What Causes Female Urinary Leakage

Urinary leakage, also known as incontinence, can feel embarrassing, but it’s a very common experience for women — during pregnancy, after giving birth, and as they age.

According to Mitchell Goldenberg, MD, a urologist with USC Urology, part of Keck Medicine of USC, who sees patients at USC Verdugo Hills Hospital, women often seek care for two types of incontinence:

• Urgency incontinence: when the bladder muscle squeezes when it’s not supposed to and gives patients a strong, sudden urge to urinate. Patients may feel the need to rush to the bathroom often or get up multiple times overnight.
• Stress incontinence: in which leakage occurs when the patient coughs, laughs, sneezes, or engages in physical activity. This is usually the result of weakened pelvic floor muscles, which are supposed to squeeze together to hold in urine.

Risk Factors

Pelvic floor muscles tend to weaken over time, with women over age 50 being most likely to experience incontinence. Having bladder or uterine surgery increases the risk, as well as lifestyle factors like carrying excess weight and smoking cigarettes.

Research shows a pregnant woman has about a 50% chance of experiencing urinary leakage, especially during the third trimester. A growing baby puts increased pressure on the pelvic floor, making it more difficult for those muscles to hold in urine.

“Hormonal changes make the connective tissues in your body more stretchy than normal” as the body prepares to give birth, Dr. Goldenberg adds. “One of the side effects is the pelvic floor can widen, which also makes it harder for the muscles to come together.”

He says postpartum incontinence, especially after a natural birth, is also common. “Incontinence can last for a few months, but usually goes away with time.”

However, he stresses that patients need to call their doctor if they see blood in their urine or if incontinence is accompanied by an infection.

Treatment Options

Dr. Goldenberg says pelvic floor physical therapy is successful for most patients. Physical therapists at USC-VHH lead patients through advanced, targeted exercises to strengthen the pelvic floor.

There is also evidence that doing pelvic floor exercises proactively may help prevent or minimize incontinence. “With appropriate guidance from their doctor, there’s often a case to be made for starting these exercises earlier rather than waiting for the symptoms to happen.”

Patients may consider surgical procedures when physical therapy is either unsuccessful or not an option. “Losing weight, for example, can help with incontinence but leakage can make exercising really difficult,” Dr. Goldenberg says. “It can be a vicious cycle for some patients. That’s where surgery can be really helpful.”

One option is a urethral bulking surgery, which involves using an injection to narrow the urinary tract. Another option is to insert a sling, made of synthetic material or the patient’s own tissue, to support the pelvic floor.

Dr. Goldenberg encourages anyone experiencing uncomfortable urinary leakage to ask their doctor about it. He says many patients assume incontinence is something they simply have to accept, but he says that’s not true.

“Even though it’s not a life-or-death problem, it can have a big impact on your quality of life,” Dr. Goldenberg. “You don’t have to live with incontinence.”

Topics