Understanding Urinary Incontinence

Picture a crowded restaurant filled with women of all different ages and backgrounds. About half have some kind of urinary issue (though incontinence can affect anyone, regardless of age or gender). That’s a lot of people.

Urinary incontinence means an involuntary loss of urine — and it can range from mildly annoying to seriously disruptive. But did you know that it’s often related to issues with your pelvic floor?

The pelvic floor is a group of muscles that stretches like a hammock between your coccyx (tailbone) and your pubic bone, serving as the base of your core. It supports structures like the bladder and bowel, as well as the uterus and vagina.

Dysfunction with pelvic floor muscles can directly affect your bladder and urethra, playing a role in stress incontinence (urine leakage from pressure during activities like laughing, coughing, or exercise) and urge incontinence (a sudden “I-gotta-go-right-now” urge to urinate).

If there’s one thing to remember about incontinence, it’s this: Just because it’s common doesn’t mean it’s normal. There are many things you can do, starting with lifestyle changes and physical therapy, to prevent and treat incontinence. The first step is understanding which type of incontinence you have.

Stress Incontinence

This is when leaking occurs during dynamic activities like jumping, running, sneezing, coughing, laughing, or lifting heavy objects. It can be due to a weakened pelvic floor, but the exact causes vary from person to person. Regardless of why it occurs, here are some ways to improve your symptoms:

  • Engage in healthy toilet habits. Avoid straining while going to the bathroom and bearing down if constipated, which puts pressure on your pelvic floor. (Ask your Hinge Health coach or physical therapist for our Good Bladder Habits and Constipation Management resources.)

  • Be consistent with your core, hip, and pelvic floor strengthening exercises (“Kegels”), if recommended by your provider. This is important. Kegel exercises are not the cure-all for every incontinence problem and they can actually make some conditions worse.

  • Engage your pelvic floor muscles when coughing or sneezing to reduce leaking. You can work with your Hinge Health physical therapist for guidance on this.

Urge Incontinence

This is when leaking occurs because of a sudden urge to go to the bathroom, often without warning and regardless of how full your bladder is (or isn’t). This can be due to:

  • Overactive bladder

  • Tight pelvic floor muscles

  • Bladder irritants in your diet

  • Dehydration (this makes urine more concentrated and irritating to the bladder)

  • Stress

  • Bladder or urinary tract infection (UTI)

  • Toileting techniques (i.e., “just-in-case” peeing when you don’t really have to go)

Urgency episodes can really disrupt your life. But there are ways to take control and manage this condition. When you feel a strong urge to urinate, follow these steps:

  • Stop where you are and stand quietly or sit down.

  • Perform five quick Kegels or hold a Kegel for five seconds.

  • Think of something else for a distraction and then calmly walk to the bathroom. You could also take a few deep belly breaths to help to relax your bladder.

  • Avoid hovering over the toilet when emptying your bladder. Rather, sit and make sure to relax. This will help your bladder to fully empty.

Deep belly breathing is another very effective practice to calm your central nervous system and decrease feelings of urgency.

Mixed Incontinence

This is what it sounds like: a mix of stress and urge incontinence. Because of the stigma associated with leakage, many people start to change their behaviors (say, peeing “just in case” before running because they’re worried about leaking), which actually causes both stress and urge incontinence.

Beyond the Pelvic Floor Muscles

Other musculoskeletal issues also affect incontinence. Your pelvic floor muscles are located at the bottom of the pelvis and work closely with the hip, core, and low back muscles. If any of those areas are not doing their job to provide stability, the pelvic floor muscles compensate, which can cause tension and tightness. Some people may benefit from doing exercises to strengthen their core, back, or hips. This may allow the pelvic floor muscles to relax and help relieve incontinence.

The Importance of a Holistic Approach

Leaking urine may seem at first like a simple problem, but it’s actually complex. Some approaches, like doing Kegels to strengthen the pelvic floor, can backfire if pelvic floor tension is the main problem, rather than weakness. This is why an evaluation with your pelvic floor physical therapist is key. They will ask about your lifestyle, routines, and other musculoskeletal symptoms to develop a treatment plan that addresses your specific issues.

For additional support and guidance on a treatment plan for incontinence, talk to your health coach or physical therapist.

Key Takeaways

  1. Urinary incontinence means there is an involuntary loss of urine. It can be due to issues with your pelvic floor muscles.

  2. There are two main types of urinary incontinence: stress incontinence refers to leaking pee during dynamic activities and urge incontinence is a sudden and urgent need to pee, regardless of how full the bladder is.

  3. Although urine leakage is common, it’s not normal and it can be treated with physical therapy and lifestyle changes.


  1. Markland, A. D., Richter, H. E., Fwu, C. W., Eggers, P., & Kusek, J. W. (2011). Prevalence and trends of urinary incontinence in adults in the United States, 2001 to 2008. The Journal of urology, 186(2), 589–593. doi:10.1016/j.juro.2011.03.114

  2. Mayo Clinic. (2019). Urinary incontinence - Symptoms and causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/urinary-incontinence/symptoms-causes/syc-20352808

  3. Bladder Irritants. (n.d.). https://www.hopkinsmedicine.org/johns_hopkins_bayview/_docs/medical_services/gynecology_obstetrics/bladder_irritants.pdf

  4. Integrated care for older people (ICOPE) Guidelines on community-level interventions to manage declines in intrinsic capacity. (n.d.). https://www.who.int/ageing/health-systems/icope/evidence-centre/ICOPE-evidence-profile-urinary-incont.pdf