Bladder leakage is often a topic brushed over in a GP consult, or never even brought up. But, it’s really common - 1 in 3 women will have bladder leakage (urinary incontinence) in their life. If we look into age brackets, it’s even more common: 40% of women over 70 have urinary incontinence, and 55% of women over 80 years old. There’s a wide range of incontinence: some people only leak a little when they laugh or cough, and others are wetting through pads throughout the day.

But 2/3 women with leakage, don’t seek help from a health professional. Why? Probably because a) most people think it’s just an inevitable part of aging and b) they’re embarrassed to bring it up.

BUT, I’m here to tell you to BRING IT UP! 70% of women can become dry, or get significant improvement with pelvic floor physiotherapy. Seek help earlier rather than later. Because, left untreated it will likely get worse. And, it’s much easier to treat, earlier on in the piece, than later. AND, it can really effect your quality of life: maybe you’ve stopped exercising, worry about leaving the house if you don’t know where the toilet is, it might affect your job (have to go to the toilet during every meeting? Difficulty looking after your kids because of bladder leakage?) plus mental health and sex life changes. Don’t settle for leaks! Getting the right treatment can improve your symptoms. But to get the right treatment, we need to know which type of incontinence you have.

Lets break incontinence down: There are two main types of bladder leakage - Stress urinary incontinence, and urge urinary incontinence.

The involuntary leakage of urine with exertion such as coughing, sneezing, laughing, straining, lifting or playing sport, is called stress incontinence. When you laugh, the force of laughter pushes the bladder down, and if there’s not sufficient support around the urine tube, the urine can be pushed out.

Urgency is a sudden, overwhelming urge to pass urine. If a person is unable to get to the toilet in time, and experiences an involuntary loss of urine they have urge incontinence.

Many people have both types (called ‘mixed incontinence’). The causes of these two different types of incontinence are very different. Which means the treatments are different. So it’s important that we differentiate which type of leakage someone has. so that they get the right management strategies.

Stress incontinence is usually from a structural issue - a change to some of the tissues or anatomy inside inside the pelvis. So the management strategies focus on restoring the structures. This includes:

-    pelvic floor muscle training (prescribed by a pelvic health physio)

-    reducing the amount of load pushing down on lengthened/weak structures, such as managing constipation, changing the way you lift heavy things, treating chronic coughs, reducing BMI

-    Changing fluid intake type and timing

-    Using internal support devices, called vaginal pessaries

Urge urinary incontinence is usually a sensory issue (a change in the messages the bladder and brain are sending and receiving), so management can include:

-    Fluid intake type and timing

-    reducing bladder irritants in diet

-    urge suppression techniques

-    using electrical nerve stimulation using a TENS machine can be really effective

Most people will get a large improvement in their symptoms with these types of strategies. If you’ve tried physio, and still bothered by your bladder, there are also medications that can help (speak to your GP about vaginal oestrogen) and also some procedures and surgeries (done by either a urogynaecologist or a urologist).

Again, don’t settle for your leaks. Seek help, and get dry!