SymptomKidneys & urinary tract
Leaking Urine (Urinary Incontinence): Why It Happens and What to Do
Urinary incontinence is any involuntary leaking of urine. If you leak when you cough, sneeze, laugh or exercise, the usual cause is weak pelvic floor muscles. If you get a sudden urge and cannot reach the toilet in time, an overactive bladder, infection or caffeine is more likely. Constant dribbling may mean the bladder is not emptying. New leaking with back pain, leg weakness or numbness in the saddle area is an emergency.
Also called: Bladder leakage, leaking urine, loss of bladder control, involuntary urination, wetting yourself
At a glance
- What it is
- Any accidental leakage of urine, from a few drops to a full bladder.
- Main patterns
- Leaking with effort (stress), leaking with a sudden urge (urge), both (mixed), or constant dribbling (overflow).
- Temporary causes
- Urinary tract infection, constipation, caffeine and alcohol, medicines and reduced mobility.
- How common
- Very common, especially in women after childbirth and menopause, and in men after prostate surgery.
- First steps
- Pelvic floor exercises, cutting back caffeine, treating constipation, and seeing a doctor; most people improve.
When to get help
Call 911 or go to the ER
- New leaking of urine or loss of bowel control with back pain, leg weakness or numbness around the genitals, buttocks or inner thighs (possible cauda equina syndrome)
- Sudden incontinence with weakness on one side of the body, slurred speech or confusion
- Being unable to pass urine with a painful, swollen lower belly, while dribbling small amounts
See a doctor within a day or two
- New incontinence with burning, fever, back or side pain, or cloudy, smelly urine
- Sudden incontinence and confusion in an older adult
- Leaking with blood in the urine
- New constant dribbling, or a feeling that the bladder never empties
Book a routine appointment
- Leaking with coughing, sneezing, laughing or exercise
- Rushing to the toilet and sometimes not making it
- Waking more than twice a night to pass urine
- A bulge or dragging feeling in the vagina
- Dribbling after urinating, or a weak stream in men
Usually safe to manage at home
- Occasional small leaks with a heavy cough or sneeze, while you start pelvic floor exercises
What leaking urine can mean
The pattern of leaking is the most useful clue to the cause. For the full guide to types, tests and treatments, see the urinary incontinence condition page.
| What happens | Type | Usual cause |
|---|---|---|
| Leaks when you cough, sneeze, laugh, lift or jump | Stress incontinence | Weak pelvic floor or urethral sphincter |
| A sudden, strong urge, then leaking before you reach the toilet | Urge incontinence | Overactive bladder muscle |
| Both of the above | Mixed incontinence | Both |
| Constant dribbling, weak stream, never feeling empty | Overflow incontinence | Bladder not emptying (blockage or weak bladder) |
| Leaking because you cannot get to the toilet in time due to mobility or memory | Functional incontinence | Arthritis, dementia, disability |
| Dribbling just after you finish urinating | Post-micturition dribble | Urine pooling in the urethra (common in men) |
Temporary causes
Some causes of incontinence are short-lived and reversible. Doctors check for these first:
- Urinary tract infection: sudden urgency, burning, frequency and leaking.
- Constipation: a full bowel presses on the bladder.
- Caffeine, alcohol and fizzy drinks: irritate the bladder and increase urine production.
- Medicines: diuretics (water pills), sedatives, some blood pressure drugs, and antihistamines or decongestants that cause retention.
- High blood sugar: in uncontrolled diabetes, large volumes of urine overwhelm the bladder.
- Delirium, reduced mobility or a recent illness in older adults.
- Pregnancy: the growing baby presses on the bladder.
Long-term causes
In women
- Pregnancy and childbirth: stretch and weaken the pelvic floor, especially after vaginal and assisted deliveries.
- Menopause: lower estrogen thins the tissues of the urethra and vagina.
- Pelvic organ prolapse: the bladder or uterus drops, causing leaking or difficulty emptying.
- Obesity: extra pressure on the pelvic floor.
- Hysterectomy and other pelvic surgery.
In men
- Enlarged prostate: causes urgency, frequency and sometimes overflow leaking.
- Prostate surgery or radiotherapy: stress incontinence is common after prostate cancer surgery, improving over months in most men.
At any age
- Overactive bladder: urgency, frequency and urge leaking.
- Nerve conditions: stroke, multiple sclerosis, Parkinson's disease, spinal cord injury and diabetes.
- Chronic cough from smoking or lung disease.
How to tell if it is serious
Most incontinence is not dangerous, but it can be a sign of something that needs urgent care:
- with back pain and saddle numbness, compression of the spinal nerves
- with a stroke or sudden confusion
- with a painful, distended bladder that is not emptying
- with fever and side pain, a kidney infection
- with blood in the urine, possible bladder or kidney disease
What you can do now
- Start pelvic floor exercises (Kegels): squeeze the muscles you would use to stop passing urine or gas, hold for up to 10 seconds, relax for 10 seconds, and repeat 10 times, 3 times a day. Do not practice by stopping your urine stream.
- Keep drinking normally. Cutting fluids makes urine more concentrated and irritating. Aim for about 6 to 8 cups a day unless your doctor advises otherwise, and reduce drinks in the 2 hours before bed.
- Cut back on caffeine, alcohol and fizzy drinks.
- Treat constipation with fiber and fluids.
- Keep a bladder diary for 3 days: what you drink, when you urinate, and when you leak. Bring it to your appointment.
- Use proper incontinence pads, which absorb urine better than period pads, and protect the skin.
How doctors assess it
A doctor will ask about the pattern of leaking, your fluid intake, childbirth history, medicines, and other symptoms. They may examine your abdomen, pelvis or prostate, test a urine sample for infection and blood, and measure how much urine is left after you go with a bladder scan. Most people can start treatment without complicated tests.
Frequently asked questions
Why am I suddenly leaking urine?
Sudden leaking is often caused by a urinary tract infection, constipation, a new medicine or increased caffeine or alcohol. In older adults, illness or confusion can trigger it. With back pain, leg weakness or numbness, or stroke symptoms, it is an emergency.
Is leaking urine when coughing normal?
It is common, especially after childbirth and menopause, but it is not something you have to live with. It is stress incontinence, caused by weak pelvic floor muscles, and pelvic floor training improves or cures it for most people within 3 months.
When should I worry about urinary incontinence?
See a doctor urgently for leaking with fever, side pain, blood in the urine, or a bladder that is not emptying. Call 911 for incontinence with back pain and saddle numbness, leg weakness, or signs of a stroke. Any ongoing leaking deserves a routine appointment.
Can urinary incontinence be cured?
Often, yes. Pelvic floor training, bladder training and lifestyle changes cure or greatly improve many cases. Medicines, devices and surgery help when these are not enough. Treatment depends on the type of incontinence and its cause.
Sources
This guide was written from current patient and clinical guidance, including:
- National Institute of Diabetes and Digestive and Kidney Diseases: Bladder Control Problems in Women
- Urology Care Foundation (American Urological Association): Urinary Incontinence
- MedlinePlus: Urinary incontinence
- NHS: Urinary incontinence
- NICE: Urinary incontinence and pelvic organ prolapse in women (NG123)