What Causes Urinary Incontinence in Women? Types, Symptoms and Treatment

Urinary incontinence in women is far more common than most people realise, and far less often discussed. Leaking when you laugh, rushing to the toilet and not quite making it, or avoiding the gym in case of an accident can quietly shape daily life, work and relationships. Many women assume it is an inevitable part of having children or getting older. It is common, but it is a medical problem with clear causes, and most women improve with the right treatment.

This guide explains the causes of urinary incontinence in women, the difference between stress and urge incontinence, why incontinence after childbirth and pelvic organ prolapse after birth are so closely linked, and the symptoms of a pelvic floor disorder. It then sets out the first-line treatment recommended by NICE, and where non-surgical options such as IncontiLase laser treatment fit, with an honest look at the evidence. If dryness and soreness after menopause are part of the picture, our guide to vaginal atrophy treatment covers that side, and our guide to vaginal rejuvenation after pregnancy looks at other changes after birth. The NHS guide to urinary incontinence ↗ is also a useful starting point.

What Causes Urinary Incontinence in Women?

Bladder control depends on three things working together: a healthy bladder muscle that relaxes while it fills, a urethra that stays closed under pressure, and pelvic floor muscles and connective tissue that support the bladder neck from below. Incontinence happens when one or more of these is weakened or irritated.

The most common causes of urinary incontinence in women are:

• Pregnancy and vaginal birth, which stretch and sometimes damage the pelvic floor muscles, connective tissue and nerves.
• Menopause, when falling oestrogen thins the tissues lining the urethra and vagina.
• Ageing, which reduces muscle strength and bladder capacity.
• Excess weight, which increases pressure on the bladder and pelvic floor.
• Chronic coughing or constipation, which repeatedly strain the pelvic floor.
• Pelvic organ prolapse, where the bladder or other organs drop and change how the bladder fills and empties.
• Repeated high-impact exercise, such as running and jumping.
• Urinary tract infections, which irritate the bladder and can cause sudden urgency.
• Some medicines, caffeine and alcohol, which increase urine production or irritate the bladder.
• Neurological conditions such as stroke, multiple sclerosis and Parkinson’s disease, which affect the nerve signals controlling the bladder.

The cause usually determines the type of incontinence, and the type determines the treatment.

Types of Urinary Incontinence: Stress, Urge and Mixed

Stress incontinence

Stress incontinence is leaking when pressure inside the abdomen rises: coughing, sneezing, laughing, lifting, running or jumping. Here “stress” means physical pressure, not emotional stress. It happens when the pelvic floor and the tissues supporting the urethra are too weak to keep it closed under that pressure. Stress incontinence is the type most closely linked to childbirth, and the most common type in younger women.

Urge incontinence

Urge incontinence is a sudden, intense need to pass urine, followed by leaking before you reach the toilet. It is usually caused by an overactive bladder, where the bladder muscle contracts before it is full. Women with urge incontinence often also go to the toilet frequently during the day and get up at night to pass urine. Bladder irritants such as caffeine, infections and some neurological conditions can make it worse.

Mixed incontinence

Mixed incontinence is a combination of stress and urge symptoms, and it is common, particularly in midlife and after menopause. Treatment usually starts with whichever symptom bothers you most.

Overflow and other types

Overflow incontinence is constant dribbling from a bladder that does not empty properly, sometimes caused by a blockage, a significant prolapse or nerve damage. Functional incontinence happens when mobility or memory problems make it hard to reach the toilet in time. Both need medical assessment.

Incontinence After Childbirth

Leaking after having a baby is extremely common. A 2010 systematic review of population studies in Acta Obstetricia et Gynecologica Scandinavica ↗ found that 33% of women had some urinary incontinence in the first three months after giving birth. Weekly leaking affected about 12% and daily leaking about 3%. Incontinence was roughly twice as common after vaginal delivery (31%) as after caesarean section (15%)^[1].

During pregnancy, the growing uterus presses on the bladder, and hormonal changes soften the pelvic tissues. During a vaginal birth, the baby’s head stretches the pelvic floor muscles far beyond their resting length, and the nerves supplying them can be stretched or compressed. Forceps or ventouse delivery, a long second stage of labour and a large baby increase the strain.

The effects can last. A 2018 cohort study of 1,528 women in JAMA ↗ followed mothers for up to two decades after their first delivery. Fifteen years after a spontaneous vaginal birth, 34% had developed stress urinary incontinence, 22% overactive bladder and 30% pelvic organ prolapse. Caesarean delivery was associated with about half the risk of stress incontinence, while forceps or ventouse delivery was associated with a higher risk of prolapse and anal incontinence^[2].

None of this means caesarean birth is “better”. It carries its own risks, and most women who give birth vaginally do not develop long-term problems. It does mean that pelvic floor symptoms after birth are expected rather than unusual, and worth treating early.

Does incontinence after birth go away?

For many women it improves over the first few months as tissues heal, and pelvic floor exercises speed this up. If you are still leaking three months after birth, or leaking is getting worse, ask your GP or health visitor for a referral to a women’s health physiotherapist. Starting pelvic floor muscle training during pregnancy and continuing after birth reduces the chance of ongoing problems.

Pelvic Organ Prolapse After Birth

Pelvic organ prolapse happens when the supports of the vaginal walls weaken and one or more pelvic organs drop down into the vagina. It is closely linked to childbirth and often occurs alongside incontinence. The NHS guide to pelvic organ prolapse ↗ describes the main types:

• Anterior wall prolapse (cystocele): the bladder bulges into the front wall of the vagina. This is the most common type and often causes urinary symptoms.
• Posterior wall prolapse (rectocele): the rectum bulges into the back wall, which can make it hard to empty the bowel.
• Uterine prolapse: the womb drops down into the vagina.
• Vault prolapse: the top of the vagina drops after a hysterectomy.

Vaginal birth is the strongest risk factor. A Swedish national study of more than 5,000 women who had given birth only once found that 20 years later, 14.6% of those who delivered vaginally had symptomatic prolapse compared with 6.3% after caesarean. Higher body weight and a heavier baby also increased the risk^[3].

Symptoms of prolapse

Mild prolapse often causes no symptoms. When it does, women describe:

• a feeling of heaviness, dragging or fullness in the vagina, often worse at the end of the day
• a bulge or lump at or beyond the vaginal opening
• a sense of “something coming down”
• needing to pass urine often, a slow stream or feeling the bladder has not emptied
• difficulty opening the bowels, sometimes needing to press on the vagina to do so
• discomfort or reduced sensation during sex

A prolapse is not usually dangerous, but it should be examined. Pelvic floor exercises, a vaginal pessary or surgery can all help depending on the type and severity.

Pelvic Floor Disorder Symptoms

“Pelvic floor disorder” is an umbrella term for problems caused when the pelvic floor muscles and connective tissue are too weak, too tight or poorly coordinated. The pelvic floor runs like a hammock from the pubic bone at the front to the tailbone at the back and supports the bladder, womb and bowel. Symptoms can affect several systems at once:

• Bladder: leaking with effort, urgency, frequency, getting up at night, a weak stream or difficulty emptying.
• Bowel: difficulty emptying, straining, or leaking wind, liquid or stool.
• Vagina: a bulge, heaviness or dragging; a feeling of looseness; vaginal wind.
• Sex: pain, reduced sensation or leaking during intercourse.
• Pain: aching in the pelvis, lower back or perineum.

Not every pelvic floor problem is weakness. Some women have an overactive or tight pelvic floor, which can cause pain during sex, difficulty emptying and urgency. Strengthening exercises can make this type worse, which is why assessment by a specialist physiotherapist matters. Symptoms such as looseness or vaginal wind after childbirth are discussed in our guides to loose vagina facts and myths and vaginal wind.

Faecal incontinence

Accidental leakage of wind, liquid or stool is less talked about than bladder leakage but affects many women after childbirth, particularly after a tear involving the anal sphincter or an assisted delivery. It is very treatable, often with specialist physiotherapy, and should always be reported to your GP.

Menopause, Ageing and Other Causes

Oestrogen helps keep the lining of the urethra and bladder neck thick and well supplied with blood. After menopause, these tissues thin, which can weaken the seal around the urethra and make the bladder more irritable. Many women notice urgency, frequency, recurrent urine infections and dryness together. This combination is called the genitourinary syndrome of menopause, and vaginal oestrogen often helps the bladder symptoms as well as dryness. Our guide to treatment options for vaginal atrophy explains the options.

Other causes are worth ruling out. Urine infections can cause sudden urgency and leaking. Constipation presses on the bladder. Diuretics, some blood pressure medicines and sedatives can all affect bladder control, and drinking a lot of caffeine, fizzy drinks or alcohol irritates the bladder. Diabetes can increase urine production. These are usually simple to identify and treat.

When Should You See a GP About Bladder Leakage?

Any bladder leakage that bothers you is reason enough to see your GP. Book an appointment promptly if you have:

• blood in your urine
• pain or burning when passing urine, or repeated urine infections
• a sudden change in bladder control without an obvious cause
• difficulty passing urine or a feeling the bladder never empties
• a bulge in the vagina
• new numbness, weakness or bowel problems alongside bladder symptoms

Your GP will ask about your symptoms, examine you, check a urine sample and may ask you to keep a bladder diary for three days, recording what you drink, when you pass urine and when you leak.

Urinary Incontinence Treatment: What NICE Recommends First

The NICE guideline on urinary incontinence and pelvic organ prolapse in women ↗ sets out a stepped approach, starting with the simplest and best-proven treatments.

Lifestyle changes

Losing weight if your BMI is over 30, cutting down on caffeine, drinking a normal amount of fluid rather than restricting it, stopping smoking and treating constipation all reduce leaking.

Pelvic floor muscle training for stress incontinence

NICE recommends a trial of supervised pelvic floor muscle training for at least three months as the first treatment for stress or mixed incontinence. This is not just squeezing occasionally: a physiotherapist checks you are contracting the right muscles and builds up the strength and endurance of each contraction over time. A 2018 Cochrane review of 31 trials ↗ found that women with stress incontinence who did pelvic floor muscle training were around eight times more likely to report cure than women who had no treatment (56% compared with 6%), and around three quarters reported cure or improvement^[4].

Bladder training for urge incontinence

For urge or mixed incontinence, NICE recommends bladder training for at least six weeks. You gradually lengthen the time between toilet visits, using urge-suppression techniques, so the bladder learns to hold more. If this is not enough, there are medicines that calm an overactive bladder, and specialist options beyond that.

Surgery for stress incontinence

If stress incontinence remains troublesome after pelvic floor training, a urogynaecologist may discuss surgical options such as colposuspension, a sling made from your own tissue, or urethral bulking injections. Each has different benefits and risks, and UK practice on mesh tapes has changed considerably in recent years, so a full specialist discussion is essential.

Where Does IncontiLase Laser Fit?

IncontiLase is a non-surgical treatment for stress urinary incontinence using a Fotona erbium (Er:YAG) laser. The laser gently heats the front wall of the vagina beneath the urethra without cutting the surface, with the aim of tightening and thickening the supporting tissue through new collagen formation. It needs no anaesthetic and no recovery time, and a course is usually two sessions about a month apart.

The evidence is genuinely mixed:

• A 2023 multicentre trial of 110 women found treatment success in 59% after laser compared with 36% after a sham treatment at six months^[5].
• A 2025 sham-controlled trial of 79 women with mild to moderate stress incontinence, run across UK, Swiss and German centres, found 62.7% met the definition of cure after laser compared with 18.2% after sham^[6].
• A 2024 double-blind trial of 144 women in Canada found laser was no more effective than sham at curing or improving stress incontinence at six months^[7].
• A 2025 trial of 75 women in Hong Kong found symptoms improved after laser, but the improvement was not significantly different from sham^[8].

Long-term results are not known. The NICE guidance on transvaginal laser therapy for stress urinary incontinence ↗ says the evidence on long-term safety and efficacy is inadequate and that the procedure should only be used in the context of research.

In practice, that means IncontiLase may suit a woman with mild to moderate stress incontinence who has already tried supervised pelvic floor training, does not want or is not ready for surgery, and understands that results vary and may not last. It is not a treatment for urge incontinence or overactive bladder, and it does not replace pelvic floor training. Our article on whether laser therapy is safe for vaginal laxity and stress incontinence covers safety in more detail, and our vaginal laser treatment page explains the related treatments.

Bladder Leakage Assessment at Centre for Surgery

At Centre for Surgery, women with bladder leakage are assessed by a doctor at our CQC-regulated hospital on Baker Street in central London. We start by establishing the type of incontinence, what you have already tried and whether anything needs investigating first. If supervised pelvic floor training has not been tried, we will tell you, and if your symptoms point to urge incontinence, a prolapse needing specialist management or a problem that needs NHS investigation, we will advise you to see your GP or a urogynaecologist.

For women with mild to moderate stress incontinence who are suitable, IncontiLase is carried out in the clinic without anaesthetic, and the doctor who assesses you is the doctor who treats you. We will explain the trial evidence, including the trials that found no benefit over sham, before you decide.

Frequently Asked Questions

Incontinence Treatment in London

If bladder leakage is affecting your life, start with your GP and a pelvic floor physiotherapist. If you have tried pelvic floor training and would like to discuss non-surgical options for stress incontinence, we can assess you and explain whether IncontiLase is likely to help.

Phone: 020 7993 4849 | Address: 95–97 Baker Street, Marylebone, London W1U 6RN
Contact us to schedule a consultation

References

1. Thom DH, Rortveit G. Prevalence of postpartum urinary incontinence: a systematic review. Acta Obstetricia et Gynecologica Scandinavica 2010;89(12):1511–1522. doi:10.3109/00016349.2010.526188
2. Blomquist JL, Muñoz A, Carroll M, Handa VL. Association of delivery mode with pelvic floor disorders after childbirth. JAMA 2018;320(23):2438–2447. doi:10.1001/jama.2018.18315
3. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG: An International Journal of Obstetrics and Gynaecology 2012;120(2):152–160. doi:10.1111/1471-0528.12020
4. 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(10):CD005654. doi:10.1002/14651858.CD005654.pub4
5. O’Reilly BA, Viereck V, Phillips C, et al. Vaginal erbium laser treatment for stress urinary incontinence: a multicenter randomized sham-controlled clinical trial. International Journal of Gynaecology and Obstetrics 2023;164(3):1184–1194. doi:10.1002/ijgo.15222
6. Phillips C, Shah G, Gamper M, Kuszka A, Chandrakumaran K, Viereck V. Vaginal erbium laser for the treatment of mild-to-moderate stress urinary incontinence: a multicentre randomised sham-controlled trial. BJOG: An International Journal of Obstetrics and Gynaecology 2025;133(4):609–617. doi:10.1111/1471-0528.70080
7. Lee P, Perruzza D, Edell H, et al. Double-blind randomized controlled trial of Er:YAG vaginal laser to treat female stress urinary incontinence. American Journal of Obstetrics and Gynecology 2024;232(6):541.e1–541.e12. doi:10.1016/j.ajog.2024.11.021
8. Yim LW, Wan OYK, Wong D, et al. Vaginal laser treatment on stress urinary incontinence: a randomized controlled trial. International Urogynecology Journal 2025;36(11):2217–2227. doi:10.1007/s00192-025-06160-8