Urinary Leakage and Incontinence

Authors: Madelyn Levasseur MS, OTR/L

Urinary leakage and incontinence can occur for many different reasons. Some people leak urine in response to an increase in pressure in the abdomen either from a laugh, sneeze, or cough or from lifting, jumping, or running. Other people leak in response to a sudden, uncontrollable urge to urinate or a “bossy bladder.” As pelvic floor therapists, we treat and approach these kinds of incontinence differently. 

Treating overactive bladder and urinary urge incontinence is one of my favorite things because it typically involves more than just muscles but also involves your habits, routines, and understanding the signals your body is sending you. When you have overactivity in your bladder, understanding your body and your brain’s connection can be a huge first step to starting to address your symptoms. 

Why does your bladder decide to start sending urine when you are not sitting on the toilet? How can you retrain your bladder so that this signaling only happens in the right context? The answers to these questions are usually different based on each individual and what initially caused the overactivity in the first place. 

For some people, they have a job that only allows them breaks to urinate at certain times and so they are no longer listening to their body’s urges, but rather peeing on a schedule. This can be confusing for your bladder, even after your schedule changes. Other people may get in the habit of urinating “just in case” when they are leaving the house or near a bathroom which can teach the bladder to send a signal or try to empty before it is actually full. 

Given that the causes of overactivity and urge incontinence can be different, the treatment strategies are also unique. Most patients can start with some of the following recommendations. One thing that I typically recommend is eliminating as much of the “just in case” peeing as possible. This is typically easy to do and can help the bladder send less premature signals to empty. Finding an urge reduction strategy that works to change or reduce the urge can begin to improve the health of the bladder and the accuracy of signaling. Ideally, you only get a strong urge to urinate when your bladder is actually full and finding out ways to retrain your bladder to relearn this optimal signaling strategy can be a really rewarding process.