About Incontinence

Understanding the Different Types of Incontinence

Urinary incontinence affects many adults, yet it often goes unmentioned despite how common it is. Bladder leakage can occur at various stages of life, during pregnancy, after childbirth, throughout menopause or simply as part of the ageing process. Understanding the type of incontinence you’re experiencing is a crucial first step in seeking targeted treatment. This awareness not only supports better symptom management but also helps rebuild confidence in your pelvic health.

By Sarah Percy, Women’s Health Physiotherapist & Founder, Female Physio Co.

Urinary incontinence typically falls into three categories: stress, urge or mixed incontinence. While some symptoms can overlap, each type has distinct characteristics and underlying mechanisms. We unpack the different forms of incontinence and provide simple, effective treatment options and continence solutions to support you as you work toward better bladder control.

Stress Urinary Incontinence

Stress incontinence occurs when urine leaks during moments of increased intra-abdominal pressure, typically brought on by a physical “stressor” such as coughing, sneezing, laughing, lifting or exercising1. Under normal circumstances, the pelvic floor muscles contract reflexively to support the bladder and maintain closure around the urethra. When these muscles are not functioning optimally, the pressure generated during these activities can exceed the available support, resulting in leakage.

Stress incontinence may also arise from reduced connective tissue support or structural changes following vaginal birth, chronic straining, hormonal fluctuations or pelvic surgery2.

A Women’s Health Physiotherapist can assess the underlying factors contributing to stress incontinence and develop a tailored treatment plan based on your anatomy, pelvic floor function and symptoms. Management often includes pelvic floor muscle training to improve strength, coordination and timing, supporting the urethra during increases in abdominal pressure.

For some women, the use of a continence pessary can also be highly effective. A vaginal pessary provides mechanical support to the urethra and bladder neck, helping to reduce leakage during activity. This device is fitted by a trained clinician (Women’s Health Physiotherapist, Gynaecologist or General Practitioner) and can be a valuable option for those wanting additional support during exercise or everyday tasks.

Together, these approaches aim to restore pelvic floor function, improve symptom control and enhance quality of life.

Urge Urinary Incontinence

Urge incontinence presents quite differently from stress incontinence and is characterised by a sudden, intense need to urinate that may be followed by leakage before reaching the bathroom1. The urgency often feels out of proportion to how full the bladder actually is. Many people also notice consistent triggers such as hearing running water, arriving home and putting a key in the door, seeing a toilet, or exposure to cold temperatures.

This type of incontinence occurs when the bladder muscle, known as the detrusor, contracts prematurely and sends signals to urinate even when the bladder is not full - a phenomenon referred to as detrusor overactivity. Urinary frequency, both during the day and night, can further contribute to this pattern of urgency.

Several lifestyle and behavioural factors may also worsen symptoms, type of fluid consumptions and habitual “just in case” voiding (more on this below).

Management typically focuses on retraining the bladder through behavioural strategies such as urge-distraction techniques, bladder drills to gradually increase the time between voids, optimising fluid intake patterns and improving pelvic floor coordination, which may include both strengthening and down-training depending on the presentation.

There is also strong evidence supporting trans-tibial nerve stimulation as an effective intervention for urge incontinence. This non-invasive technique can significantly reduce urgency and frequency, but it should only be performed under the guidance of a qualified Women’s Health Physiotherapist to ensure correct application and safety3.

Mixed Urinary Incontinence

Mixed incontinence includes features of both stress and urge incontinence. Someone may leak with physical effort but also experience unpredictable urges at other times. This presentation is particularly common in postpartum and menopausal women. Because both mechanisms are involved, treatment often requires a combination of pelvic floor rehabilitation, bladder training, urge-suppression techniques and lifestyle or bowel management strategies. A Women’s Health Physiotherapist can determine the driving factor of your symptoms and prioritise this during the early stages of treatment.

 

References

  1. Haylen, B. T., et al. (2010). An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourology and Urodynamics, 29(1), 4–20.
  2. Haylen, B. T., et al. (2024). Stress urinary incontinence. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK539769/
  3. Nandy, S., & Ranganathan, S. (2022). Urge incontinence. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK563172/