Urogynecology · Newport Beach · 2026

Urinary Incontinence Treatment
Bladder Leakage Is Treatable

Not a normal part of aging. Not something to just live with.

Urinary incontinence affects up to half of adult women — yet most never seek treatment. Whether you leak when you cough, can’t make it to the bathroom in time, or both, effective options exist. This guide covers the types of incontinence, how they’re evaluated, and the full range of treatments from pelvic floor therapy to surgery.

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◆ Short Answer

The Canonical Answer

Urinary incontinence is the involuntary loss of urine, affecting up to 50% of adult women. It is not a normal part of aging and is treatable AUA/SUFU 2017. The two most common types are stress urinary incontinence (SUI — leakage with coughing, sneezing, or physical activity) and urgency incontinence (overactive bladder — sudden urge with involuntary leakage) ACOG PB #155. First-line treatment for SUI is pelvic floor muscle training with a trained physical therapist Cochrane 2018. For urgency incontinence, bladder training and medications (antimuscarinics, beta-3 agonists) are first-line. When conservative management fails, the mid-urethral sling offers >80% long-term success for SUI Dmochowski 2017. At Broad Medical Group, Dr. Jennifer Broad provides comprehensive evaluation and individualized treatment for urinary incontinence in Newport Beach.

Medically reviewed by Dr. Jennifer Broad, MD, FACOG Board-Certified Obstetrician-Gynecologist · Newport Beach, CA

Last reviewed: April 2026 Next review: October 2026

Calm consultation room at Broad Medical Group â€

What Is Urinary Incontinence?

Urinary incontinence is the involuntary loss of urine — any leakage that occurs when you don’t intend it. It ranges from a few drops when you cough or sneeze to a sudden, overwhelming urge that sends you running for the bathroom, sometimes without making it in time.

The numbers are striking. Studies estimate that up to 50% of adult women experience some form of urinary incontinence. Despite how common it is, most women never bring it up with their doctor. Some assume it’s a normal consequence of childbirth or aging. Others feel embarrassed. Many simply don’t know that effective treatments exist.

Urinary incontinence is not a normal part of aging. It is a medical condition with identifiable causes and, in the vast majority of cases, it is treatable. The first step is an accurate diagnosis — because different types of incontinence require different treatment approaches.

Important

Incontinence is not a normal part of aging. While prevalence increases with age, bladder leakage always has a cause — and that cause is almost always treatable. If you are modifying your activities, avoiding exercise, or wearing pads “just in case,” it is time to talk to your OBGYN.

Types of Urinary Incontinence

Accurately identifying the type of incontinence is the foundation of effective treatment. Each type has a different mechanism, different triggers, and a different treatment pathway.

Type	Mechanism	Triggers / Characteristics
Stress Urinary Incontinence (SUI)	Weakened urethral support — the urethra cannot stay closed under pressure	Coughing, sneezing, laughing, jumping, lifting, running, high-impact exercise
Urgency Incontinence (OAB)	Involuntary detrusor (bladder muscle) contractions — the bladder squeezes when it shouldn’t	Sudden, intense urge to urinate; leakage before reaching the bathroom; triggers include running water, cold exposure, key-in-lock
Mixed Incontinence	Combination of both stress and urgency mechanisms	Features of both SUI and urgency — very common; treatment targets the predominant type first
Overflow Incontinence	Bladder does not empty completely — urine overflows when bladder is full	Rare in women; associated with neurological conditions, severe prolapse, or bladder obstruction

Stress urinary incontinence is the most common type in younger women and is strongly associated with pregnancy, childbirth, and activities that put pressure on the pelvic floor. Urgency incontinence (often called overactive bladder, or OAB) becomes more common with age and is characterized by a sudden, overwhelming need to urinate. Many women have mixed incontinence — a combination of both — which is actually the most common presentation in clinical practice.

Understanding which type you have is essential because the treatments differ. Pelvic floor strengthening is the cornerstone of stress incontinence treatment, while bladder training and medication are the foundation for urgency incontinence. Dr. Broad evaluates each patient individually to determine the type, severity, and most appropriate treatment plan.

Causes & Risk Factors

Urinary incontinence in women is multifactorial — meaning it usually results from a combination of factors rather than a single cause. Understanding your risk factors helps guide both treatment and prevention.

Pregnancy and Childbirth

Vaginal delivery is the strongest modifiable risk factor for stress urinary incontinence. The pelvic floor muscles, nerves, and connective tissue that support the urethra can be stretched or damaged during delivery. This is why SUI is particularly common in women who have had vaginal births — though it can also occur in women who have never been pregnant. The risk increases with multiple deliveries, prolonged labor, and large birth weight.

Menopause and Estrogen Decline

Estrogen plays a critical role in maintaining the health and elasticity of urethral and vaginal tissue. As estrogen levels decline during and after menopause, the urethral lining thins and the supporting tissues weaken. This contributes to both stress and urgency incontinence in postmenopausal women. Topical vaginal estrogen can help restore tissue integrity and is often part of the treatment plan.

Other Contributing Factors

Obesity — Excess weight increases intra-abdominal pressure on the bladder and pelvic floor. Even modest weight loss (5–10%) can significantly improve symptoms.
Chronic cough — Repeated forceful coughing (from asthma, smoking, or chronic bronchitis) stresses the pelvic floor over time.
High-impact exercise — Running, jumping, and heavy lifting can provoke or worsen stress incontinence, though exercise itself is not a cause.
Pelvic surgery history — Prior hysterectomy or pelvic surgery can alter the support structures around the bladder and urethra.
Neurological conditions — Multiple sclerosis, stroke, Parkinson’s disease, and spinal cord injuries can affect bladder control.
Chronic constipation — Repeated straining increases pelvic floor stress and can worsen incontinence symptoms.

How Incontinence Is Evaluated

Effective treatment begins with accurate diagnosis. Not all bladder leakage is the same, and the evaluation is designed to determine exactly which type of incontinence you have, how severe it is, and what is causing it.

History and Symptom Diary

The evaluation starts with a detailed conversation about your symptoms — when leakage occurs, what triggers it, how much urine you lose, how often you void, and how it affects your daily life. A bladder diary (recording fluid intake, voiding times, leakage episodes, and urgency over 2–3 days) provides objective data that helps Dr. Broad determine the type and severity.

Physical Examination

A pelvic floor assessment evaluates the strength and coordination of the pelvic floor muscles. The cough stress test — asking you to cough with a full bladder — can directly demonstrate stress incontinence. The exam also evaluates for pelvic organ prolapse, which commonly coexists with incontinence and can affect treatment decisions.

Additional Testing

Urinalysis — Rules out urinary tract infection, which can mimic or worsen urgency incontinence.
Post-void residual (PVR) — An ultrasound measurement taken after voiding to ensure the bladder is emptying completely.
Urodynamic testing — Specialized testing that measures bladder pressure, capacity, and function. Reserved for complex cases, mixed incontinence, or when initial treatment has not been effective.

Dr. Broad evaluates the type and severity of incontinence to determine the right treatment pathway. For many patients, the diagnosis can be made with a history, physical exam, and urinalysis alone — more advanced testing is reserved for cases where it will change the treatment plan.

Non-Surgical Treatment

Clinical Guideline

AUGS and AUA recommend behavioral therapies as first-line treatment for both stress and urgency incontinence. This includes pelvic floor muscle training for SUI and bladder training for urgency incontinence. Medications are second-line for urgency symptoms. Surgery is considered when conservative measures have failed or are insufficient.

Pelvic Floor Physical Therapy

Pelvic floor muscle training (PFMT) is the first-line treatment for stress urinary incontinence. A Cochrane review confirmed that supervised pelvic floor exercises are effective in reducing leakage, with many women achieving complete continence. The key word is supervised — working with a trained pelvic floor physical therapist produces significantly better results than doing Kegels on your own.

Patient Tip

Pelvic floor physical therapy is not just Kegels. A trained pelvic floor PT assesses your muscle strength, coordination, and timing, then designs a personalized program. Many women perform Kegels incorrectly — bearing down instead of lifting, or activating the wrong muscles entirely. A PT uses biofeedback and manual techniques to ensure you’re engaging the right muscles effectively. The typical course is 6–12 weeks.

Bladder Training and Timed Voiding

Bladder training is the first-line behavioral treatment for urgency incontinence. The goal is to gradually increase the interval between voids, teaching the bladder to hold more urine and reducing the frequency and intensity of urgency episodes. A typical program starts with voiding every 2 hours and gradually extends the interval over several weeks. Timed voiding establishes a regular schedule to prevent the bladder from becoming overly full.

Lifestyle Modifications

Weight loss — For overweight and obese women, losing 5–10% of body weight can reduce incontinence episodes by up to 50%. This is one of the most effective non-surgical interventions.
Dietary modifications — Caffeine, alcohol, carbonated beverages, and artificial sweeteners can irritate the bladder and worsen urgency. Reducing or eliminating these triggers often provides noticeable improvement.
Fluid management — Neither excessive fluid intake nor severe restriction is helpful. A moderate, steady intake throughout the day (typically 6–8 cups) is recommended.

Topical Vaginal Estrogen

For postmenopausal women, topical vaginal estrogen (cream, ring, or tablet) helps restore the thickness and elasticity of urethral and vaginal tissue. This can improve both stress and urgency symptoms. Topical estrogen is locally acting and does not carry the same risks as systemic hormone therapy.

Medications for Urgency Incontinence

When bladder training alone is not sufficient for urgency incontinence, medications can help calm the overactive bladder muscle:

Antimuscarinics (oxybutynin, tolterodine, solifenacin) — Block the receptors that trigger involuntary bladder contractions. Effective but can cause dry mouth, constipation, and cognitive effects (particularly in older women).
Beta-3 agonists (mirabegron, vibegron) — Relax the bladder muscle through a different mechanism. Generally better tolerated than antimuscarinics with fewer cognitive side effects. Increasingly preferred as first-line medication.

Medications are most effective when combined with bladder training rather than used alone. Dr. Broad discusses the benefits and side effects of each option to determine the best choice for your situation.

Surgical Options

Surgery is considered when conservative management has not provided sufficient improvement, or when stress incontinence is moderate to severe and significantly affecting quality of life. The goal of surgery is to restore the support mechanism of the urethra so it can stay closed during physical activity.

Mid-Urethral Sling

The mid-urethral sling is the gold standard surgical treatment for stress urinary incontinence. A narrow strip of synthetic mesh is placed under the mid-urethra through small incisions to provide a supportive hammock. When intra-abdominal pressure increases (during a cough, sneeze, or jump), the sling compresses the urethra against it, preventing leakage.

Success rate: Greater than 80% long-term cure or significant improvement
Procedure time: Typically 20–30 minutes
Recovery: Most patients return to normal activities within 1–2 weeks; avoid heavy lifting for 4–6 weeks
Approach: Retropubic (TVT) or transobturator (TOT), selected based on individual anatomy and clinical factors

Burch Colposuspension

An alternative to the sling, the Burch procedure elevates and supports the bladder neck using sutures attached to a strong ligament behind the pubic bone. This can be performed laparoscopically and is sometimes chosen when a sling is not appropriate or when other pelvic surgery is being performed at the same time. For information on minimally invasive surgical approaches, see our dedicated guide.

Periurethral Bulking Agents

Injectable bulking agents are placed around the urethra in an office procedure to improve the urethral seal. This is a less invasive option with a shorter recovery, but the results are generally less durable than the sling, and repeat injections may be needed. Bulking agents may be appropriate for women who prefer to avoid surgery or who are not candidates for a sling procedure.

When Is Surgery Considered?

Conservative treatment (pelvic floor PT, lifestyle changes) has been tried and has not provided adequate improvement
Stress incontinence is moderate to severe
Leakage is significantly affecting quality of life, exercise, work, or social activities
The patient prefers a more definitive solution

Dr. Broad discusses all options — including expected outcomes, risks, and recovery — so you can make an informed decision. Surgery is never the only option, and the decision is always collaborative.

Living with Incontinence

If you have been managing bladder leakage on your own — using pads, limiting fluids before outings, skipping exercise, or mapping every bathroom in every building you enter — you are not alone. But you also don’t have to keep doing this.

This is a medical condition, not something to “just live with.” Pads and liners are a management tool, not a solution. They manage the symptom without addressing the cause. And the longer incontinence goes untreated, the more it can affect your physical activity, mental health, sexual health, and overall quality of life.

Many women wait years before discussing bladder leakage with their doctor — often because they feel embarrassed, or because they assume it’s just part of having children or getting older. It is neither. And the earlier treatment begins, the more effective it tends to be.

A conversation with your OBGYN is the starting point. Whether the answer is pelvic floor therapy, a medication adjustment, or a surgical procedure, there is a treatment pathway for every type and severity of incontinence.

If incontinence is something you have been dealing with silently, your annual well-woman exam is an excellent opportunity to bring it up. Dr. Broad routinely asks about bladder symptoms because she knows how common and how undertreated this condition is.

Key Takeaways

Urinary incontinence affects up to 50% of adult women — it is extremely common but widely undertreated.
It is not a normal part of aging — incontinence is a medical condition with identifiable causes and effective treatments.
Accurate diagnosis of the type is essential — stress, urgency, and mixed incontinence each require different treatment approaches.
Pelvic floor physical therapy is first-line for stress incontinence — supervised training with a PT is significantly more effective than Kegels alone.
Bladder training and medications are first-line for urgency incontinence — beta-3 agonists are increasingly preferred for fewer side effects.
The mid-urethral sling is the gold standard surgery for SUI — with >80% long-term success when conservative treatment is insufficient.
Early treatment is more effective than waiting — talk to your OBGYN rather than managing symptoms on your own.

References & Clinical Sources

American Urological Association / Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: AUA/SUFU Guideline. 2019 (amended 2023).
American College of Obstetricians and Gynecologists. Practice Bulletin No. 155: Urinary Incontinence in Women. Obstetrics & Gynecology, 126(5), e66–e81. 2015. Reaffirmed 2023.
Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews. 2018;10:CD005654.
Dmochowski RR, Blaivas JM, Gormley EA, et al. Update of AUA Guideline on the Surgical Management of Female Stress Urinary Incontinence. Journal of Urology. 2017;198(4):875–883.

Related Resources

Bladder Leakage Is Treatable. Let’s Talk About It.

If incontinence is affecting your daily life, your exercise, or your confidence, effective treatment is available. Dr. Broad provides expert evaluation and a full range of treatment options — from pelvic floor therapy to surgery — in Newport Beach.

Schedule an Evaluation →

Broad Medical Group — Newport Beach, California

Medical Disclaimer: This content is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Consult Dr. Jennifer Broad or your healthcare provider for guidance specific to your situation. Current as of April 2026. If you are experiencing a medical emergency, call 911 immediately.