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The 4 Types of Urinary Incontinence (+ How to Stop Each Kind of Leak)

pee problems pelvic floor dysfunction
 

Liz leans over the counter to help her third grader with his math – and feels wetness in her underwear. She didn’t have to go, so where did that come from!?

Juliette is having drinks with a friend. She bursts out laughing, immediately crossing her legs to try to stop the leak she knows is coming.

Brittany is out hiking when all of a sudden she has to go NOW. Her body didn’t give her much warning, but she knows she’s got to find a spot to pee and SOON.

Liz, Juliette, and Brittany are experiencing different types of urinary incontinence (aka pee leaks). Often lumped together, different types of incontinence have different causes – and often different solutions. Continue reading to identify which type of leak you have and what you can do to address it at its root.

How is my bladder supposed to work?

Your bladder works in close relationship with your kidneys. Urine is produced by your kidneys, which are located under your ribs towards your back. The urine travels through ureters (tubes) down to your bladder, which sits in the bottom of the pelvis below the uterus. (Skip to 1:18 in the video for a visual aid.) As the bladder fills with urine, it expands and lifts up and out of the pelvis. Normal bladder capacity is 16-24 ounces; for reference, the smaller Stanley water cups hold 20 ounces. As the bladder becomes full, your body signals that it’s time to pee. If everything is functioning as it should, you pee by relaxing an inner and an outer sphincter to allow urine to flow until the bladder is completely empty.

What causes bladder dysfunction?

There are many possible causes of incontinence, the most common being pregnancy. As the uterus increases in weight as the baby grows, more stress is placed on the bladder. Organs shift positions to accommodate the baby, and sometimes don’t make it back to their original place after delivery. Hormonal changes intentionally loosen muscles and ligaments to allow the baby to pass through. It’s important to note that these changes happen regardless of delivery type (vaginal or Cesarean). Various birth interventions can also impact your bladder function in different ways.

In addition to pregnancy, other factors like having a history of respiratory diseases like asthma or chronic bronchitis that involve chronic coughing, chronic constipation, doing high impact activities like cheerleading, running, or heavy lifting from a young age as well as genetic conditions such as Ehlers Danlos Syndrome or other hypermobility disorders can also contribute to pelvic floor dysfunction (an umbrella term that includes incontinence).

What is incontinence?

Urinary incontinence is lack of control over the flow of urine from the bladder, commonly referred to as pee leaks. Fecal incontinence is a similar lack of control over stool in the rectum. This article and the video above focus on urinary incontinence; if you’re struggling with fecal incontinence, you may find this video helpful.

There are 4 types of incontinence: 

  1. Stress incontinence
  2. Urge incontinence
  3. Overflow incontinence
  4. Overactive bladder

Women can experience multiple types of incontinence, with stress and urge incontinence often happening together. Better understanding which type of leak you have is often the first step towards fixing it.

 

What is stress incontinence?

The most common type of incontinence in the women we work with, these leaks are triggered when pressure increases in your abdomen. Sneezing, laughing, coughing, or jumping all stress the muscles in your abs, which then creates downward pressure towards your bladder. When your pelvic floor muscles are weakened or dormant, they’re not able to withstand this pressure – and a leak occurs. Skip to the 4:00 minute mark for a more visual explanation of what’s happening.

Another way to think about stress incontinence is to picture a toothpaste tube. When you squeeze the top, pressure builds. If the cap is off, that pressure causes toothpaste to come out. Strengthening your pelvic floor is like putting that cap back on so the toothpaste only comes out when you’re ready.

What should I do if I have stress urinary incontinence?

NOT kegels! Tighten Your Tinkler advocates for a movement-based protocol to rebuild functional strength and stop this type of leak at its source. Wearing a liner or pad might be a good short term fix, but stress incontinence won’t go away unless you address its root cause. If you’re a member of our Signature Program, be sure to complete the 10 minute Daily Warm-up five days a week. (If you’re not a member, you can learn more here.) This article explains how kegels, as well as internal devices, can cause a hypertonic (read: weak) pelvic floor and why we don't recommend them. 

What is urge incontinence?

Stress incontinence often accompanies urge incontinence. Urgency happens when you go from not needing the bathroom to needing to go NOW very quickly, sometimes resulting in leaks or accidents. This happens because of an involuntary contraction of the bladder, which is usually caused by an issue with your nervous system. The bladder has nerves that control it from both our conscious and subconscious nervous system. The conscious part (hopefully) allows you to decide when to let pee flow out. 

The subconscious part is connected to our fight or flight response (think, “I was so startled or scared I peed my pants”). Anxiety is an important component when discussing bladder health. (Minute 6:55 of the video explains this in detail.) Helping your body return to a state of ‘rest and digest’ can help with urge incontinence. We recommend using the 90/90 decompression position to do so. Signature Program members can find a detailed video and PDF tutorial inside the Recovery Tools section; if you’re not a member, we can email you this free version. Resting in this posture while doing breath work can decrease pressure on the vagus nerve and help you get out of fight or flight. We also recommend it for women experiencing back or hip discomfort – it’s a simple tool that should leave you feeling better, physically and mentally.

*Note: The 90/90 decompression position has you lay on your back with your legs up, which is contraindicated for women 20+ weeks pregnant. Save it for after delivery!

What is overflow incontinence?

Overflow incontinence can feel like random leaks or dribbles, often with no prior urge to pee and no apparent trigger. This type of incontinence (8:30 mark in the video) happens when there’s a blockage in the tube through which you pee, making it difficult to fully empty your bladder. Prolapse or other pelvic floor issues can cause this tube to get kinked or smooshed - which diagnostically is called a urethrocele.  When that happens, pee is blocked and pressure builds, much like a kinked garden hose. A change in position, such as leaning forward, can suddenly allow urine to flow – and because pressure has been building, you might not be able to stop it. 

One sign that your overflow incontinence is caused by an incomplete emptying of your bladder is frequent UTIs (urinary tract infections). Recurring or hard-to-get-rid-of UTIs can be rooted in pelvic floor dysfunction, particularly in incomplete emptying of your bladder.

Making sure you relax your pee out (never push!) - doing your best to completely empty your bladder can help with overflow leaks. A squatty potty can help; Signature Program members, be sure to watch the Potty Talk video in the Recovery Tools section for more visual recommendations.   

Don’t have a squatty potty? We like this bamboo one* that can accommodate multiple heights.

*As Amazon partners, we may earn a small commission (at no added cost to you) should you purchase using one of our links. We only recommend products we use ourselves. Thank you for supporting our small business!

What is an overactive bladder?

Overactive bladder is a catch-all term for women peeing more than 10 times/day, waking up to pee at night, and experiencing some level of urgency and/or stress incontinence. We dislike this term, in part because women are often told they “just” have an overactive bladder and these symptoms are “normal”.

Please hear us: you do NOT have to accept frequency, urgency, or leaks as part of aging/life after pregnancy. Without intervention, these issues will continue to worsen – but WITH intervention, you can improve not just these conditions but all the areas impacted by them: your sleep, mood, even relationships.

How bad are my leaks?

You might be wondering if your leaks are bad enough for you to take action. Or your issues may have gotten so bad you’re wondering if it’s too late to fix. Our diagnostic assessment can help you get a feeling for “how bad” your issues are; many of the women who complete it (it takes <5 mins) say it also helped them connect the dots between problems they didn’t know were related. Your results show immediately after you hit submit, with further information shared via email.