Going to the bathroom is a totally normal part of human existence. But for lots of women, incontinence issues can make this daily activity stressful or embarrassing.  I think it’s important to discuss all aspects of women’s health — no “taboos” here! I’m here to help start open and honest conversations that can help you learn more about urinary incontinence, bust the social stigmas, and find a better way forward.

Urinary leakage is really common, but that doesn’t make it “normal.” If you’re dealing with any symptoms, don’t be embarrassed or afraid to seek help! Most pelvic floor physical therapists have tons of empathy and expertise on this topic, making them the perfect people to help you reclaim control of your bathroom schedule. There are simple ways to treat urge incontinence that can improve your daily life, so don’t wait!

What is urge incontinence?

Urinary dysfunction is not a one-size-fits-all situation. There are a handful of ways that this issue can show up – and a number of factors that cause it in the first place! Today, we’re going to unpack urge incontinence, which is defined as a sudden, compelling urge to empty the bladder along with an ill-timed contraction of the bladder. This results in urinary leakage. This commonly occurs in women who aren’t able to go to the bathroom as needed because of their schedules or work situations, but it can affect anyone – including pregnant and postpartum women!

Urge incontinence differs from stress incontinence, which is categorized by urinary leakage that occurs due to rigorous activity or imbalanced pelvic floor pressure. (Some women experience symptoms of both, which is called mixed incontinence.) Stress incontinence shows up for many women when they’re at the gym or performing physical activity, but it can also pop up in everyday moments like laughing or sneezing. If you think you may be dealing with stress incontinence, I wrote an entire blog about it!

Here are some common symptoms of urge incontinence. If this list resonates with you, you’re in the right place!

• Always feeling like you need to rush to get to the bathroom
• Needing to urinate as soon as you get home, hear running water, or feel cold
• Waking up repeatedly in the night to empty your bladder
• Needing to urinate again right after you’ve gone to the bathroom 
• Leaking urine while sleeping at night or out and about during the day

What causes urge incontinence? 

From an anatomical perspective, several factors can cause urge incontinence. Here’s why you could be dealing with this diagnosis: 

1. Overactive bladder muscles

It’s important to note that “overactive bladder” and urge incontinence are not quite the same. With the latter, the urge to urinate is actually followed by leakage. However, these two diagnoses share a similar cause — the muscles of the bladder are overactive. 

As a healthy bladder fills up throughout the day, nerve signals tell your brain when it’s time to go to the bathroom. But for someone experiencing urge incontinence, the bladder muscles start to contract even when the bladder is not yet full. When these muscles contract, they are stronger than the sphincter in your urethra that keeps your urine in your body until you’re ready to go to the bathroom – which leads to urinary leakage. 

2. Nerve damage

Sometimes, bladder contractions occur at the wrong time because the nerves around it are damaged. This can be due to a number of factors, from diabetes to multiple sclerosis or Parkinson’s disease. Nerve damage can also occur after bodily trauma or stroke. 

This is not the case for many women who experience urge incontinence, so don’t panic! However, if conservative treatment options are not working for you, or you know you have another condition like the ones listed above, check with your provider to discuss treatment options for your specific situation. 

3. Lifestyle factors

Sometimes, urge incontinence develops because of our own bathroom habits, stress, or our dietary choices. Caffeine, carbonated beverages, or alcohol can exacerbate incontinence, and constipation can also play a role in urinary health. 

If you’ve noticed your urge incontinence began during a period of intense stress, finding ways to mitigate your anxiety may help. And if you find yourself needing to “hold it” for long periods of time on a regular basis, re-evaluate your schedule wherever possible. Ignoring those bodily cues can cause our nerves and bladder muscles to lose function over time. 

Who does urge incontinence affect?

Urge incontinence affects many different groups of people. It gets more common with aging in both men and women, but it doesn’t only affect older populations. You’re not “too young” to be experiencing incontinence, because there are a variety of other factors! According to research, incontinence affects 25% of young women, 44-57% of middle-aged women, and 75% of older women. Higher risk factors for developing urge incontinence include:

• Pregnancy and childbirth
• Hysterectomy or pelvic surgery
• Certain drugs, including antidepressants and blood pressure medications
• Menopause or hormonal changes
• Obesity
• Smoking
• Recurrent UTIs
• Neurological disorders
• Diabetes

It’s also common to see urge incontinence in certain fields of work. Women who are teachers, nurses, or in similar roles that don’t allow them to take bathroom breaks when they’re needed are often affected by this at much higher rates. 

How to treat urge incontinence 

Dealing with incontinence can be frustrating, but you are not alone and you do have options! Discuss them with your provider or physical therapist. They’ll work with you to determine the root cause of your urge incontinence and find a treatment plan based on your situation.

1. PELVIC FLOOR PHYSICAL THERAPY

No matter what type of incontinence you’re experiencing, pelvic floor therapy should be your first line of defense. PT can absolutely help you to retrain your bladder muscles and strengthen your pelvic floor. This is also the most conservative treatment option available, so it’s best to give it a try before moving to other methods. If you’re feeling nervous before your appointment, give your physical therapist a call! All of the PTs I know would love to chat with you and set your mind at ease before you show up.

At your first pelvic floor physical therapy appointment, your PT will perform an evaluation to get a sense of what’s going on, then create a customized treatment plan based on what they find. They may recommend: 

• pelvic floor exercises
• biofeedback
• pessary devices
•  bladder retraining
• a combination of these 

Even if you do end up needing additional treatment options, pelvic floor PT will almost always be a part of your incontinence treatment, and there’s no shame in getting the help you need.  Find a provider close to you to begin a treatment plan that could reduce or eliminate your symptoms.

2.  MEDICATION

There are a few medications that your doctor may prescribe for urge incontinence. This is an individual decision for you to make with your doctor, and the root cause of your incontinence will determine if medication is a good option for you. 

3. LIFESTYLE MODIFICATIONS

For many women with urge incontinence, retraining the bladder and changing bathroom behaviors can make a huge difference. Here’s what I recommend to many of my patients:

• Avoid bladder irritants — typical triggers include alcohol, caffeine, and carbonation, but it may be helpful to keep a journal or phone note to see what stressors are true for you. 
• Avoid power peeing — this means using diaphragmatic breathing and focusing on your pelvic floor. 
• Avoid hovering above the toilet — this can cause overuse of your muscles and exacerbate any existing dysfunction. 
• Avoid just in case peeing — wait until your body gives you the signal, and listen to it when it does! 
• Practice bladder retraining — your pelvic floor PT will teach you how. 

Need more help? 

If you’re experiencing any symptoms of urge incontinence, an in-person exam from a local pelvic floor physical therapist is the best place to start. That said, I know not everyone has access to this type of care, due to provider waitlists, or lack of childcare.

If you’re experiencing urge incontinence after childbirth, My Movement Through Early Postpartum course can help. In it, you’ll learn how to connect with your pelvic floor to build strength AND mobility — both of which are needed to manage urge incontinence. Inside the course, you’ll find movements designed to retrain and rebuild your pelvic floor and core, no matter how many weeks/months/years you are postpartum. You’ll also get educational modules that tackle incontinence, proper toileting techniques and other common diagnoses, empowering you to understand what’s going on in your body. Incontinence does not have to be a part of your story forever. Don’t be afraid to start getting the answers and treatment you need!