Leaking Urine: Why It Happens and How to Treat It

There are a few types of urinary incontinence. Each affects people differently and happens for different reasons.

Maybe a little bit of pee squeaked out when you sneezed. Maybe it happened on your run, and your shorts are wet this time. Or maybe you have the sudden urge to go and don't quite make it to the toilet on time.

More than 33 million people in the United States experience leaking urine daily. There are different types of urinary incontinence that people may experience. Here's what you need to know about the condition and how to get help.

Why Do People Experience Leaking Urine?

There are several reasons or causes for leaking urine, also called urinary incontinence. Urinary incontinence is any unintentional loss of urine. People experience urinary incontinence for many reasons, including:

  • A weak or overactive bladder or pelvic floor muscles
  • Certain health conditions, like multiple sclerosis (MS), diabetes, or Parkinson's disease, which damage nerves that regulate the bladder
  • Arthritis, which makes it challenging to get to the bathroom
  • Pelvic organ prolapse, which happens when your bladder, rectum, or uterus moves out of place
  • Inflammed, enlarged, or damaged prostate gland in men

Leaking urine includes leaking a few drops once a month to multiple times a day, David Sheyn, MD, an OB-GYN and urologist in the division of female pelvic medicine and reconstructive surgery at University Hospitals in Chardon, Ohio, told Health

Types of Urinary Incontinence

Your bladder stores urine. When you need to urinate, your bladder muscles tighten. That movement forces the urine out of your bladder and through your urethra, the tube connected at the bottom of your bladder. For urine to release from your body, the sphincter muscles around the urethra relax. 

Several types of urinary incontinence may interfere with that process, causing urine to leak. Here's what you need to know about each type and its causes.

Stress Urinary Incontinence (SUI)

You can experience SUI when your bladder leaks urine during physical activity or exertion. Your pelvic floor muscles, which support the urethra, and the sphincter muscles, which control the release of urine, weaken. 

When those muscles weaken, everyday activities that use abdominal and pelvic muscles—like laughing, coughing, exercising, and lifting—can put pressure on your bladder and cause urine leakage. Sudden movements can also cause urine to leak.

SUI is more common for women than men. Events like pregnancy and childbirth can weaken pelvic floor muscles that play a key role in coordinating urination, Kristin Sapienza, DPT, a pelvic floor physical therapist and founder of FemFirstHealth in New York, told Health.

Scar tissue and pain may also affect your muscles' abilities to contract and relax as they should, added Sapienza. SUI brought on by pregnancy can begin either during pregnancy or after delivery.

Urge Incontinence

Urge incontinence happens when there's a problem with your nervous system, pelvic floor muscles, or pelvic nerves. With urge incontinence, your bladder empties without your permission explained Dr. Sheyn.

Urge incontinence is often associated with overactive bladder (OAB). OAP happens when your bladder muscles contract involuntarily. Symptoms of OAB include:

  • Urinating eight or more times a day
  • Urinating two or more times at night
  • Having the sudden, strong need to urinate immediately
  • Leaking urine after a sudden, strong urge to urinate

If you make it to the bathroom in time, you might not urinate much when you get there. The urgency of OAB can kick in even when you don't have a lot of urine in your bladder.

Mood disorders, such as anxiety, can play a role in urge incontinence and OAB. The part of your brain that controls anxiety also controls the bladder, and mood can affect your need to urinate, explained Dr. Sheyn. 

In one study published in 2020 in Journal, researchers linked high levels of anxiety and depression to urge incontinence. The researchers wrote that the conditions share hormonal and neurological paths.

Overflow Incontinence

Overflow incontinence happens when your bladder doesn't empty, causing too much urine to stay in your bladder. When your bladder gets too full, you may experience frequent or constant dribbling of urine. 

Overflow incontinence is most common among men. Tumors, kidney stones, diabetes, and certain medicines may cause overflow incontinence.

Functional Incontinence

Functional incontinence happens when a person has a physical or mental disability, trouble speaking, or some other problem that keeps them from getting to the toilet quickly. 

For example, if someone has arthritis, they may have trouble unbuttoning their pants in time. Or if a person has Alzheimer's disease, they may not realize they need to use the toilet.

Transient Incontinence

A temporary situation, like an infection or new medicine, causes transient incontinence. Once the infection subsides or you finish taking the medicine, transient incontinence goes away.

Mixed Incontinence

Mixed incontinence is a combination of more than one type of the condition. Usually, mixed incontinence is a combination of SUI and urge incontinence. The symptoms of one type of incontinence may be more severe than the other.

Urinary Incontinence Symptoms

Symptoms will depend on the type of incontinence you're experiencing. But typically, symptoms of urinary incontinence include the following:

  • Leaking urine during daily activities like lifting, bending, coughing, exercising
  • Being unable to hold in urine after a sudden, strong urge to urinate
  • Leaking urine without any warning or urge
  • Wetting your bed while sleeping
  • Leaking urine while having sex

Another symptom of urinary incontinence is often urinating—more than seven times per day or more than once at night.

Risk Factors for Urinary Incontinence

Urinary incontinence can happen for different reasons. But some factors can increase your risk of developing the conditions, including:

  • Gender: Women are more likely to have urinary incontinence than men. Pregnancy, childbirth, and menopause increase the risk of the condition. Pregnancy and childbirth affect the muscles that hold urine. With menopause, decreased levels of the hormone estrogen may cause urinary incontinence. Some evidence suggests that having low levels of estrogen may weaken the urethra.
  • Age: As you age, your urinary tract muscles weaken, making it harder to hold in urine. Although, urinary incontinence is not an inevitable part of aging.
  • Prostate issues: In men, an enlarged prostate, which is right below the bladder and surrounds the top of the urethra, can lead to urinary incontinence. Urinary incontinence can also be a symptom of prostate cancer.
  • Certain health conditions: Diabetes, obesity, and long-lasting constipation can increase your risk of urinary incontinence. Conditions involving the central nervous system, like MS, stroke, or Parkinson's disease, affect how the brain and bladder communicate, decreasing the ability to urinate properly, explained Dr. Sheyn.
  • Smoking: Smoking irritates the bladder and may cause frequent urination. It can also cause coughing spasms that can lead to leaking urine.

Still, people with no risk factors can often experience urinary incontinence. 

"Almost 70% of urge incontinence is idiopathic, meaning we don't know what causes it to happen in otherwise perfectly healthy people," said Dr. Sheyn.

When To See a Healthcare Provider

Talking to a healthcare provider may help if you're altering your life to manage symptoms or frequently leaking urine. A gynecologist, urologist, or pelvic floor specialist can help with urinary incontinence.

Besides the impact urinary incontinence can have on your social, work, and personal life, the condition can also lead to skin problems, like rashes, infections, and sores, from constantly wet skin or urinary tract infections (UTIs).

"I think [people] suffer in silence thinking that they can't get help, but it is treatable," explained Sapienza.

Some people aren't concerned with a few leaks here or there. And if it's truly not bothering you, then you likely don't need to see anyone, added Dr. Sheyn.

How Is Urinary Incontinence Diagnosed?

Starting a few days before your appointment, a healthcare provider may ask you to keep a bladder diary. In that case, you will record how much and when you drink liquids, when and how much you urinate, and whether you leak urine.

During the appointment, the healthcare provider will do the following:

  • Ask about your medical history and symptoms.
  • Perform a physical exam, which might include a rectal exam. For women, they may also perform a pelvic exam.
  • Ask you to cough or do another simple maneuver that can initiate leaking urine.

A healthcare provider can determine the type of urinary incontinence you have. To make a diagnosis, the healthcare provider might also run some tests, including:

  • Urine tests
  • Blood tests
  • Bladder function tests
  • Imaging tests

How To Treat Leaking Urine

"Most patients can be cured or really well-managed with treatment," said Dr. Sheyn. "The most common thing I hear from patients is, 'I wish I would have done this sooner.'"

There are a lot of ways to treat leaking urine, including:

  • Lifestyle changes: Being physically active, not smoking, and maintaining a healthy body weight can help. Also, drinking the right amount of fluids at the right time is important. Some apps help people with OAB manage fluid intake, explained Dr. Sheyn.
  • Pelvic floor physical therapy: Your pelvic floor is essentially the bottom of your core, said Sapienza. Pelvic floor physical therapy helps release, strengthen, or relax your muscles depending on their strength. Pelvic floor specialists use techniques like Kegel exercises, dilator therapy, biofeedback, or yoga positions, to help.
  • Medication: Several medications relax an overactive bladder or block nerve signals that cause urinary frequency and urgency. Some medications can shrink the prostate gland to improve urine flow for men.
  • Devices: Stress incontinence devices can assist with pelvic floor exercises to ensure you're performing them properly. Motion sensors connected to an app equip those devices to provide feedback and help you isolate the pelvic floor muscles, explained Dr. Sheyn. Some devices have a direct role in preventing leaking. For example, a pessary is a soft, plastic device that inserts into the vagina and helps keep the urethra in place to decrease urine leaks.
  • Botox: Injections into your bladder can help relax the muscle, decreasing the chance of leakage if you have urge incontinence. Healthcare providers generally prescribe Botox only after other treatments fail.
  • Electrical nerve stimulation: This technique changes your bladder's reflexes using mild pulses of electricity. That electricity stimulates the nerves that control your bladder and sphincter muscles.
  • Sling surgery: This is one of the most common surgeries for stress incontinence among women. Sling surgery involves inserting a strip of material between the vagina and the urethra. Men with stress incontinence can also have sling surgery.
  • Implant surgery: This surgery involves implanting an artificial urinary sphincter, a small, fluid-filled ring around the bladder neck. That ring keeps the urinary sphincter shut until you need to urinate. You press a valve under your skin to deflate the ring, which allows urine to leave your bladder.

Practical matters, like time commitment and access to healthcare providers, will play a factor in choosing the best option for you. Treatment will also depend on the following:

  • What type of incontinence you have
  • How intrusive your symptoms are
  • What your treatment goals are
  • What your insurance covers
  • Whether you're interested in invasive or noninvasive treatment

How To Prevent Leaking Urine

You can't always prevent urinary incontinence. But there are some things you can do to reduce your risk, including:

  • Maintaining a healthy weight
  • Practicing pelvic floor exercises
  • Avoiding bladder irritants, such as caffeine, alcohol, and acidic foods
  • Trying to maintain regular bowel movements, as constipation can cause urinary incontinence
  • Not smoking or, if you do smoke, quitting

You may consider scheduling an assessment to evaluate pelvic floor health with a healthcare provider once you're six weeks postpartum if you're pregnant, advised Sapienza. If you're already postpartum, it's never too late to make that visit.

A Quick Review

There are several types of urinary incontinence, which causes leaking urine. By making some lifestyle changes and doing pelvic floor exercises, you may be able to prevent or minimize leaking urine. 

But if you have symptoms affecting your quality of life and activities, talking with a healthcare provider may help. They can figure out what type of urinary incontinence you have and offer suggestions for treating it.

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Sources
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