Urine Leaks and ‘Accidents’: Urinary Incontinence Tips from Physical Therapists

Nope, it’s not just you. Far from it, actually. Leaking urine when you sneeze or dashing to the bathroom and not quite making it can be embarrassing, sure. But you’re so not alone. In a room crowded with women of all ages and in different life stages, more than half are likely experiencing similar urinary problems. Involuntary urine leakage is called urinary incontinence. It affects a lot of people, most often women. For some, the symptoms are a small annoyance; for others, they can get in the way of everyday life. But just because urinary incontinence is common doesn’t make it normal or something you just have to live with. There are solutions. 

Read on to learn about the causes and types of urinary incontinence in women and how you can help prevent and treat symptoms — including the benefits of exercise and pelvic floor physical therapy for urinary incontinence.

What Is Urinary Incontinence?

Urinary incontinence is the involuntary or accidental loss of urine. Symptoms can range from an occasional leak when you cough or sneeze (aka “peezing”) to more severe, frequent wetting. Causes of urinary incontinence can include lifestyle habits, underlying health conditions, or physical problems. Often, it’s related to issues with your pelvic floor. The pelvic floor is a group of muscles that stretches between your pubic bone in the front and your tailbone in the back. Like the foundation of a house, it supports structures above it, such as your bladder and bowel, as well as your uterus and vagina. Pelvic floor muscle dysfunction can affect your bladder and urethra, which may contribute to different types of urinary incontinence.

Types of Urinary Incontinence

Urinary incontinence in women takes different forms and can trigger leakage for different reasons. Types of urinary incontinence include:

• Stress incontinence. Urine leaks when you cough, sneeze, laugh, exercise, or lift something heavy — which puts pressure on your bladder. Stress incontinence can result from a weakened pelvic floor. But the exact cause can vary from person to person.

• Urge incontinence. Urine leaks after a sudden and intense urge to pee — often without warning and whether your bladder is full or not. This can be due to:

  • Overactive bladder muscles

  • Tight pelvic floor muscles

  • Bladder irritants in your diet (such as coffee or citrus fruits)

  • Dehydration (urine becomes more concentrated and irritates the bladder)

  • Stress

  • Bladder or urinary tract infection

  • Neurologic conditions like spinal cord injuries, multiple sclerosis, Parkinson’s, Alzheimer’s and others

• Overflow incontinence. Urine constantly leaks or dribbles because your bladder doesn’t empty all the way. 

• Mixed incontinence. Just as it sounds, this is when you experience more than one type of urinary incontinence — most often a mix of stress and urge, from a combination of different factors. For example, you may change your bathroom habits to avoid leakage — say, peeing “just in case” before heading out the door, even when you don’t have to go. This behavior can lead to both stress and urge incontinence.

Physical Therapy for Urinary Incontinence

When problems with your pelvic floor muscles contribute to incontinence, pelvic floor physical therapy can help. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

To help ease symptoms of urinary incontinence, physical therapists may recommend:

Exercises to strengthen your pelvic floor, such as Kegel exercises. Strong pelvic floor muscles can help hold urine inside the bladder, preventing leakage. Strengthening exercises can be combined with biofeedback from devices that monitor the strength of your pelvic floor contractions. 

Note that Kegels are not the cure-all for every urinary problem: If your pelvic floor is too tight instead of weak, strengthening exercises can make some urinary problems worse.

Engaging your pelvic floor when coughing or sneezing to keep from stressing your pelvic floor muscles and help reduce leaking.

Practicing diaphragmatic breathing, or deep belly breathing, for a few minutes every day to calm your nervous system, which can decrease feelings of urgency.

Beyond the pelvic floor, other musculoskeletal issues can also affect incontinence. Your pelvic floor muscles work closely with the muscles in your hip, core, and lower back. Weakness in any of those areas can cause your pelvic floor muscles to compensate, which can lead to tension and tightness. PTs may recommend exercises to help strengthen the hips, core, and lower back to allow the pelvic floor muscles to relax and function at their best to help relieve incontinence.

How to Improve Symptoms of Urinary Incontinence

A treatment plan will depend on your specific type of urinary incontinence. To help prevent accidental leaks and better manage symptoms, try these strategies:

• Practice healthy toilet habits. Don’t hover when peeing; instead, sit and relax to help fully empty your bladder. Also, don’t delay bowel movements. If you’re constipated, avoid straining, which can put pressure on your pelvic floor.

• Stay hydrated. Dehydration can irritate your bladder and lead to feelings of urgency. It can also contribute to constipation. 

• Avoid or limit bladder irritants. If certain foods or drinks increase your symptoms, consider cutting them from your diet or reducing your intake. Read more about bladder irritants here.

• Urge suppression. When you feel a sudden urge to pee, follow these steps to improve your bladder control:

  • Stop where you are and stand quietly or sit down.

  • Perform five quick Kegel exercises or hold a Kegel for five seconds.

  • Take a few deep breaths to help relax your bladder.

  • Think of something else to distract you.

  • Delay as long as possible and then calmly walk to the bathroom.

• Bladder training. These are techniques that can help you train the muscles that control your bladder. While it’s meant for people who pee more frequently than “normal” (often about eight times a day with two to four hours in between), bladder training can also help you manage incontinence:

  • Set an interval goal (say, two hours between trips to the bathroom).

  • Make a schedule.

  • Practice urge suppression if you feel the urge to pee before your scheduled time. Delaying even five minutes can help your bladder learn to wait to empty.

  • Gradually adjust the interval between bathroom breaks until you reach three to four hours between trips.

There are many ways to improve symptoms of urinary incontinence in women. Studies show that exercise, lifestyle changes, and other non-surgical interventions can lead to big improvements — including the complete resolution of symptoms. That means no more leakage. Your provider and physical therapist can help determine the best treatment plan for you.

PT Tip: It’s More Than Just Kegel Exercises

When doing exercises to help your pelvic floor and treat urinary incontinence, “don’t limit yourself just to Kegel exercises,” says Kandis Daroski, PT, DPT, a Hinge Health pelvic floor physical therapist. “The pelvic floor muscles are interconnected with your core, hip, abdominal, and spinal muscles. A program that addresses how all these areas work together is the most effective way to improve urinary leakage.”

Remember, Dr. Daroski says, “urinary leakage doesn’t have to be a part of your story long term. You can improve and get back to doing what you love, worry free.” 

Learn More About Hinge Health for Pelvic Symptom Relief

If you have pelvic pain or symptoms that are affecting your quality of life, you can get the relief you've been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

References

1. Cho, S. T., & Kim, K. H. (2021). Pelvic floor muscle exercise and training for coping with urinary incontinence. Journal of Exercise Rehabilitation, 17(6), 379–387. doi:10.12965/jer.2142666.333

2. Definition & Facts for Bladder Control Problems (Urinary Incontinence) | NIDDK. (2021, July). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/definition-facts

3. Faiena, I., Patel, N., Parihar, J. S., Calabrese, M., & Tunuguntla, H. (2015). Conservative Management of Urinary Incontinence in Women. Reviews in urology, 17(3), 129–139.

4. Kopańska, M., Torices, S., Czech, J., Koziara, W., Toborek, M., & Dobrek, Ł. (2020). Urinary incontinence in women: biofeedback as an innovative treatment method. Therapeutic advances in urology, 12, 1756287220934359. doi:10.1177/1756287220934359 

5. Markland, A. D., Richter, H. E., Fwu, C. W., Eggers, P., & Kusek, J. W. (2011). Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. The Journal of urology, 186(2), 589–593. doi:10.1016/j.juro.2011.03.114

6. Patel, U. J., Godecker, A. L., Giles, D. L., & Brown, H. W. (2022). Updated Prevalence of Urinary Incontinence in Women: 2015–2018 National Population-Based Survey Data. Female Pelvic Medicine & Reconstructive Surgery, 28(4), 181–187. doi:10.1097/spv.0000000000001127

7. Subak, L. L., Quesenberry, C. P., Posner, S. F., Cattolica, E., & Soghikian, K. (2002). The effect of behavioral therapy on urinary incontinence: A randomized controlled trial. Obstetrics & Gynecology, 100(1), 72–78. doi:10.1016/s0029-7844(02)01993-2

8. Todhunter-Brown, A., Hazelton, C., Campbell, P., Elders, A., Hagen, S., & McClurg, D. (2022). Conservative interventions for treating urinary incontinence in women: an Overview of Cochrane systematic reviews. The Cochrane database of systematic reviews, 9(9), CD012337. doi:10.1002/14651858.CD012337.pub2