Urinary incontinence is the accidental loss of urine. It can mean a few drops when you cough or run, a sudden urge that does not leave time to reach the bathroom, or steady leakage after prostate surgery. It is common in both women and men, it is not simply a normal part of aging, and in most cases it can be improved significantly.
The single most important step is working out which kind of incontinence you have, because the treatments are different and a treatment aimed at the wrong type will disappoint. Stress incontinence is leakage with physical effort. Urge incontinence is leakage that follows a sudden, strong need to urinate, usually from an overactive bladder. Many people, especially women, have both, which is called mixed incontinence. When both are present, we treat the overactive bladder first, because calming the urge component often changes how much the stress component still matters.
Who it affects and why it happens
Stress incontinence happens when an action such as coughing, sneezing, laughing, lifting or exercise puts pressure on the bladder and the muscles and tissues that support the urethra cannot hold it closed. In women the common background is pregnancy and childbirth, pelvic organ prolapse and the tissue changes of menopause, as the NIDDK describes. A chronic cough from smoking, asthma or allergies adds repeated strain. In men, the most common cause is surgery or radiation for prostate cancer, which can weaken the sphincter that keeps urine in.
Urge incontinence comes from bladder muscle that contracts when it should be relaxing and filling. It can be driven by nerve problems, bladder irritation or prostate enlargement, but we also see a simpler cause every week: many "overactive bladders" are really overactive drinking habits. Large volumes of water, coffee, tea or alcohol through the day will fill any bladder quickly. For most adults, about 2 liters of total fluid a day is enough.
How we evaluate incontinence at NYMD Center
We ask you to keep a bladder diary for a few days before your visit. A phone app works well, together with any measuring cup from the kitchen. Write down what you drink, when you urinate, how much comes out, and when you leak and what you were doing at the time. This simple record often reveals more than any test and tells us immediately whether fluid intake is part of the problem.
At the visit we take a careful history: when the leakage happens and what brings it on, pregnancies and deliveries, any chronic cough, prior pelvic or prostate surgery, and the medications you take. The examination is followed by quick office tests. A uroflow measures the strength and pattern of your urine stream, a bladder scan after you void measures the post-void residual, meaning how much urine is left behind, and a urine dip checks for infection, blood or sugar.
When the picture is not clear, when treatment has not worked, or before any procedure, we recommend cystoscopy and urodynamics. Cystoscopy lets us look directly inside the urethra and bladder, and urodynamic testing measures how the bladder fills, stores and empties. Together they map exactly what is happening and give a baseline for judging treatment. Mayo Clinic likewise notes that urodynamic testing is usually recommended when surgery is being considered.
Treatment options, least invasive first
We always start with what asks the least of you in risk and recovery, and move forward only if needed.
Behavioral measures and bladder training
Adjusting fluid amounts and timing, cutting back on caffeine and alcohol, scheduled voiding and urge-suppression techniques help both urge and stress leakage and cost nothing. Weight loss and treating a chronic cough reduce pressure on the pelvic floor.
Supervised pelvic floor rehabilitation
Kegel exercises done alone at home often do not work well, mostly because many people squeeze the wrong muscles or not consistently enough. Pelvic floor rehabilitation with a trained therapist uses biofeedback, sensors that show you on a screen whether you are contracting the right muscles, and the NIDDK recognizes biofeedback as a way to learn these exercises properly. It takes weeks of commitment but carries no risk.
The Emsella chair
Emsella is a noninvasive treatment in which you sit fully clothed on a chair that uses electromagnetic energy to produce thousands of pelvic floor contractions in each session. A typical course is about six sessions of roughly 30 minutes, twice a week, with no downtime. It suits people who want to strengthen the pelvic floor without doing the exercises themselves or who struggle to isolate the muscles.
Medication, PTNS and bladder Botox for urge leakage
If urgency remains after behavioral changes, medications that relax the bladder are the next step, though side effects such as dry mouth or constipation lead some people to stop them. The next options are Urgent PC, a form of percutaneous tibial nerve stimulation in which a fine needle near the ankle delivers mild impulses to the nerves that control the bladder over a series of short office sessions, and Botox injected into the bladder wall through a cystoscope. Both are described on our bladder Botox and PTNS page.
Office bulking injection
For stress incontinence, a bulking agent can be injected into the tissue around the urethra in the office to help it close more firmly. Recovery is usually quick. The trade-off is durability, and the injection may need to be repeated.
Sling surgery
When stress leakage is significant and other measures have not been enough, a sling placed under the urethra provides lasting support. It is surgery, with a recovery period and surgical risks, and it is reserved for when it is needed.
Options for men after prostate surgery
For men with leakage after prostatectomy, a bulking agent is the least invasive option and can help milder cases. For high-volume leakage, the artificial urinary sphincter is the most reliable choice. A cuff placed around the urethra squeezes it closed at rest, and a small pump in the scrotum opens the cuff when you want to urinate, after which it closes again on its own.
What to expect at your visit
Bring your bladder diary and a list of your medications, and arrive with a comfortably full bladder so we can perform the uroflow. Most first visits include the history, an exam, the office tests and a clear explanation of which type of incontinence you have. We then agree on a first step together, often behavioral changes and pelvic floor work, with a follow-up to check progress.
When to seek care urgently
Seek prompt care if leakage comes with fever, burning or blood in the urine, if you suddenly cannot urinate at all, or if new incontinence appears together with back pain, leg weakness or numbness in the groin, which can signal a nerve problem that needs emergency evaluation.
Questions patients ask
What is the difference between stress and urge incontinence?
Stress incontinence is leakage when pressure rises in the abdomen, such as with coughing, sneezing, lifting or exercise, because the urethral support is weak. Urge incontinence is leakage after a sudden, strong need to urinate, usually from an overactive bladder. Many people have both. Treatments differ, so identifying the type is the first step, and in mixed cases we treat the urge component first.
Do Kegel exercises really work?
They can, but done alone at home they often do not work well, because many people contract the wrong muscles or do not keep them up. Supervised pelvic floor rehabilitation with biofeedback shows you on a screen whether you are using the right muscles, which makes the exercises far more effective. The Emsella chair is an alternative for people who struggle to isolate the muscles.
Should I drink less water to stop leaking?
Not drastically, but many people drink far more than they need. Large amounts of water, coffee, tea or alcohol fill the bladder quickly and can look like an overactive bladder. For most adults about 2 liters of total fluid a day is enough. A bladder diary shows us your real intake so we can adjust it safely rather than having you guess.
What are the options for leakage after prostate surgery?
Some men improve on their own over the first months, helped by pelvic floor training. When leakage persists, a bulking injection is the least invasive option and suits milder leakage. For heavier leakage, the artificial urinary sphincter is the most reliable choice: a cuff squeezes the urethra closed at rest, and a pump in the scrotum opens it when you want to urinate.
Is urodynamic testing painful?
Most people find it uncomfortable rather than painful. Thin catheters are placed in the bladder and sometimes the rectum to measure pressure while the bladder is slowly filled and then emptied. It takes under an hour, and you go back to normal activity afterward. The information it gives is especially valuable before any procedure, because it shows exactly how your bladder behaves.