Bladder leaks – common, and far more treatable than assumed
Leaking when you cough or not making it to the toilet are different problems with different treatments. Neither is an inevitable part of ageing or childbirth.
Two different problems
- Stress incontinence — leaking when you cough, sneeze, laugh, lift or exercise. The pelvic floor is not holding against sudden pressure. Common after childbirth and around menopause.
- Urge incontinence — a sudden desperate need with little warning, sometimes leaking before you reach the toilet, often with frequent daytime and night-time trips. The bladder muscle is contracting when it should not.
- Many women have both, and the treatments differ, so it is worth working out which dominates.
This is enormously common and enormously under-reported — most women wait years, and many never mention it at all. It is not a normal consequence of having children or of getting older, and it responds well to treatment.
Pelvic floor exercises, done properly
Pelvic floor training is first-line treatment for stress incontinence and helps urge symptoms too. It works — but only when done correctly and consistently, and most people do it wrong.
- Identify the right muscles: the ones you would use to stop yourself passing wind, or to stop the flow of urine. Do not use stopping the flow as a regular exercise, only as a one-off check.
- Do not tighten your buttocks, thighs or stomach, and keep breathing.
- Do both kinds: quick squeezes, and longer holds building up to about ten seconds.
- Several sets a day, every day. Improvement takes about three months, not a fortnight.
- Brace before you cough, sneeze or lift — a habit that helps immediately while strength builds.
- Ask for referral to a pelvic floor physiotherapist if you are unsure you are doing it right. This is the single biggest determinant of whether it works.
Other things that help
- Do not cut fluids drastically — concentrated urine irritates the bladder and makes urgency worse. Aim for normal intake, less in the evening.
- Reduce caffeine and fizzy drinks, both bladder irritants.
- Treat constipation, which puts constant pressure on the pelvic floor.
- Lose weight if you are carrying extra — it has a measurable effect on stress incontinence.
- Stop smoking; chronic coughing undoes pelvic floor work.
- Bladder training for urgency — gradually extending the time between visits, with guidance.
- Vaginal oestrogen after menopause improves urgency, frequency and recurrent infections, and is under-used.
Where exercises and habits are not enough:
Solifenacin — Vesicare
Overactive bladder; urinary urgency and frequency; urge incontinence
Mirabegron — Betmiga
Overactive bladder; urge urinary incontinence
Estrogen (Topical/Vaginal) — Ovestin, Vagifem
Vaginal atrophy; urogenital symptoms of menopause; recurrent UTI prevention
When to see someone promptly
Common questions
- Is this just what happens after having children?
- It is common after childbirth, but common is not the same as normal or untreatable. Most women improve substantially with proper pelvic floor training, and there are further options if that is not enough.
- Should I use pads and leave it?
- Pads manage the symptom and do nothing about the cause, and many women stay on them for decades. They are fine as a stopgap while treatment works, not as the treatment.
- Do pelvic floor exercises really work?
- Yes, with good evidence — when done correctly and consistently for at least three months. Technique is the usual failure point, which is why a pelvic floor physiotherapist makes such a difference.
Sources
- Primary Healthcare Standard Treatment Guidelines and Essential Medicines ListNational Department of Health, South Africa
- Clinical and public health guidanceWorld Health Organization
Last reviewed 4 August 2026.