By Sarah Percy, Women’s Health Physiotherapist & Founder, Female Physio Co.
Urinary incontinence is defined as any involuntary loss of urine, essentially, leaking when you don’t intend to. It can occur for a number of reasons and in different situations, from leaking with a cough, sneeze, or exercise, to experiencing a sudden, intense urge to urinate that’s difficult to control.
Many women notice bladder leaks as they get older, but it’s something most don’t feel comfortable talking about. Over time, it’s become so normalised that many assume it’s just an unavoidable part of ageing. But in truth, leakage is simply a sign that the body needs a bit more support. With the right approach, these changes can be managed, improved, and in many cases, completely resolved - far more easily than most women realise.
A large 2021 study involving more than 500,000 women aged 55-106 found that approximately one in three experienced urinary incontinence1. This doesn’t mean leakage should be viewed as ‘normal’, but it does show how widespread the issue truly is. Even though it affects so many women, incontinence is rarely talked about, despite its significant impact on confidence, social connection, exercise, and intimacy.
As women get older, several physiological changes occur within the lower urinary tract and pelvic floor muscles - let’s unpack exactly what’s going on and factors putting you at risk.
Ageing is associated with reduced bladder capacity, a diminished sensation of fullness, slower detrusor (bladder) muscle contraction, decreased pelvic floor muscle resistance, and an increase in residual urine volume after voiding1.
Menopause further contributes to these changes: declining oestrogen levels and reduced collagen lead to decreased tissue elasticity, atrophic changes in the pelvic floor, and a heightened likelihood of incontinence2.
Reproductive history also plays a significant role. Urinary incontinence is more common in women who have had multiple births, particularly vaginal deliveries, which remain key risk factors3.
Obesity can worsen symptoms over time, as the increased load on the pelvic organs places added strain on the bladder and pelvic floor4.
Diabetes can contribute to urinary incontinence through several pathways. Elevated blood glucose levels increase urine production and can heighten bladder muscle activity, which over time may lead to detrusor dysfunction5.
So, what can you actually do about it?
The most important thing to understand is that urinary incontinence is treatable, and age does not limit your ability to improve or completely resolve your symptoms. Here are 10 practical tips to help reduce your incontinence that you can start straight away.
1. Strengthen your pelvic floor.
Incorporate a mix of slow, sustained holds to build endurance and quick pulses to improve coordination and your reflexive response to coughing, sneezing, or sudden movement.
2. Reduce bladder irritants.
Fluids such as caffeine, carbonated drinks, alcohol, and artificial sweeteners can heighten urgency and frequency. Reducing these can make a noticeable difference.
3. Space out your fluid intake.
Drinking large amounts of water in one sitting can overwhelm the bladder and trigger urgency. Sip fluids steadily throughout the day and aim to empty your bladder every 2-4 hours.
4. Use “The Knack.”
Before and during any activity that increases abdominal pressure (coughing, sneezing, laughing, or lifting), gently squeeze your pelvic floor. This protective reflex can significantly reduce leakage.
5. Avoid “just in case” voiding.
Going to the toilet too often can train your bladder to become more sensitive. Gradually stretch the time between voids (ideally with guidance from a Women’s Health Physiotherapist).
6. Manage constipation.
Straining places pressure on the bladder and pelvic floor. Use a footstool when emptying your bowels, stay well hydrated, and keep active throughout the day to encourage regular bowel movements.
7. Strengthen beyond the pelvic floor.
Hip, core, gluteal, and upper-back strength all support continence. Incorporating strength training or Pilates can be a highly effective addition to your routine.
8. Consider hormonal support.
For peri- and postmenopausal women, topical oestrogen (prescribed by a GP or Gynaecologist) can improve vaginal tissue health, reduce dryness, and enhance pelvic floor responsiveness.
9. Practice urge-suppression techniques.
When a sudden urge hits, pause instead of rushing to the toilet. Try 3-5 deep breaths, curl your toes, lift your heels to tense your calves, or count backwards from a large number in sevens. These distraction strategies help dampen the urgency reflex.
10. Consider vaginal pessaries.
A continence pessary can provide immediate symptom relief for many women. It doesn’t weaken or strengthen the pelvic floor, it simply offers structural support to the bladder, reducing leakage during daily activities or exercise.
The gold-standard approach is to see a Women’s Health Physiotherapist for a comprehensive pelvic floor assessment, including an internal examination if appropriate. This allows us to identify the specific factors contributing to your symptoms and develop a personalised treatment plan tailored to your body and your goals.
If you’re beginning to notice leaks, don’t ignore them. These early signs are worth paying attention to, and with a proper assessment and the right treatment plan, meaningful improvement is not only possible but highly likely. You deserve comfort, control, and the confidence to move through life without hesitation.