor support, muscle strength, and whether leakage can be demonstrated.
Urinalysis to rule out infection or other findings that could explain your symptoms.
Bladder diary. I may ask you to keep a log of your fluid intake, how often you void, and when leakage happens. This is one of the most useful tools we have.
Urodynamic testing. In some cases, we’ll do more detailed testing to measure how your bladder stores and empties urine. This is especially helpful when the diagnosis isn’t clear-cut or if surgery is being considered.
Cystoscopy. A quick look inside the bladder with a small camera. Not always needed, but useful in certain situations.

Treatment Options

Treatment depends on the type and severity of your incontinence. I want patients to know about all of their available options, including expectant management, medical and physical therapy, and surgery, so they can decide what’s right for them. That’s consistent with current AUA/SUFU guidelines, which moved away from mandatory stepwise treatment in favor of shared decision-making.

Conservative Treatments

Pelvic floor physical therapy. This is where I start for most patients. A specialized PT can work with you on strengthening, coordination, and behavioral strategies. It goes well beyond just doing Kegels.
Bladder training. Techniques to gradually increase the time between voids and reduce urgency. Particularly helpful for urge incontinence.
Lifestyle modifications. Weight loss, managing fluid intake, reducing caffeine and alcohol, and treating constipation can all make a real difference.

Medications

Depending on the type of incontinence:

Antimuscarinics (like oxybutynin or solifenacin) for overactive bladder and urge incontinence
Beta-3 agonists (like mirabegron or vibegron), another option for overactive bladder, often with fewer side effects
Topical vaginal estrogen for perimenopausal and postmenopausal women; helps restore tissue health around the urethra

Devices

Pessaries. A vaginal device that supports the bladder neck and urethra. Can be very effective for stress incontinence, no surgery required.

Interventional Therapies

Botox injections. Injected into the bladder muscle to calm an overactive bladder. The effect typically lasts 6 to 9 months.
Urethral bulking. A gel injected around the urethra to improve closure. This can be done in the office or as an outpatient procedure, depending on the situation.
Sacral neuromodulation. An implanted device that modulates the nerves controlling the bladder. Think of it as a pacemaker for the bladder.

Surgical Options

When conservative treatments aren’t enough:

Sling procedures. A small strip of mesh or tissue placed under the urethra to prevent leakage with activity. This is the most common surgery for stress incontinence.
Colposuspension. Lifts and supports the bladder neck. Less commonly performed now but still an option for certain patients.

Choosing the Right Treatment

There’s no one-size-fits-all answer. The right treatment depends on:

What type of incontinence you have
How much it’s affecting your life
Your overall health and what you’ve already tried
What matters most to you. Some women want to avoid surgery at all costs, others want the most definitive fix.

I spend a lot of time in clinic talking through these options. I want you to understand what’s available, what the tradeoffs are, and what I’d recommend for your situation. Then we decide together.

It’s Worth Talking About

Urinary incontinence is common, but it’s not something you have to accept. Most women improve with treatment, often without surgery. If you’ve been dealing with leakage and haven’t brought it up with a doctor yet, this is a good reason to start that conversation.

References

Aoki Y, Brown HW, Brubaker L, Cornu JN, Daly JO, Cartwright R. Urinary incontinence in women. Nat Rev Dis Primers. 2017;3:17042. doi:10.1038/nrdp.2017.42
Lukacz ES, Santiago-Lastra Y, Albo ME, Brubaker L. Urinary incontinence in women: a review. JAMA. 2017;318(16):1592-1604. doi:10.1001/jama.2017.12137
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10(10):CD005654. doi:10.1002/14651858.CD005654.pub4
Lightner DJ, Gomelsky A, Souter L, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment 2024. J Urol. 2024;212(1):18-32. doi:10.1097/JU.0000000000003985
Kobashi KC, Vasavada SP, Zambon JP, et al. Updates to surgical treatment of female stress urinary incontinence (SUI): AUA/SUFU guideline (2023). J Urol. 2023;209(6):1091-1098. doi:10.1097/JU.0000000000003435

Frequently Asked Questions

What is urinary incontinence?

Urinary incontinence is a condition that involves the involuntary leakage of urine. It can significantly impact quality of life and affects millions of people worldwide, particularly women.

What are the types of urinary incontinence?

There are several types of urinary incontinence: 1. Stress Incontinence: Urine leakage during physical activities that put pressure on the bladder such as laughing, coughing, sneezing, or exercise. 2. Urge Incontinence: Sudden, intense urge to urinate followed by involuntary loss of urine. 3. Mixed Incontinence: A combination of stress and urge incontinence. 4. Overflow Incontinence: Frequent or constant dribbling of urine due to incomplete bladder emptying. 5. Functional Incontinence: Physical or mental impairments prevent reaching the toilet in time.

What causes urinary incontinence?

Urinary incontinence can be caused by various factors, including: - Weakness in the pelvic floor muscles - Pregnancy and childbirth - Menopause - Neurological disorders - Urinary tract infections - Certain medications - Obesity - Chronic coughing - Age-related changes in the urinary tract

What are the symptoms of urinary incontinence?

Symptoms can vary depending on the type of incontinence but may include: - Leaking urine during physical activities - Sudden, intense urge to urinate - Frequent urination (more than 8 times in 24 hours) - Nighttime urination (nocturia) - Constant dribbling of urine - Inability to empty the bladder completely

How is urinary incontinence diagnosed?

Diagnosis typically involves: 1. Medical history review 2. Physical examination 3. Urinalysis 4. Bladder diary 5. Urodynamic testing 6. Cystoscopy in some cases

What are the treatment options for urinary incontinence?

Treatment options include: 1. Conservative treatments: Pelvic floor exercises (Kegels), bladder training, lifestyle changes, and pelvic floor physical therapy 2. Medications: Antimuscarinic medications, beta agonists, and topical vaginal estrogen for some women 3. Medical devices: Vaginal inserts and pessaries 4. Interventional therapies: Botox injections, bulking agents, and sacral nerve stimulation 5. Surgical options: Sling procedures and colposuspension for severe cases

How is the right treatment for urinary incontinence chosen?

The choice of treatment depends on various factors, including: - The type and severity of incontinence - The impact on quality of life - Overall health and medical history - Personal preferences and goals Healthcare providers may use decision aids to help patients make informed choices about treatment options.

Is urinary incontinence a normal part of aging?

No, while urinary incontinence is common, it is not a normal part of aging and shouldn't be ignored. With proper diagnosis and treatment, many people find significant improvement in their symptoms and quality of life.

What should I do if I think I have urinary incontinence?

If you're experiencing symptoms of urinary incontinence, don't hesitate to speak with a healthcare provider. Remember, you're not alone, and effective treatments are available to help you manage this condition.