Female incontinence: treatment, causes and options
Incontinence in women is more common than many people think. Involuntary urination can occur after pregnancy and childbirth, during menopause or as a result of a weakened pelvic floor, overactive bladder or changes in tissue and nerve function.
The good news is that incontinence is treatable. This guide will give you an overview of types, causes and treatment options – from pelvic floor exercises and bladder training to clinical treatment with Pelvic Chair, shockwave and EMTT.
- Attentive treatment in a safe clinic
- Evidence-based, personalized courses
- Long-term results & lasting improvement
Facts about incontinence in women:
- Types: Stress incontinence, urge incontinence and mixed incontinence are among the most common types.
- Diagnostics: Assessment of pelvic floor function, symptom patterns and possibly an ultrasound scan.
- Treatment: Pelvic floor training, Pelvic Chair, focused shockwave and EMTT Magnetolith.
- Effect: 79% of clients experience improvement within 4-8 weeks with the clinic’s protocol.
- Who does it affect? Women of all ages, including after pregnancy and childbirth, during menopause or after strain, trauma or pelvic floor weakness.
International speaker & expert in shockwave and EMTT treatment for incontinence.
Female incontinence is not something you just have to live with
Many women experience incontinence at some point in their lives. Yet it’s a condition many keep to themselves because it can feel embarrassing, a practical inconvenience or something you just have to accept after childbirth or with age.
You don’t have to. Female incontinence is a well-documented condition with several treatment options. For some, pelvic floor exercises are enough. For others, it requires a more targeted approach that combines muscle, connective tissue, blood flow and nerve function.
At MS Insight in Copenhagen S, I work with an individual approach to incontinence treatment, where the goal is to find the solution that suits your type of incontinence, your symptoms and your everyday life.
What is female incontinence?
Incontinence means that you involuntarily leak urine. It can be a few drops when you cough, sneeze, laugh, run or lift. It can also be a sudden and strong urge to urinate that you can’t hold back.
For some women, the discomfort is mild and only occurs occasionally. For others, incontinence affects exercise, work, sex life, social activities and the feeling of freedom in everyday life.
Incontinence can be mild, moderate or severe, but what all degrees have in common is that there are treatment options. The most important thing is to find out what type of incontinence you have and what triggers it.
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Typical symptoms of incontinence in women
Incontinence can manifest itself in several ways. Some women only experience a few drops during physical activity, while others experience a sudden and strong urge that is hard to hold back.
- Urine leakage when coughing, sneezing, laughing, running, jumping or heavy lifting
- Sudden and strong urge to urinate
- Frequent toilet visits, also at night
- After-drip or feeling of not being able to keep your mouth shut
- Need to plan everyday life around the nearest toilet
- Concern about odor, stains or leakage during sex and intimacy
- Sensation of heaviness or pressure in the abdomen
Symptoms can fluctuate from day to day and are often affected by sleep, stress, hormones, fluid intake, caffeine and physical strain. Therefore, it makes sense to look for patterns before choosing a treatment.
Three types of incontinence in women
Stress incontinence
Stress incontinence manifests itself as urine leakage during physical activity or a sudden increase in pressure in the abdominal cavity. It can happen when coughing, sneezing, laughing, running, jumping, heavy lifting or playing sports.
The cause is often a weakened pelvic floor or a closure mechanism around the urethra that cannot withstand the pressure. Stress incontinence can occur after pregnancy and childbirth, after tissue changes during menopause or with prolonged strain on the pelvic floor.
Urgency incontinence
Urgency incontinence is also called urge incontinence. Here you experience a sudden and strong urge to urinate that can be difficult or impossible to hold back.
This type of incontinence is often associated with an overactive bladder, where the bladder contracts even though it is not full. The incidence increases with age and can become more pronounced after menopause.
Mixed incontinence
Mixed incontinence is a combination of stress incontinence and urgency incontinence. This means that you can both leak when physically stressed and experience a sudden urge to urinate.
Treatment must therefore address both: pelvic floor strength and function, and bladder overactivity and signaling.
Rarer forms of incontinence
Some women experience other forms of incontinence. Overflow incontinence can occur if the bladder is not emptying properly. Functional incontinence can occur if pain, reduced mobility or other health conditions make it difficult to reach the toilet in time.
It can be difficult to distinguish between the types yourself. A simple rule of thumb is that leakage when straining often indicates stress incontinence, while leakage on the way to the toilet with a sudden urge often indicates urgency incontinence.
Causes and risk factors of incontinence in women
Incontinence in women is rarely caused by one single thing. It’s often a combination of a weakened pelvic floor, altered connective tissue, impaired nerve-muscle control, hormonal changes and strain over time.
Pregnancy and childbirth
Pregnancy and childbirth are among the most common causes of stress incontinence. During pregnancy, the pelvic floor carries an increased weight for many months, and during vaginal birth, muscles and connective tissue are stretched significantly.
Even a caesarean section can affect the pelvic floor because pregnancy itself puts strain on the muscles, connective tissue and support function in the abdomen.
Menopause
During menopause, estrogen levels drop. This can affect mucous membranes, connective tissue, the urethra and pelvic floor, causing the tissue to lose some of its elasticity and strength.
That’s why some women find that incontinence occurs or worsens in their 40s, 50s or 60s, even if they haven’t had problems before.
Pelvic floor and the pudendal nerve
The pelvic floor supports the bladder, uterus and bowel. The pudendal nerve supplies parts of the pelvic floor and affects both closure function and sensation. If the pelvic floor is weakened, overactive or poorly coordinated, it can cause leakage, pain and problems in sexual life.
The key is coordination: the pelvic floor must be able to tense at the right moment and release completely. In some cases, an overactive pelvic floor can cause symptoms similar to weakness because the muscles are not working flexibly and precisely.
Overweight
Being overweight increases pressure on the bladder, pelvic floor and pelvic organs. This can exacerbate both stress and urgency incontinence because the pelvic floor has to constantly withstand greater pressure.
Age and inactivity
The pelvic floor muscles, like other muscles, can weaken with age, especially if they are not actively exercised. At the same time, nerve function, tissue quality and muscle control can change over time.
Other factors
- Urinary tract infections
- Neurological diseases such as Parkinson’s disease or multiple sclerosis
- Smoking and chronic cough
- Heavy lifting over long periods of time
- Constipation and repeated pressure when using the toilet
- Abdominal surgery or injuries in the genital area
- High-impact sports without adequate pelvic floor support
Incontinence, sex and intimacy
Incontinence can affect sex life, self-esteem and desire for intimacy. Many women become concerned about leakage, odor or discomfort during intimacy, and this can lead to avoidance, even if the desire is still there.
Leaking during sex is not dangerous, but it can feel vulnerable. Practical steps like emptying your bladder before sex, using a towel, choosing a slow pace and talking openly about your concerns can take some of the pressure off.
If you experience dryness, burning or pain, especially after menopause, local estrogen therapy and lubricants may be relevant. For pelvic floor pain or tension, the focus should not only be more pelvic floor exercises, but also relaxation and proper assessment.
What can you do for incontinence yourself?
There are several things you can do yourself if you experience incontinence. However, the effect depends on the type of incontinence, the severity of your symptoms and whether you can activate your pelvic floor correctly.
Pelvic floor training and pelvic floor exercises
Pelvic floor exercises are one of the best proven forms of self-treatment for stress incontinence. The exercises strengthen the muscles that support the bladder, urethra and pelvic organs.
A good starting point is:
- 3 sets of 10-12 pinches daily
- Hold each pinch for 6-8 seconds
- Let go completely after every pinch
- Train consistently for at least 3-4 months
- Focus on correct technique rather than hard or many pinches
It’s important that you squeeze upwards and inwards in the pelvic floor. If you instead tighten your buttocks, thighs or stomach, you’re not working the right muscles.
Remember the relaxation too. An overactive or overly tense pelvic floor can cause pain, discomfort during intercourse and increased tension in the lower abdomen. Therefore, the ability to fully release is just as important as the squeeze itself.
You can read more in the guide on pelvic floor exercises for women.
Bladder training
Bladder training can be especially relevant for urgency incontinence. Here, you work with fixed urination intervals and gradually lengthening the time between toilet visits.
The goal is to retrain the bladder capacity and reduce the sudden urge. For many, you start by urinating at set intervals and gradually increase the time so the bladder learns to last longer.
Bladder diary
A bladder diary can provide a clear picture of what triggers your incontinence. It can also make it easier to assess whether your symptoms are primarily due to stress incontinence, urgency incontinence or a mixture.
Note for 3-7 days:
- How much you drink and when you drink
- How often you go to the toilet
- When you experience leakage
- Whether leakage occurs during exercise, e.g. coughing, sneezing, lifting or sports
- Whether leakage happens by sudden urge
- Whether coffee, alcohol, carbonation or certain habits make symptoms worse
Many people find that certain patterns recur. It could be ‘just in case’ trips to the toilet, too much caffeine, constipation, stress or certain movements that trigger leakage.
Lifestyle changes
Small changes in everyday life can make a noticeable difference, especially if incontinence is exacerbated by pressure, irritation or bladder overactivity.
- Drink evenly throughout the day, typically around 1.5-2 liters of fluid daily
- Reduce coffee, alcohol and carbonated drinks if they make cravings worse
- Work on weight loss if excess weight strains the pelvic floor
- Avoid constipation as pressure increases strain on the pelvic floor
- Consider quitting smoking if chronic cough worsens leakage
Two concrete techniques you can use in everyday life
Pinch before loading
For stress incontinence, you can use a short pre-activation squat just before coughing, sneezing, lifting, standing up or jumping. The goal is to activate the pelvic floor before the pressure hits the urethra.
The urge brake for sudden urge to urinate
For urgency incontinence, try stopping, breathing calmly into your abdomen, doing a few short and gentle squeezes and shifting your focus until the urge subsides. Only then walk calmly towards the toilet.
Both techniques require practice, but they can provide more control in everyday life, especially when combined with pelvic floor and bladder training.
When are knee exercises not enough?
For many women, regular pelvic floor exercises bring noticeable improvement. But there are also situations where self-training is not enough.
It may be relevant to seek professional assessment if:
- You’ve been doing knee exercises daily for 3 months with no clear progress
- You are unsure if you are activating the right muscles
- You can’t feel the pelvic floor clearly
- Incontinence occurred or worsened after a complicated birth
- You experience worsening after menopause
- You have stress incontinence that affects exercise, work or everyday activities
- You have mixed incontinence where both leakage and sudden urges are present
When pelvic floor exercises don’t work, it doesn’t mean you’ve done something wrong. It could be weakened muscles, impaired nerve-muscle connection, connective tissue changes or that the pelvic floor is not being activated effectively enough with voluntary exercise.
This is where clinical care can be relevant.
MS Insight combination combination treatment: Pelvic Chair, shockwave and EMTT
At MS Insight, I treat female incontinence with a combination of Pelvic Chair HIFEM, shockwave and EMTT. The treatment is customized and chosen based on your symptoms, your type of incontinence and your history.
It’s not just Pelvic Chair with something extra on the side. It’s a comprehensive approach where we work on two key parts of the problem: the muscle function of the pelvic floor and the quality of the surrounding tissue.
Pelvic Chair HIFEM: neuromuscular rehabilitation
Pelvic Chair uses HIFEM technology, which stands for high-intensity focused electromagnetic stimulation. The technology activates the pelvic floor muscles through electromagnetic pulses and triggers powerful muscle contractions.
The treatment may be relevant if you have difficulty activating the pelvic floor yourself, if the muscles are significantly weakened, or if you haven’t gotten enough out of pelvic floor exercises alone.
During the treatment, you sit fully clothed in the chair. The treatment is non-invasive, requires no recovery and typically lasts 30 minutes.
Shockwave and EMTT: treating tissue, blood flow and nerve function
Pelvic floor problems are not just about weak muscles. In some women, reduced blood flow, altered connective tissue, tissue irritation and reduced nerve function also play a role, especially after menopause or after prolonged symptoms.
Shockwave uses focused sound waves to stimulate tissue. EMTT, also known as Extracorporeal Magnetotransduction Therapy, uses electromagnetic pulses to affect cells and tissues in depth.
When combined with Pelvic Chair, we can work with both muscle activation and the tissue in which the muscles function. This provides a more holistic treatment than pelvic floor training alone.
Who can benefit from combination therapy for incontinence?
- Women who have been practicing pelvic floor exercises for 3 months or more without sufficient effect
- Women with stress incontinence that affects exercise, work or everyday activities
- Women with incontinence occurring or worsening after menopause
- Women who have difficulty activating the pelvic floor correctly
- Women who want an intensive, non-invasive rehabilitation program
- Women who want to avoid or postpone surgical treatment if it is medically justifiable
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More treatment options for female incontinence
Treatment of incontinence in women depends on the type, cause and severity. Some need primarily exercise. Others need medical assessment, topical hormone therapy, technology-assisted treatment or surgery.
Assistive technology and support
Assistive technology can provide reassurance while you work on the actual treatment. They don’t necessarily solve the cause of the incontinence, but they can make everyday life easier and give you peace of mind to be active.
- Absorbent pads or inserts for urine leakage
- Discreet sports inserts for physical activity
- Diaphragm or urethral support for selected forms of stress incontinence
- Skin care for irritation after moisture or frequent leakage
Aids can be a good temporary support, but if incontinence is affecting your everyday life, you should also assess what treatment can reduce the problem itself.
Local estrogen therapy
After menopause, local estrogen therapy may be relevant for some women. Treatment with Vagifem or Estring, for example, can strengthen the mucous membranes and tissues around the vagina, urethra and pelvic floor.
The effect is typically gradual over 1-3 months. Local estrogen therapy is prescribed by your doctor or gynecologist.
Medical treatment
For urgency incontinence, medication can sometimes reduce the involuntary contractions of the bladder. For example, antimuscarinic medication.
For stress urinary incontinence, duloxetine can in some cases be used to affect urethral closure. Medical treatment should always be assessed and prescribed by a doctor.
Surgery and procedures
For severe stress urinary incontinence where conservative treatment has not had sufficient effect, surgery may be an option. A TVT sling surgery supports the urethra and is one of the most common surgical solutions for stress incontinence.
For severe urgency incontinence, Botox in the bladder wall may be an option if other treatments are not sufficient.
Other procedures may be relevant in some cases, such as bulking injections around the urethra for stress incontinence or nerve stimulation for severe overactive bladder. The choice depends on symptoms, examinations and previous treatments.
Surgery can be effective, but it’s also a major step. Therefore, it often makes sense to try relevant non-surgical options first if it fits your situation.
Technology-assisted clinical treatment
When exercises are not enough and you want a non-invasive treatment option, technology-assisted therapy may be relevant. At MS Insight, I work with a combination of Pelvic Chair, shockwave and EMTT.
The aim is to work with both pelvic floor muscle activation and the surrounding tissue, including blood flow, nerve function and tissue response.
Frequently asked questions about incontinence in women
Can you get medication for incontinence?
Yes, you can. For urgency incontinence, medications such as antimuscarinic drugs can sometimes reduce the involuntary contractions of the bladder. For stress incontinence, duloxetine can sometimes be used. Medication is prescribed by a doctor and primarily treats the symptoms. At MS Insight, I work with clinical treatment that targets pelvic floor function and the underlying tissue.
Can Vagifem help with incontinence?
Yes, local estrogen therapy like Vagifem or Estring can help some women, especially if the incontinence has started or worsened after menopause. Estrogen deficiency can affect the elasticity of the tissue around the vagina, urethra and pelvic floor. The effect is typically gradual over 1-3 months. Treatment should be assessed and prescribed by a doctor.
How do you stop incontinence?
Treatment depends on the type of incontinence. Stress incontinence is often treated with pelvic floor exercises and possibly technology-assisted treatments such as Pelvic Chair, shockwave and EMTT. Urgency incontinence is often treated with bladder training, lifestyle changes and in some cases medication. Mixed incontinence typically requires a combined approach.
Can you have surgery for incontinence?
Yes, you can. For severe stress incontinence, TVT sling surgery may be relevant if conservative treatment has not had sufficient effect. For severe urgency incontinence, Botox in the bladder wall may be an option. Surgery can be effective, but should be carefully considered and assessed by relevant medical specialists.
When are knee exercises not enough?
Pelvic floor exercises are not always enough if you’ve been exercising daily for 3 months without clear progress, if you can’t activate the pelvic floor correctly, or if incontinence is significantly affecting your everyday life. It may be due to severe muscle weakness, impaired nerve-muscle connection or tissue changes. An individual assessment can determine whether Pelvic Chair or combination therapy is relevant.
Is incontinence normal after childbirth?
It’s common to experience incontinence after childbirth, but that doesn’t mean you have to put up with it. Proper pelvic floor training, gradual rebuilding and possibly professional assessment can make a big difference, even if the symptoms have been present for a long time.
Does incontinence go away on its own?
Some women experience spontaneous recovery, especially after childbirth. However, if symptoms persist, affect your everyday life or don’t change after targeted training, it’s a good idea to assess the cause. The more precisely the problem is treated, the better the chances of progress.
Do coffee, alcohol and strength training worsen incontinence?
Coffee, alcohol and carbonation can worsen the urge to urinate in some women. Heavy strength training can trigger leakage in stress incontinence if the pelvic floor is not activated correctly. The solution is not necessarily to stop exercising, but to adapt load, technique and pelvic floor timing.
Have a no-obligation conversation about incontinence as a woman
Are you unsure if your pelvic floor exercises are working – or would you like to know if Pelvic Chair is relevant for you? You are always welcome to contact me by phone: 41 40 08 58 or email: michael@msinsight.dk. Otherwise, you can fill out the contact form with your details and a brief description of your problem. I’ll get back to you quickly with a customized solution proposal so we can find the best way forward together.
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