It would be easy to think that incontinence is an old person’s problem. But it affects younger women more than we realize: Two out of five women under 60 have some leakage, says Jill Rabin, M.D., professor of obstetrics and gynecology at Hofstra North Shore-LIJ School of Medicine and author of Mind Over Bladder. Often, the problem isn't having to go suddenly (a.k.a. urge incontinence), but situational incontinence caused by movements like coughing, sneezing, working out, or even having sex.
Think of the Friends and 30 Rock jokes about “peeing a little” when laughing. This is stress incontinence, which is about pressure, not being stressed. It’s caused by organs pushing down on your bladder as the result of weakness of the muscle or connective tissue in your pelvic floor. It’s much more common in women than men, since pregnancy and birth can cause the aforementioned weakness or tissue-tearing (even in moms who never wind up pushing, Dr. Rabin says C-sections can also lead to incontinence because there’s cutting across nerves). It's rare in women who haven't had children or pelvic surgery, but it can affect athletes in their teens and 20s who train for several hours daily, according to Victor W. Nitti, M.D., professor of urology and obstetrics and gynecology at NYU Langone Medical Center.
Women who have kids may have some degree of pelvic prolapse, in which organs like the uterus or small bowel are not fully anchored to the levator muscle of your pelvic floor, which Dr. Rabin describes as a trampoline at the bottom of your abdomen. With prolapse, the organs droop and can actually push through the openings in the muscle like a hernia, which can cause stress incontinence. The more children you have, the more likely you are to have a weaker pelvic floor and torn connective tissue — although not all women are affected, Dr. Rabin says.
Depending on the person, stress incontinence can be annoying, or embarrassing, or both, and it may not be something you’ve shared with your doctor. Some women wear tampons when working out because they find they leak less (it does hold up the pelvic floor a little bit). It’s a temporary solution, but Dr. Rabin recommends learning to do good ol’ Kegels, which are like CrossFit for your pelvic floor. She tells patients to pull up like you’re trying not to pee, hold for a count of three Mississippi, then relax for that amount of time. Do that three times an hour, every hour. “The levator muscle will grow thicker, from a veal cutlet to a filet mignon. That stabilizes your bladder so it won’t drop as much, and it will treat small degrees of prolapse.” Then, if you know you’re going to sneeze or cough, you can pull up your pelvic floor beforehand. Eventually, this will become almost reflexive, protecting against the pressure and hopefully preventing leaks.
Kegels are great, but you should still talk to your gynecologist, who can determine whether the leaking is a result of a problem with your nerves, muscles, connective tissue, or a combination of those factors. Your doctor can also recommend a specific treatment plan, which might include pelvic-floor therapy with a physical therapist or using vaginal weights or cones. Talking with your doctor is important because stress incontinence can get worse over time and may not respond as well to first-line treatments, Dr. Nitti says. He says some women may not bring it up because they think it’s just a fact after having kids. “It just doesn’t bother them. Some women have been taught that this is sort of normal. ‘This is supposed to happen. It happened to my mom.’”
Many obstetricians tell women to do Kegels during pregnancy or right after childbirth, but if you develop stress incontinence and it doesn’t get better with minimal rehab after delivery and it’s affecting your day-to-day, it’s worth discussing. And Dr. Nitti says you don't need a severe problem to consider additional treatment: “Some women that we operate on, they’re soaking multiple pads. Others, it may just be one small pad, but the degree of bother is there. It’s interfering with their life; they don’t exercise because of it.”
It’s important to note that the fix isn’t always surgery. Options range from simple exercises to urethral bulking agents, incontinence rings, and disposable pessaries that work like the aforementioned tampon method. Dr. Nitti says some women see ads on TV about the horrors of vaginal mesh and think, I’m not going to see a doctor because I don’t want vaginal mesh. But, he adds, "Nobody comes into my office with stress incontinence and I say, ‘You have to have surgery.’ It’s, ‘Here are the things we can do. What suits you?’”
Of course, it’s also possible that women would leak less if their bladders weren’t as full. Dr. Rabin recommends going to the bathroom at least every two to three hours while you’re awake. This also applies to women without incontinence problems and women who don't plan to have kids. If you hold it all day, you can overstretch your bladder and affect its ability to empty fully. Years from now, you might have frequent urges to go because your bladder can only empty small amounts each time. And the last thing your future self needs is pee regret.