The Different Types of Urinary Incontinence: What’s Causing Your Leaking?

Sep 12

Urinary leakage may be common, but it is definitely not normal, and it is not something you simply have to live with!

Many people assume that leaking urine automatically means they have a “weak pelvic floor” and that the answer is simply to do more Kegels. But urinary incontinence is much more complex than that. There are several different types of urinary incontinence, and each can have different contributing factors and require a different treatment approach.

Kegels are not a one-size-fits-all solution to urinary leakage, despite what you may hear online or even from your healthcare providers. That doesn't mean Kegels are the enemy—it just means they might not be the right fit for you! The key is figuring out why you're leaking before deciding what treatment you need.

What Is Urinary Incontinence?

Urinary incontinence is the involuntary leakage of urine. It may happen when you:

Cough or sneeze
Laugh
Exercise or jump
Lift something heavy
Have a strong, sudden urge to urinate
Can't make it to the bathroom in time
Wake up multiple times at night to urinate
Experience difficulty fully emptying your bladder

While urinary leakage is common, it is not something you simply have to accept. A pelvic floor physical therapist can help identify the type of incontinence you are experiencing and help you get back to a life with more confidence and fewer leaks!

1. Stress Urinary Incontinence

Stress urinary incontinence occurs when urine leaks because pressure inside your abdomen increases and your bladder and pelvic floor are unable to adequately manage that pressure.

Despite its name, stress incontinence is not caused by emotional stress. Instead, “stress” refers to physical stress or pressure placed on your bladder and pelvic floor.

You may leak with:

Coughing
Sneezing
Laughing
Jumping
Running
Lifting
Squatting
Exercising
Getting up from the floor
Changing positions

Stress urinary incontinence may occur when the pelvic floor muscles are:

Too weak to generate enough force
Unable to contract quickly enough
Poorly coordinated with the diaphragm and abdominal muscles
Unable to respond effectively to changes in pressure
Overly tight or fatigued and therefore unable to function optimally

Your pelvic floor needs to be not only strong enough, but also able to relax, lengthen, and coordinate with the rest of your body.

Think about a trampoline. If the trampoline were completely frozen and unable to move with you, jumping on it would create a very different experience. Your pelvic floor is similar. It needs to be able to respond and adapt to the pressure created by a cough, sneeze, jump, or lift.

If your pelvic floor is too tight, it may not be able to lengthen and adjust appropriately to changes in pressure.

If your pelvic floor is too weak, it may not have the strength to contract and provide the support needed to help prevent leakage.

Your pelvic floor needs to be able to do both: contract when you need support and relax when you need movement.

2. Urgency Urinary Incontinence

Urge urinary incontinence occurs when you experience a sudden, difficult-to-control urge to urinate followed by involuntary urine leakage.

You might feel like the urge to pee comes on so quickly that you can't control it. You may leak before reaching the bathroom, while unlocking your front door, or when you hear running water.

Common triggers include:

Hearing or touching running water
Arriving home
Seeing the bathroom
Drinking certain beverages
Sudden changes in activity
Anxiety or heightened stress

The bladder and nervous system work together to determine when it is appropriate to empty. When this communication becomes overly sensitive or reactive, the bladder may begin signaling urgency before it is actually full.

This doesn't necessarily mean your bladder is “weak.” In some cases, the pelvic floor muscles may actually be overactive or unable to fully relax, which can contribute to urgency and frequency.

3. Mixed Urinary Incontinence

Some people experience both stress urinary incontinence and urgency urinary incontinence. This is called mixed urinary incontinence.

For example, you may leak when you sneeze or exercise and experience sudden urgency that sometimes results in leakage. When treating mixed incontinence, it is important to look at the bigger picture rather than focusing exclusively on pelvic floor strengthening.

4. Overflow Urinary Incontinence

Overflow incontinence occurs when the bladder does not empty completely, leading to urine leakage when the bladder becomes overly full. This can happen for a variety of reasons, including bladder outlet obstruction, certain medications, neurological conditions, impaired bladder muscle function, or problems with the coordination of the pelvic floor and bladder.

Think about your bladder like a water balloon. As it becomes increasingly full, the pressure inside the balloon increases. If the bladder becomes overly full and cannot empty properly, small amounts of urine may begin to leak out.

Instead of getting a strong urge to urinate, you may experience:

Frequent small amounts of leakage
A weak urine stream
Difficulty starting urination
A sensation that you cannot fully empty your bladder
Dribbling after urination
Frequent urination
A constantly full bladder sensation

Because incomplete bladder emptying can sometimes lead to complications such as UTIs, it is important to have this type of leakage evaluated by a medical provider.

A pelvic floor PT may also be able to help if pelvic floor muscle tension or coordination is contributing to difficulty emptying.

5. Functional Urinary Incontinence

Functional incontinence occurs when a person has adequate bladder control but is unable to reach the bathroom in time because of another physical, cognitive, or environmental factor.

For example, someone may leak because:

They have difficulty walking quickly
They use a wheelchair or assistive device
The bathroom is difficult to access
They have difficulty removing clothing quickly
Cognitive changes affect their ability to recognize or respond to bladder signals

In these cases, treatment may involve addressing mobility, environmental barriers, bathroom accessibility, or other underlying factors.

6. Continuous or Insensible Urinary Leakage

Some people experience urine leakage without being aware of exactly when it happens.

You may notice:

Damp underwear throughout the day
Leakage without a strong urge
Leakage that doesn't seem connected to coughing, sneezing, or activity
Persistent dampness that is difficult to explain

There are many possible causes of continuous or insensible leakage, and the pattern should be evaluated carefully by a healthcare provider.

In some situations, additional medical testing may be needed to determine the source of the leakage.

Your Pelvic Floor Is Only One Piece of the Puzzle

When it comes to urinary incontinence, it's easy to assume the pelvic floor is the only thing that matters. But your bladder function is influenced by your entire body.

A pelvic floor PT may assess:

Pelvic floor muscle strength
Pelvic floor muscle tone
Your ability to relax and lengthen the pelvic floor
Breathing mechanics
Abdominal pressure management
Hip and pelvic strength
Mobility
Coordination and timing
Movement patterns
Bladder habits
Bowel function and constipation
Exercise and activity demands

When Should You Seek Help?

You don't have to wait until urinary leakage is significantly impacting your life to seek help.

Consider talking with a healthcare provider or pelvic floor physical therapist if:

You regularly leak urine
You avoid exercise because of leakage
You plan your day around bathroom access
You frequently experience urinary urgency
You wake up multiple times each night to urinate
You feel like you can't fully empty your bladder
You experience pelvic pain alongside bladder symptoms
You are experiencing new or worsening bladder changes

At SóL Pelvic Wellness Studio, we look beyond the symptom to understand why you're leaking and how your bladder, pelvic floor, breathing, core, and whole-body movement patterns may be contributing.

You deserve to feel confident in your body, whether you're running, lifting, jumping, chasing your kids, or simply making it through your day without constantly worrying about where the nearest bathroom is.

Ready to figure out what's really causing your leakage? A pelvic floor physical therapy evaluation can help you understand your symptoms and create an individualized plan to get you back to doing the things you love.

Kellyn Snow