Bladder Leaks (Incontinence)
Leaks when you cough, laugh or jump, or a sudden urge that won’t wait. Very common, rarely talked about, and very treatable. The first fix is free and lives in your pelvis.
Types: stress leaks happen with coughing, sneezing, laughing or exercise. Urge leaks come with a sudden, strong need to go, often with frequent and night-time trips (overactive bladder). Mixed is both. Overflow is leaking from a bladder that doesn’t empty properly, more common in men with prostate problems.
Risk factors: pregnancy and childbirth, extra weight, constipation, urine infections, chronic cough, diabetes, some medicines, mobility problems, and in men an enlarged prostate or prostate surgery.
Diagnosis: your story, an examination, a urine test and a bladder diary for a few days. Sometimes a bladder ultrasound.
The bladder ladder
Pelvic floor training is the main event for stress leaks; bladder training for urge leaks. Give them a fair go: 3 months and 6 weeks respectively.
- Step 1 · Self-careTweak drinks and bowelsCut back caffeine, fizzy drinks and alcohol, drink evenly through the day, treat constipation, and lose weight if needed.
- Works
- Recommended first; helps some people and costs nothing
- Cost
- Free
- How long
- 2–4 weeks to notice
- Watch for
- Drinking too little can make things worse, not better.
Dehydration is not a continence strategy.
- Step 2 · Self-carePelvic floor muscle trainingAt least 8 squeezes, 3 times a day, for at least 3 months. See our pelvic floor exercise plan.
- Works
- Stress leaks: about 56 in 100 cured vs 6 in 100 untreated; 74 in 100 cured or improved vs 11 in 100
- Cost
- Free
- How long
- 3 months to judge, then keep going
- Watch for
- Many people squeeze the wrong muscles at first; a check helps.
The only workout you can do in a meeting.
- Step 3 · Allied healthContinence physio or nurseChecks your technique and tailors the program. Electrical stimulation if you can’t contract the muscles. Also helps men after prostate surgery.
- Works
- Most trials tested supervised programs; a check makes sure you’re training the right muscles
- Cost
- About $90–130 a session; Medicare rebates with a GP care plan
- How long
- 3–6 visits over 3 months
- Watch for
- Ask for a physio with pelvic health training.
Like a personal trainer, for muscles no one sees.
- Step 4 · Self-careBladder training (urge leaks)Gradually stretch the time between the urge and going to the toilet. Combine with pelvic floor training for mixed leaks.
- Works
- The standard first treatment for urge leaks
- Cost
- Free
- How long
- At least 6 weeks
- Watch for
- Don’t “just in case” wee; it trains the bladder to hold less.
You’re the boss of your bladder. It just hasn’t been told yet.
- Step 5 · PrescriptionBladder medicines (urge leaks)Tablets or patches that calm an overactive bladder, such as oxybutynin or mirabegron.
- Works
- Reduce urgency for some people; reviewed at 4 weeks
- Cost
- Prescription; many under or around the $25 PBS co-payment
- How long
- Ongoing, reviewed every 6–12 months
- Watch for
- Dry mouth, constipation, blurred vision, tiredness.
Helpful backup, not a substitute for the training.
- Step 6 · SpecialistSurgery for stress leaksIf stress leaks don’t improve with training. A gynaecologist or urologist explains the options.
- Works
- Usually the next step when training hasn’t worked
- Cost
- Specialist fees vary; Medicare rebates with a GP referral
- How long
- Weeks to recover
- Watch for
- Ask about the risks and long-term results of each option.
Worth it for some, after the free fix has had its turn.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Biofeedback gadgets and apps on their ownLittle good evidence they add much, though they can motivate some people.
- Cutting right back on fluidsConcentrated urine can irritate the bladder and worsen urgency.
- Pads as the whole planPads manage leaks but don’t treat them. Useful while treatment kicks in.
What you can do
- Start our pelvic floor exercise plan today.
- Keep a 3-day bladder diary: drinks, trips and leaks.
- Treat constipation; straining weakens the pelvic floor.
- Australia: call the National Continence Helpline on 1800 33 00 66 for free advice.
See your GP if
- Leaks bother you or limit what you do
- Burning, stinging or blood in your urine (see urinary tract infection)
- Constant dribbling, or feeling you can’t empty your bladder
- Leaks started after surgery or with a new medicine
Get emergency help (call 000 (Australia) or your local emergency number. From a mobile, 112 works in most countries.) for sudden loss of bladder or bowel control with back pain, numbness between the legs or leg weakness. This can mean nerve compression.
Common questions
Is bladder leakage just part of having children or getting older?
It is common, but it is not something you have to accept. Most people improve with pelvic floor or bladder training.
Do pelvic floor exercises really work?
Yes, especially for stress leaks. In trials, about 56 in 100 women were cured with training, compared with 6 in 100 without it, and about 3 in 4 were cured or improved.
Can men get bladder leaks?
Yes, especially with an enlarged prostate or after prostate surgery. Pelvic floor training and continence physiotherapy help men too.
Should I drink less to stop leaking?
No. Drinking too little can concentrate your urine and make urgency worse. Drink evenly through the day and cut back on caffeine and fizzy drinks.
Helpful resources
- Pelvic floor exercise planPrintable step-by-step training plan. Free, from us.
- National Continence HelplineFree advice from continence nurses on 1800 33 00 66. Australia.
- NHS: Incontinence treatmentClear guide to training, medicines and other options. Free, UK.
Evidence and more information
- Cochrane: Pelvic floor muscle training for urinary incontinence in women
- NHS: Urinary incontinence, non-surgical treatment
- Healthdirect: Urinary incontinence
maladywise.com/bladder-leaks/