Understanding Urine Leakage Causes: Why It Happens and How to Manage It

Got sneeze pee? Need to rush straight to the toilet when you get home? Even though there are fewer stigmas associated with urine leakage now than there used to be, people still feel plenty of shame over this very common problem. Thankfully, there are solutions: depending on the cause of urine leakage, it can be treated and managed so that you can get back to enjoying life without shame.

Why Is Urine Leakage Important?

Most people will experience some episodes of urine leakage, also known as urinary incontinence, over the span of their lives. Involuntary leakage can be embarrassing and uncomfortable, especially if it happens frequently. If it’s not well-managed, the continual presence of urine on the skin can cause damage and make you more susceptible to infections, including UTIs. For all of these reasons, addressing urinary incontinence will improve your quality of life.

There are five types of leakage:

• Stress incontinence refers to leakage that occurs due to excessive intra-abdominal pressure and the stress it puts on the pelvic floor. This leakage usually happens during activities like running, jumping, sneezing, coughing, laughing, lifting heavy weights, etc.
• Urge incontinence is a sense of urgency around needing to urinate and/or involuntary leakage that is caused by overactive bladder tissue.
• Mixed urinary incontinence is leakage of urine caused by a combination of stress and urge urinary incontinence
• Overflow incontinence happens when your bladder is overly full, usually because the tissue making up the bladder is compressed or under-active
• Functional incontinence is leakage that occurs when there are physical or environmental barriers to toileting

It’s important to know which kind of incontinence you’re dealing with in order to treat it–so your first stop should be with your primary care physician, who can refer you to a specialist such as a urologist, urogynecologist, occupational or physical therapist, depending on the kind of leakage you’re having.

When should you seek help? A good time to check in with your healthcare provider is when you notice incontinence episodes happening frequently and fairly consistently. The occasional leak the one time every year that you jump on a trampoline? Probably not a big deal. Coughing for days and lose control of your bladder, but function normally when you’re back to normal health? Again, probably less of an issue. But if you find that you’re leaking while coughing during an illness and it doesn’t get better when the coughing goes away, then it’s time to seek help.

Common Causes of Urine Leakage

Diagnosing urinary incontinence requires knowing when the leakage occurs and what seems to aggravate it, so be prepared to discuss your toileting habits with your healthcare provider–and be ready to push back when they tell you it’s “just normal for people your age.” Just because it’s common doesn’t mean it isn’t worth addressing. Here are some reasons for urine leakage:

Pregnancy and Childbirth

The stress that pregnancy and childbirth place on your body is enormous. Pregnancy increases pressure on the bladder and pelvic floor as the fetus grows; not everyone adapts well to this increase in pressure. Childbirth can damage the muscles and nerves in the pelvic floor–the pressure of the baby moving through the vagina and out of the pelvis can be quite intense. But people who have Cesarean births also risk developing pelvic floor issues like incontinence due to the muscles and nerves that are cut during the procedure and scar tissue left in the pelvis after you’ve recovered.

Pelvic Organ Prolapse

Pregnancy and vaginal childbirth are the biggest risk factors for pelvic organ prolapse (where one or more of the organs in the pelvis moves out of place). Pelvic organ prolapse can also be a cause of urinary incontinence due to changes in pressure on the bladder. Learn more about pelvic organ prolapse here.

Excessive Intra-abdominal Pressure

Intra-abdominal pressure is the pressure in the abdominal cavity. Intra-abdominal pressure isn’t inherently bad. It’s part of the breath system and managed by the diaphragm, pelvic floor, and core. But if you’re already holding extra tension in the core or pelvic floor, then unusual or excessive pressure, such as a sneeze or cough, can cause stress incontinence. If your breathing and body mechanics aren’t supportive of optimal management of intra-abdominal pressure, you may experience leaking. Circumstances that often play a role in excessive intra-abdominal pressure and stress incontinence include:

• High-impact or high-load exercise like running or weightlifting
• High body weight
• Pregnancy and childbirth
• Chronic cough

Overactive Bladder

An overactive bladder can cause urge incontinence. Overactive bladder can be due to consuming too many bladder irritants or diuretics or UTIs; sometimes, the urge is more mental than physical. Noticing whether there’s a pattern to the urgency can help you better work with your healthcare provider to sort out solutions.

Some common irritants of the bladder are:

• Caffeine (found in coffee, tea, soda, and energy drinks)
• Alcohol
• Spicy foods
• Citrus fruits and juices
• Artificial sweeteners
• Carbonated drinks
• Tomato-based products
• Chocolate
• Vinegar
• Some medications (such as antihistamines, antidepressants, and diuretics)

Perimenopause, Menopause, and Aging

As people age, the incidence of urine leakage increases. For many people with uteruses, the drop in estrogen that begins during perimenopause causes the tissues of the bladder and the rest of the pelvic floor to weaken. As a result, your body is less able to manage conditions that might not have resulted in leakage before.

For folks with prostate glands, the prostate grows through adulthood and into old age, which means that it may end up putting pressure on the bladder and causing overflow incontinence, where the bladder is too full, or urine tends to dribble.

Other Medical Conditions

Many other medical conditions may play a role in your urine leakage. That’s why it’s important to check in with your doctor first. Neurological disorders like multiple sclerosis, Parkinson’s disease, or stroke can interfere with the nerve signals involved in bladder control. Bladder stones, while much rarer than kidney stones, can make fully emptying your bladder difficult. Bladder cancer can cause symptoms like urinary leakage and urgency, so again, check with your doctor if you’re having any difficulty urinating or experiencing regular urinary leakage.

Managing Urine Leakage in Daily Life

Once you’ve checked in with your doctor, you will likely still experience some leakage as you figure out the cause and solutions for your leakage.

Products for Managing Incontinence

Thankfully, the market for products that help you stay clean and dry even during incontinence episodes has come a long way. There are disposable products as well as reusable underwear that can absorb leaks. There are even reusable, insertable devices that may be useful.

Do not use menstrual products to absorb urine–they’re not meant to hold the quantity of liquid you may leak. If they work for you, great. But if not, do seek out other options.

You may also require an absorbent pad for your bed–these are easy to find.

Exercises for Incontinence

If you’re suffering from stress incontinence or mixed incontinence, you may be directed to physical therapy or occupational therapy for rehab. Your physical therapist can help you retrain your pelvic floor muscles to the tasks that you need to engage in. It’s important to work with a professional who can evaluate whether your pelvic floor muscles are overactive or too lax–the common advice to practice kegel exercises as a blanket solution to all pelvic floor issues is outdated and contraindicated in many cases. You might also find that you can continue your progress with a whole-body approach like the one in Restore Your Core^®.

Quick tip: If you’re trying to delay a trip to the bathroom, try a standing heel raise or curl your toes to contract your calf muscles. Contracting your calves stimulates the tibial nerve, which is connected to other nerves in the sacrum (sacral plexus) that control your bladder.

Urine Leakage is Manageable

Over the long term, you can manage and find more comfort even with some leakage, and depending on the cause, you may be able to reduce how often you leak significantly. If you notice any sort of burning or discomfort while urinating, see your doctor immediately. If your leakage is persistent, see your doctor. It’s very common for people to experience urine leakage; I promise you will not be the first person your healthcare provider has seen who is concerned about it. Knowing what’s going on with your body makes it much easier to figure out how to live a full life, even with chronic incontinence.