Urinary Incontinence: Causes & Treatment
"Just Part of Having Babies"? Urinary Incontinence Is Never Something You Just Have to Live With
If you've ever laughed a little too hard, sneezed at the wrong moment, or felt a sudden, undeniable urge to go the second your key hit the front door lock ‚and leaked ‚ you are far from alone. And no, it is not "just part of having kids," it's not "just getting older," and it's not something you have to white-knuckle through for the rest of your life. Incontinence has a root cause, and it can be treated.
In our office, we see this every single day. We see 14-year-old athletes who notice a small dribble during jumping jacks. We see pregnant women whose growing bellies put new pressure on their pelvic floor. We see postpartum moms navigating weakness and poor coordination in muscles that just went through an enormous physical event. We see perimenopausal women whose changing estrogen levels are altering the strength and integrity of their pelvic floor muscles. And we see women in every one of these groups who've quietly rearranged their lives around it ‚skipping the girls' trip, avoiding the trampoline park with their kids, only ever wearing black pants "just in case."
It's Not Just an "Old Lady" or "New Mom" Problem
One of the biggest misconceptions we hear is that leaking is only tied to pregnancy, childbirth, or aging. In reality, we treat teenagers, athletes, women who've never been pregnant, and men‚ because the pelvic floor is a muscle group, and like any muscle group, it can become weak, overly tight, or poorly coordinated for all kinds of reasons.
Two Different Problems: Stress vs. Urge Incontinence
Stress incontinence happens when something increases pressure on the system faster than the pelvic floor can respond, think coughing, sneezing, laughing, jumping, lifting. Your pelvic floor, abdominals, and breath all work together as a pressure management system. When that system can't coordinate quickly enough or appropriately to counteract a sudden spike in pressure, leakage happens.
Stress on the bladder can also come from what's inside it. If you're not drinking enough water, or if the ratio of bladder irritants, i.e. coffee, tea, soda, to water is too high, the urine becomes more concentrated. That concentrated urine irritates the bladder lining itself, which can increase urgency and leakage.
Urge incontinence is the "key in the door" phenomenon. You pull into the driveway, or put your key in the lock, and suddenly your brain sends an unstoppable signal that you have to go right now. This can also happen with the sound of running water or the moment you get out of bed. It's a learned brain-bladder pattern, tied to habitual cues, rather than your bladder actually being full.
The Kegel Myth
So many patients come to us frustrated. They've done their kegels faithfully. Maybe they've tried medication. Maybe they've tried the Emsella chair. And yet, they are still leaking.
Here's why: when we perform an internal assessment, we very often find that the pelvic floor isn't weak at all, it's actually too tight. A pelvic floor that is already gripped and overactive doesn't have anywhere to go when it needs to contract further to hold back urine, and it often can't fully relax either, which is just as important. Add in patients who are unconsciously bracing their abdominals or clenching their glutes and inner thighs to "help”, and you end up with more downward pressure on the bladder, the opposite of what the body needs.
Attempting kegels on a pelvic floor that's already overworked and tight is a bit like telling someone who's already clenching their fist to squeeze harder. There isn’t any more contraction to be had and It won't solve the underlying coordination problem, and it can even make things worse.
The Habits That Make It Worse (Even Though They Feel Like Solutions)
When you're leaking, your instinct is to control the variables. We understand that completely. But two of the most common coping strategies we see actually reinforce the problem:
- Drinking less water, hoping less liquid means less risk. This just concentrates the urine, irritates the bladder, and can worsen urgency.
- "Just-in-case" peeing every 30-60 minutes to keep the bladder from ever getting too full. This retrains your brain to send urgency signals way too early, even when there's only a small amount of urine present. Over time, this actually creates more urge incontinence, not less.
A healthy bladder should comfortably hold urine for roughly two hours between trips to the bathroom. If you're going every 30 minutes, your brain and bladder have essentially formed a new, unhelpful habit loop. Good news though, that loop can be retrained and so can the bladder.
Don't Forget About Constipation
Bladder and bowel health are deeply connected. Constipation increases pressure throughout the entire pelvic cavity, which makes it harder for the pelvic floor to coordinate properly and control the bladder. If you're dealing with both incontinence and constipation, treating one without the other is unlikely to get you all the way to relief.
The Words We Hear Every Day
If any of these sound familiar, you are in good company:
- "This is just part of having babies, you just get used to it."
- "I feel like I can't do everything with my kids the way I want to because I'm afraid of wetting my pants."
- "I don't go out with my girlfriends anymore because I'm scared I'll leak while I'm out."
We also hear about the quiet embarrassment ‚ worrying someone can smell urine, only wearing black pants to the gym or out in public "just in case," planning entire outings around where the nearest bathroom is. This isn't just a physical issue. It affects confidence, social life, parenting, and independence. In fact, incontinence is one of the leading reasons older adults lose the ability to live independently and need to move into a care facility.
What Actually Helps
Real, lasting improvement starts with a proper pelvic floor assessment. Not guesswork, not generic kegel handouts, and not a one-size-fits-all device. A specialist can determine:
- Whether your pelvic floor is weak, overly tight, or poorly coordinated (or some combination)
- Whether your abdominals, glutes, or adductors are compensating in ways that add pressure rather than relieve it
- Whether your bladder habits, fluid intake, bathroom frequency, or irritants, are working for you or against you
- Whether constipation or bowel habits are part of the picture
From there, treatment is tailored to you to help with retraining the pelvic floor to both contract and relax appropriately, coordinating breath and pressure management, adjusting fluid and bathroom habits, and gradually increasing the time between bathroom trips.
Getting Your Life Back
You shouldn't have to skip the trampoline park, avoid the girls' trip, or plan every outing around bathroom locations. Incontinence is common, but it is not something you have to simply manage forever. With the right assessment and the right treatment plan, patients get back to playing with their kids without hesitation, going out with friends without fear, and maybe most importantly, get their mental space back, no longer spending energy scanning every new place for the nearest bathroom.
If this sounds like you, or like someone you love, know that help exists, and it starts with understanding why this is happening, not just trying to power through it.
Schedule an evaluation with us today if you are local to the Des Moines, Iowa area.
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