Urinary Incontinence

Jun 16

Written By

Reviewed by Cheryl Long, AHPC-registered physiotherapist, Goji Physio

Urinary incontinence — any unintentional leakage of urine — is among the most common and most treatable conditions in women's health. It affects women of all ages, not just those who have given birth. Yet many women do not seek treatment, assuming it is an inevitable consequence of childbirth or ageing. It is not. Pelvic floor physiotherapy is the first-line treatment recommended by international guidelines for the most common forms of urinary incontinence.

What are the different types of urinary incontinence?

The most clinically relevant types for women are:

Stress urinary incontinence (SUI): leakage that occurs with increased intra-abdominal pressure — coughing, sneezing, laughing, running, jumping, or lifting. The underlying mechanism is insufficient urethral closure when the pelvic floor is rapidly loaded.
Urgency urinary incontinence (UUI): leakage associated with a sudden, strong urge to urinate that is difficult to defer. Often involves bladder overactivity.
Mixed urinary incontinence: a combination of stress and urgency incontinence, which is common.
Overflow incontinence: incomplete bladder emptying leading to dribbling or constant leakage. Less common in women; requires medical assessment.

Understanding which type you have is important because the physiotherapy approach differs. Our Physiotherapist will clarify this during your assessment.

Is leaking after birth normal?

Leaking in the immediate postnatal period (weeks 1–6) is common, and a degree of spontaneous improvement is expected as the pelvic floor recovers from birth. However, leaking that persists beyond 3 months postpartum, or that is affecting your ability to exercise, return to work, or live without anxiety about accidents, warrants physiotherapy assessment. Waiting and hoping it resolves is a reasonable approach in the first 6–8 weeks; it is not a strategy beyond that point.

Is doing "Kegel" exercises enough?

Pelvic floor exercises are an essential component of physiotherapy for stress incontinence — but "Kegels" done without assessment are only part of the picture. Many women squeeze rather than contract the correct muscles, or hold their breath, or have pelvic floor overactivity rather than weakness as their primary problem (in which case strengthening exercises may worsen symptoms). An assessment establishes what the pelvic floor is actually doing before prescribing a programme that addresses your specific presentation.

What does a session at Goji involve?

Our Physiotherapist will take a full bladder history — what you drink, how often you void, when you leak, and what triggers it. This provides an accurate picture of your bladder behaviour and helps distinguish between stress and urgency incontinence. The physical assessment typically includes:

Pelvic floor muscle assessment: evaluating resting tone, ability to contract, ability to relax, endurance, and coordination. An internal vaginal assessment provides the most accurate information about pelvic floor function and is offered (but not required).
Load testing: assessing how the pelvic floor responds under the demands that are relevant to you — coughing, jumping, lifting
Screen for contributing factors: fluid intake, caffeine, bladder habits, and any ongoing hormonal factors (particularly relevant peri- and post-menopause)

You will leave with a programme specifically designed for your pelvic floor — not a generic leaflet — and a realistic understanding of the progress timeline.

Frequently asked questions

How long does physiotherapy take to improve urinary incontinence?

International guidelines recommend a minimum of 3 months of supervised pelvic floor training before assessing the outcome. Many women see meaningful improvement before that. Factors influencing the timeline include the severity of leakage, pelvic floor starting function, consistency of the home programme, and whether urgency incontinence is also present.

Can urinary incontinence happen even if I never had a vaginal birth?

Yes. Pregnancy itself — regardless of delivery mode — places significant load on the pelvic floor. Urinary incontinence also occurs in women who have never been pregnant, associated with high-impact exercise, chronic cough, or connective tissue factors. Pelvic floor physiotherapy is appropriate across all these presentations.

I leak when I run or jump. Does that mean I should stop exercising?

Not necessarily, and not indefinitely. The goal of physiotherapy for exercise-associated leakage is to build pelvic floor capacity to the point where you can load it without leakage — not to avoid load permanently. In the short term, it may be appropriate to modify high-impact activity while building pelvic floor function. Our Physiotherapist will guide this specifically for your activity level and goals.

Could my incontinence be related to prolapse?

Urinary incontinence and pelvic organ prolapse frequently co-occur, as they share common risk factors and the pelvic floor structures involved overlap. A comprehensive pelvic floor assessment will screen for both.

Is urinary incontinence more common during perimenopause?

Yes. The decline in oestrogen during perimenopause affects the urethral and bladder tissue, reducing their elasticity and closure function. Both stress and urgency incontinence often worsen or appear for the first time during this transition. Physiotherapy addresses the muscular component; topical oestrogen (prescribed by a GP or gynaecologist) often supports tissue health in parallel.

I've been leaking for years. Is it too late for physiotherapy to help?

No. The evidence supports pelvic floor physiotherapy regardless of how long incontinence has been present. Improvement may take longer in longstanding cases, but it remains the recommended first-line treatment before any surgical intervention is considered.

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Reviewed by Cheryl Long, BSc (Hons) Physiotherapy, AHPC-registered
Clinical Director, Goji Physio — Women's and Family Physiotherapy, Lentor, Singapore