You laugh. You sneeze. You cough. You go for a run. And suddenly, there it is: that little leak.
For many women, this becomes something they simply learn to manage. Crossing your legs before you sneeze, avoiding certain exercises, wearing a pad just in case or making sure you know where the nearest toilet is.
Stress urinary incontinence is incredibly common in women, particularly after pregnancy and childbirth and during or after menopause. But common doesn’t mean you simply have to put up with it.
For some women, it’s an occasional inconvenience. For others, it starts influencing what they wear, whether they exercise, how relaxed they feel during sex or even whether they’re confident enough to leave the house without knowing exactly where the nearest toilet is.
So why does stress incontinence happen, and more importantly, what can you actually do about it?
Stress urinary incontinence, often shortened to SUI, is the involuntary leakage of urine when pressure inside the abdomen increases.
That’s why you may notice leaking when you:
Unlike urge incontinence, where you experience a sudden and difficult-to-control need to urinate, stress incontinence tends to happen in response to physical pressure or movement.
It can occur at any age, but pregnancy, childbirth and menopause can all contribute to changes in the pelvic floor and the tissues supporting the bladder and urethra.
Pregnancy places significant pressure on the pelvic floor before you’ve even reached labour.
During vaginal childbirth, the muscles, connective tissues, and nerves that support the pelvic organs can be stretched or injured. This can affect how effectively the pelvic floor supports the bladder and helps keep the urethra closed when abdominal pressure suddenly increases.
You don’t necessarily need to have experienced a difficult birth to develop symptoms, either. Pregnancy itself can affect pelvic floor function.
Some women notice leaking almost immediately after having a baby. Others may only notice it later, particularly when they return to running, exercise, or other higher-impact activities.
And yes, pelvic floor rehabilitation absolutely deserves a place in this conversation.
This is something I think we need to talk about far more.
Menopause doesn’t only affect your periods, mood, sleep or skin. Falling oestrogen levels can also affect the vulva, vagina, urethra, bladder and surrounding tissues.
The tissues can become thinner, drier and less elastic, while changes to pelvic floor strength and support may make existing bladder symptoms more noticeable.
You might therefore reach your 40s, 50s or beyond and suddenly find that something you’d barely noticed before is becoming harder to ignore.
These urinary and genital changes can form part of genitourinary syndrome of menopause (GSM), a collection of symptoms associated with declining oestrogen levels affecting the vulva, vagina and lower urinary tract.
Symptoms can include vaginal dryness, irritation, discomfort during sex, urinary urgency and recurrent urinary symptoms alongside changes in bladder control.
It’s one reason I’m so passionate about women understanding their intimate health as they age. We’ve been taught plenty about periods and pregnancy, yet far fewer women have been told what may happen to their vulval, vaginal and urinary health during menopause.
It’s common, but that doesn’t mean it should automatically be accepted as an inevitable part of being a woman.
This is an important difference.
If you’re experiencing urinary leakage, the first step should be understanding why it’s happening.
Stress incontinence isn’t the only cause of bladder leakage. Urge incontinence, overactive bladder, urinary tract infections, pelvic organ prolapse and other conditions can cause urinary symptoms too.
A proper assessment helps establish what’s happening before deciding which treatment, if any, is appropriate.
Treatment depends on the severity of your symptoms, their underlying cause and factors including childbirth history, menopause and your wider pelvic health.
For many women, there isn’t one magic treatment. A combination of approaches may give the best outcome.
Pelvic floor muscle training is generally one of the first treatments recommended for stress urinary incontinence.
Your pelvic floor is a group of muscles that supports the bladder, bowel, uterus and other pelvic structures. Strengthening these muscles can improve support around the bladder and urethra and help reduce leakage.
The important bit? Doing a few squeezes whenever you remember probably isn’t the same as proper pelvic floor rehabilitation.
Technique matters.
A specialist pelvic health physiotherapist can assess how your pelvic floor is functioning and create an appropriate programme for you. Interestingly, not every pelvic floor needs simply to be made ‘stronger’. Coordination, relaxation and how the muscles respond to pressure can all be important.
Depending on your symptoms, relatively simple changes may also help.
These can include looking at caffeine and alcohol intake, managing constipation, maintaining a healthy weight where appropriate and adapting high-impact exercise while pelvic floor function is being addressed.
This doesn’t mean giving up the things you enjoy forever. It means looking at the factors that could be increasing pressure on an already compromised pelvic floor.
For women whose urinary symptoms occur alongside menopause-related vulval or vaginal changes, it may be appropriate to discuss menopause management with a suitably qualified healthcare professional.
Local vaginal oestrogen can be used to treat symptoms of genitourinary syndrome of menopause, including vaginal dryness and some urinary symptoms.
It won’t be the right treatment for every case of stress incontinence, which is why identifying what’s contributing to your symptoms matters.
This is where newer non-surgical options may form part of a wider treatment plan for appropriately selected women.
At House of Glo, radiofrequency treatment uses controlled energy to gently heat the tissues within the intimate area. The aim is to stimulate collagen production and support tissue quality, firmness and elasticity.
For some women, intimate radiofrequency treatment may be considered where changes to vaginal tissue and support are contributing to their concerns.
Treatment suitability should always be assessed individually. Bladder leakage can have several causes, and an energy-based treatment shouldn’t replace appropriate medical assessment or pelvic floor rehabilitation where those are needed.
If conservative approaches haven’t improved stress incontinence sufficiently, specialist services may offer additional treatments.
Depending on the individual, these may include procedures designed to support the urethra or improve continence.
An appropriate healthcare professional should assess persistent, severe, or worsening symptoms and discuss the options available, including whether referral to a urogynaecologist, urologist, or other specialist is needed.
I’d be wary of anyone promising a universal ‘cure’.
Stress incontinence can be influenced by several factors, from pelvic floor function and childbirth-related changes to tissue changes associated with menopause. Treatment needs to reflect what’s actually causing the symptoms.
Radiofrequency treatment may be an option for some women as part of an individualised intimate health plan, but it isn’t automatically the answer for every woman experiencing bladder leakage.
Sometimes the best recommendation is pelvic health physiotherapy. Sometimes menopause support needs to be considered. Sometimes further investigation is warranted. And sometimes several approaches may work together.
That’s why assessment comes first.
Please speak to a healthcare professional if urinary leakage is new, persistent, worsening or affecting your quality of life.
You should also seek medical advice if you experience symptoms such as blood in your urine, pain when urinating, recurrent urinary infections, difficulty emptying your bladder, significant pelvic pain or a sensation of pressure, bulging or heaviness within the vagina.
Those symptoms deserve proper investigation rather than simply being attributed to ageing, childbirth or menopause.
One of the biggest problems with stress incontinence is that women often feel embarrassed to mention it.
So they adapt.
They stop jumping in the gym. They wear a pad ‘just in case’. They cross their legs before they sneeze. They know which pair of leggings absolutely cannot be trusted on a run.
Eventually, these little adjustments become normal.
But women deserve to understand what’s happening to their bodies after childbirth, during perimenopause, through menopause and beyond. That includes the pelvic floor, bladder, vagina and vulva.
At House of Glo, we approach intimate health conversations exactly as they should be: openly, sensitively, and without embarrassment.
If bladder leakage is affecting your confidence or day-to-day life, book an intimate health consultation at House of Glo. We can discuss your symptoms, explore what may be contributing to them, and talk you through the options that may be appropriate for you.
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