Oct 31, 2026
Hazem Elshoreya, MD, FACOG, MSCP
Urinary leakage is common, but the circumstances surrounding it matter. Some women leak while coughing, laughing, exercising, or lifting. Others experience a sudden urge to urinate and cannot reach the bathroom in time. Some experience both.
These patterns are called stress urinary incontinence, urgency urinary incontinence, and mixed urinary incontinence. They often need different treatment plans.
At Revive Gynecology & Cosmetics in Marlton, NJ, we start by identifying the type of leakage and any contributing factors. The right diagnosis helps avoid treatments that do not address the underlying problem.
Stress incontinence: Urine leaks when physical pressure increases inside the abdomen, such as during a sneeze, cough, jump, or workout. The word “stress” refers to physical pressure, not emotional stress.
Urgency incontinence: A sudden, difficult-to-defer need to urinate is followed by leakage before reaching the toilet. This can occur as part of overactive bladder (OAB).
Mixed incontinence: Both patterns occur in the same person. One may be more bothersome than the other.
These distinctions follow the NIDDK definitions of bladder control problems.
Stress urinary incontinence occurs when the support around the bladder neck and urethra cannot consistently withstand an increase in abdominal pressure. Typical triggers include:
Leakage may range from a few drops to a larger amount. Pregnancy, childbirth, pelvic floor changes, and aging can contribute, but stress incontinence can also occur in women who have never delivered vaginally.
Weak pelvic floor muscles, impaired muscle coordination, and altered urethral support are not identical problems. An examination is often more useful than guessing from symptoms alone.
Urgency urinary incontinence is associated with a sudden, compelling need to urinate that is difficult to postpone. Some women experience “key-in-the-door” urgency on arriving home, leakage on the way to the bathroom, or frequent trips to the toilet.
Overactive bladder can also cause frequent daytime urination and waking at night to urinate, even without leakage. It is a symptom-based diagnosis after other explanations, including urinary tract infection, have been considered.
The 2024 AUA/SUFU overactive bladder guideline recommends bladder training and behavioral approaches. Medication and additional therapies may be appropriate based on symptoms and patient preferences.
Yes. Mixed urinary incontinence means both stress and urgency symptoms are present. You might leak during a workout and also experience intense urgency on the drive home. Treating only one component may leave the other unchanged.
When symptoms are mixed, we consider which type is most disruptive and whether constipation, pelvic organ prolapse, or menopause-related changes are contributing.
Pregnancy and childbirth can affect pelvic floor muscles, connective tissues, and nerves. These changes may contribute to stress leakage, although not every woman who gives birth develops incontinence.
During perimenopause and menopause, declining estrogen can affect vaginal and urinary tissues. Genitourinary syndrome of menopause (GSM) may coexist with urgency, irritation, and recurrent urinary tract infections. It does not explain every case of incontinence.
Weight changes, chronic coughing, constipation, diabetes, certain medications, and bladder irritants may also influence symptoms. A personalized plan considers these factors rather than attributing all leakage to aging.
Evaluation usually begins with a focused history and examination. We ask when leakage happens, whether you feel an urge first, how frequently you urinate, what you drink, and whether you have pain or recurrent infections.
A bladder diary covering several days can be helpful. Recording fluid intake, bathroom visits, urgency, and leakage episodes often reveals patterns that are difficult to remember during a consultation.
Depending on symptoms, evaluation may include urinalysis, pelvic examination, a cough stress test, and assessment of bladder emptying. More specialized testing is reserved for selected cases, particularly when the diagnosis is unclear or procedural treatment is being considered.
Pelvic floor muscle training is a well-established conservative treatment. Supervised pelvic floor physical therapy can help patients learn proper strength and coordination rather than simply doing more repetitions.
Other options include managing constipation and chronic cough, weight management when appropriate, and selected vaginal support devices such as a pessary. Persistent or more severe stress incontinence may warrant discussion of urethral bulking or sling surgery after evaluation.
The 2023 AUA/SUFU stress incontinence guideline update supports counseling about conservative and procedural choices based on individual circumstances.
Urgency symptoms often respond to a different combination of strategies:
Shared decision-making matters because effectiveness, convenience, and potential side effects vary.
Revive offers pelvic floor electromagnetic muscle stimulation (EMS) as a noninvasive option for selected patients. The technology stimulates repeated pelvic floor contractions while the patient is seated.
An assisted muscle-contraction session is not the same as an individualized pelvic floor rehabilitation program. The evidence for specific EMS devices is less established than the evidence supporting supervised pelvic floor muscle training for stress incontinence. Results vary; EMS should not be described as a guaranteed cure or as the equivalent of a specific number of effective Kegel exercises.
We discuss whether EMS may have a role, whether pelvic floor physical therapy is indicated, and whether another treatment better matches the type of leakage.
For women with menopause-related GSM, local low-dose vaginal estrogen can improve vaginal and urinary tissue symptoms and may reduce recurrent urinary tract infections in appropriate patients. It is not a universal treatment for stress urinary incontinence.
The 2025 AUA/SUFU/AUGS GSM guideline emphasizes identifying GSM and offering evidence-based local treatment when appropriate. Women with urgency, dryness, burning, or repeated UTIs may benefit from evaluating these concerns together.
For more information, read our guide to vaginal health and local estrogen.
Energy-based vaginal procedures and platelet-rich plasma treatments are sometimes marketed for urinary leakage, but evidence for effectiveness and long-term safety remains limited or inconsistent. They are not established first-line substitutes for guideline-supported pelvic floor rehabilitation, bladder training, medications, or indicated surgery.
Before considering any elective procedure, patients should understand the evidence, alternatives, costs, and possible risks for their particular diagnosis.
Arrange an evaluation if leakage disrupts exercise, sleep, or daily life. Seek prompt medical assessment for blood in the urine, fever, painful urination, difficulty emptying the bladder, or a sudden significant change in urinary control. New bladder symptoms accompanied by leg weakness, numbness around the groin, or loss of bowel control require emergency assessment.
Urinary symptoms can also result from infection, medication effects, pelvic organ prolapse, or neurologic conditions. Not every symptom is a pelvic floor problem.
At Revive Gynecology & Cosmetics, Dr. Hazem Elshoreya, a board-certified OB-GYN and Certified Menopause Practitioner, evaluates bladder leakage in the context of pelvic health, childbirth history, menopause symptoms, and each patient's goals.
Whether you leak during exercise, experience sudden urgency, or have a combination of symptoms, the first step is identifying the cause. Learn about our urinary incontinence treatment options in Marlton, NJ, serving South Jersey and the Greater Philadelphia area.
Schedule a private consultation at Revive GYN to discuss your options.
Leakage during coughing, sneezing, laughing, or exercise is typical of stress urinary incontinence. An evaluation can confirm the cause and identify suitable treatments.
Stress incontinence involves leakage during physical pressure, such as a cough or jump. Urgency incontinence involves leakage associated with a sudden, difficult-to-control urge to urinate. Some women have both.
Yes. Depending on the cause, options include pelvic floor muscle training, bladder training, lifestyle measures, support devices, and medications. Not every treatment works for every type of leakage.
Pelvic floor muscle training helps many women with stress incontinence, but technique, consistency, and diagnosis matter. Urgency incontinence or mixed symptoms may need additional treatments.
Menopause-related tissue changes can contribute to urgency and recurrent urinary tract infections. Other causes, including overactive bladder and infection, should also be considered.
No. EMS stimulates muscle contractions using a device, while pelvic floor physical therapy includes individualized assessment, exercise technique, coordination, and behavioral strategies. EMS may be discussed as an adjunct for selected patients.
Reviewed for publication October 31, 2026. This article is educational and does not replace individualized medical evaluation.
