What causes urinary incontinence?

You and your healthcare provider might talk about why you're having trouble controlling your bladder leading to wet underwear. Here are some possible reasons:

• Pregnancy and childbirth
• Active lifestyle
• Genetics
• Menopause
• Urinary tract infections (UTIs)
• Medications
• Nerve damage
• Tumors in the urinary tract
• Constipation
• Side effects of hysterectomy
• Using too many diuretics (water pills or food/drinks that cause you to pee more)

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If you’re looking for treatment options, read our post on Treating Urinary Incontinence

Urinary Incontinence after childbirth

During pregnancy, hormones stretch the pelvic floor muscles. Additionally, the weight of the expanding uterus can weaken the strength of a woman’s pelvic floor muscles and cause urine to leak. When the baby moves down during birth, the pelvic floor stretches more. This, combined with hormonal changes, weakens the muscles controlling the bladder, sometimes causing accidental urine leaks.

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Additional conditions often add to urinary incontinence after childbirth:

• Nerve Damage: Harm to the nerves that manage the bladder, rectum, and pelvic floor muscles.
• Changes in Position: Shifting of the urethra and bladder from their original positions.
• Delivery Complications: An episiotomy (a cut made to widen the vaginal opening) or tearing of the pelvic floor muscles during childbirth.
• Assisted Vaginal Delivery: Forceps or a vacuum during delivery, which may harm the pelvic floor and anal sphincter, leading to issues with urine or bowel control.

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After childbirth, many women experience urinary incontinence (leaking urine), with one in three facing this issue. Stress incontinence, where urine leaks during activities like laughing or exercising, is common among new mothers.

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We are not saying that vaginal birth WILL cause permanent damage with urinary incontinence, and we want to make it clear that we are not saying women should avoid labor/vaginal birth and skip straight to c-section in order to prevent urinary incontinence or other tissue damage. There are countless benefits to vaginal birth, and you should discuss your specific situation with your healthcare provider.

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Reasons you MIGHT be more prone to urinary incontinence after childbirth:

• You had bladder or bowel issues before being pregnant – they might become more problematic after giving birth.
• You experienced bladder problems during pregnancy.
• This is your first time having a baby.
• You are expecting a big baby.
• You have a lengthy labor, especially during the second stage.
• Your delivery is challenging, like needing stitches, tearing, or requiring tools like a vacuum cup or forceps.

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Despite being a common occurrence after childbirth, some new moms may feel shame or embarrassment about experiencing incontinence. Limited discussion on this topic in various communities might make women believe it's an issue without easy solutions.

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“Whether I’m older or younger, how can I treat urinary incontinence?” Most mommy blogs will tell you to do some Kegel exercises, build a strict bladder training regimen, or take some medication. There is a far simpler and more effective way to treat urinary stress incontinence. Have you heard of the O-Shot? Learn more…

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Urinary incontinence caused by lifestyle:

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Incontinence during activity, also known as stress incontinence or stress urinary incontinence, happens when your pelvic floor muscles are not strong enough to control your urethra (pee tube) from expelling pee. When pressure builds up these weak muscles can't prevent your bladder from leaking urine.

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You leak urine. Or to kick the medical jargon, you pee in your underwear when you:

• cough
• sneeze
• laugh
• bend over
• lift heavy things
• engage in sexual activity

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If incontinence during exercise happens once in a while you might not need to see a doctor. Perhaps adding pelvic floor exercises to strengthen your pelvic muscles may be enough to avoid further medical intervention.

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However, if you're experiencing incontinence while exercising more frequently, it's a good idea to talk to a healthcare professional. They can check for any underlying health issues or other reasons causing the problem.

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You might ask, why can my friend engage in various activities without urinary incontinence, but I'm stuck with pee in my pants? Well, let’s discuss genetics and how they play a role in urinary incontinence.

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Are genetics causing urinary incontinence?

Your genes are like a blueprint for your body, determining things like the color of your eyes, your hair type, and more. They also play a role in your health, influencing whether you might be more prone to certain conditions. Urinary incontinence, a common issue affecting nearly 10 million Americans, is also influenced by genetic factors.

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A study with twins in Sweden found that about half of the likelihood of developing urinary incontinence can be explained by genetics. This doesn't mean everyone inherits it directly from their parents, but around 50% of the risk can be connected to genes. The study also revealed that genes are significant for nighttime urination (nocturia), explaining about one-third of the variation.

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The researcher, Anna Lena Wennberg, suggests that there isn't just one gene responsible for incontinence but a combination of different genes. These genes, along with various environmental factors, contribute to the risk of experiencing urinary incontinence.

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Urinary incontinence has many contributing factors. While genes can be part of it, it seems that they might be more connected to it rather than being the direct cause.

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Menopause can lead to urinary incontinence:

As women get older, lower levels of estrogen, especially after menopause, can make the lining of the urethra (the tube carrying urine out of the bladder) thinner. The muscles around the pelvic area may also weaken with age, a condition called "pelvic relaxation." This can lead to an increased chance of urinary incontinence, where urine leaks involuntarily. The primary factors that raise the risk of urinary incontinence are vaginal birth and getting older.

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Incontinence during menopause can worsen due to:

• Constipation – Pushing hard during a bowel movement can stress the muscles that handle bladder control.
• Higher BMI – Extra weight can strain the muscles in charge of the bladder.
• Medications – Some drugs, especially diuretics (often called "water pills"), might contribute to urinary incontinence.
• Nerve damage – Conditions like diabetes can cause nerve damage, sending the wrong signals to the bladder.
• Surgery – If you have a hysterectomy, where the uterus is removed, it can affect the pelvic floor muscles that help manage bladder function.

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Urinary incontinence can cause challenges during sex. About a quarter of women with incontinence may experience leaking during intercourse. This can be embarrassing and make women avoid sex or feel anxious about leakage.

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But you don't have to tolerate urinary incontinence issues. At Epiphany Women’s Health, we offer an incredible solution for urinary incontinence and low sex drive, all-in-one natural treatment. It’s called the O-Shot®. We won’t discuss this here, but you can click O-Shot® to learn more.

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Urinary incontinence from urinary tract infection (UTI):

UTIs are infections that happen in different parts of the urinary system: the tube (urethra), bag (bladder), tubes (ureters), or bean-shaped organs (kidneys). The usual cause of UTIs is bacteria, such as Escherichia coli (E. Coli), commonly found in the gut. When the bacteria get into the urinary system and start growing, it causes an infection. This can lead to symptoms like needing to pee a lot, feeling a burning sensation when you pee, and having cloudy or bloody urine. There might also be a bad smell, fever, and/or pain with a UTI. To treat a UTI, healthcare providers usually prescribe antibiotics.

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UTIs can cause urge incontinence. Urge urinary incontinence is caused by the bladder believing that it is full when in fact it still has more capacity. When you have a UTI your bladder becomes inflamed causing swelling and irritation. This makes the bladder contract more than when an infection is not present. Once the bladder muscles contract the urethral sphincter muscles relax allowing urine to be released.

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In this context, the main treatment for urinary incontinence is to treat the UTI. Please consult your healthcare provider, or book an appointment at Epiphany Women’s Health with one of our female nurse practitioners.

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Urinary incontinence from nerve damage:

For your bladder to work properly, muscles and nerves need to team up. Messages go back and forth between your brain and the muscles that help you pee. If these nerves get hurt or sick, the muscles might not do their job of tightening or relaxing at the right times.

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In people with a neurogenic bladder, the nerves and muscles don't cooperate very well. This can lead to problems like the bladder not filling or emptying the right way. The muscles might squeeze too much, even when the bladder isn't full yet, causing leaks. On the other hand, the muscles might be too relaxed and let urine out before you're ready (incontinence).

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In some cases, the bladder muscle might not work well. It won't squeeze when it's supposed to, so the bladder won't empty like it should. The muscles around the urethra, the tube where urine comes out, might also act up. They might stay tight when you're trying to pee. Some people might have both problems – the bladder squeezing too much sometimes and not enough at other times.

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Neurogenic bladder is often linked to another health issue. The most common ones include Alzheimer’s disease, spinal cord birth defects, tumors in the brain or spinal cord, cerebral palsy, encephalitis, multiple sclerosis, Parkinson's disease, and spinal cord injury.

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Urinary incontinence from hysterectomy:

Hysterectomy is a commonly used procedure to treat benign conditions such as abnormal uterine bleeding, pelvic organ prolapse (POP), and uterine fibroids. Having a hysterectomy may increase the risk of stress urinary incontinence (SUI), where urine leaks involuntarily during activities or exertion. This is believed to be due to the impact on pelvic anatomy and nerve supply during the surgery.

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There are a few reasons why you might have incontinence after a hysterectomy:

• The nerves near your bladder, which are close to the uterus, may get damaged during the removal of your uterus. This can cause incontinence.
• Your uterus supports the pelvic floor muscles, preventing them from sagging and supporting your bladder. When the uterus is removed, the lack of support can lead to incontinence.
• The urinary sphincter, responsible for holding urine and preventing leaks, may be damaged during a hysterectomy, resulting in incontinence.
• If your ovaries, which produce estrogen, are removed, the decrease in estrogen levels can weaken the pelvic floor muscles, contributing to incontinence.

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Coffee and tea (diuretics) can cause urinary incontinence?

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Things like caffeine (found in coffee, tea, sodas, and energy drinks), vitamin C, and chocolate can make you produce more urine, possibly making incontinence worse. If you’re experiencing urinary incontinence eliminating some foods and drinks that may cause the symptoms would be a great place to start. 

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Common foods and drinks that can cause urinary incontinence:

• Tomato products
• Coffee
• tea 
• Chocolate 
• Citrus 
• Alcoholic drinks 
• Carbonated drinks 
• Spicy foods 
• Sweeteners 
• Processed foods 
• Onions 
• Cranberries 
• Excessive water intake*

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*Mayo Clinic's recommended daily water intake is 11 and 1/2 cups for women. So, to consume substantially more water than recommended could result in urinary incontinence. However, we do not recommend that you decrease your water intake as this can lead to dehydration and a host of health conditions.

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If you find it uncomfortable to talk about incontinence, remember that more than 50% of women are struggling with urinary incontinence. You’re not alone. When you’re at Epiphany Women’s Health, you’re in a judgment-free zone. We are here to get you back on top of your game and living your best life. No more peeing your pants!

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If you’re ready to take the first step toward treating urinary incontinence, please book an appointment with one of our female nurse practitioners.