"The number of women I see who've been doing the wrong pelvic floor exercises for months — because nobody told them which type of incontinence they have — is staggering," says Sarah Brennan, a continence physiotherapist based in Liverpool with over fifteen years of clinical experience. "Getting the diagnosis right isn't just a box-ticking exercise. It genuinely changes everything about how we treat you."
She has a point. According to Bladder & Bowel UK, urinary incontinence affects around one in three women at some point in their lives — yet surveys consistently show that women wait an average of six years before speaking to their GP about it. When they finally do seek help, many are handed a generic leaflet and told to "do your Kegels." The trouble is, Kegels are brilliant for one type of incontinence, largely irrelevant for another, and actively unhelpful for a third.
This article breaks down the four main types of urinary incontinence that affect women in the UK, explains why the distinction matters clinically, and shows you exactly what to tell your GP so you can access the right pathway from the very first appointment.
1. Stress Urinary Incontinence — The Leaks That Come With Movement
Stress urinary incontinence (SUI) is the most common type in women under 60, and the word "stress" here refers to physical stress on the bladder — not emotional pressure. It happens when the pressure inside the abdomen suddenly increases and the pelvic floor and urethral sphincter cannot hold the gate shut fast enough.
Classic triggers include:
- Coughing, sneezing, or laughing
- Running, jumping, or high-impact exercise
- Lifting heavy shopping or a child
- Standing up quickly
The NHS notes that SUI is closely linked to childbirth (particularly vaginal deliveries involving long pushing stages, forceps, or a large baby), the menopause (falling oestrogen weakens urethral tissue), and obesity. Chronic coughing — from asthma or smoking — is also a contributing factor that is frequently overlooked.
Why the right diagnosis matters: SUI responds well to supervised pelvic floor muscle training (PFMT). The NICE guideline CG171 recommends at least three months of supervised PFMT as first-line treatment before any other intervention is considered. But — and this is critical — those exercises need to be performed correctly and consistently. Research cited by the Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) group suggests that up to 70% of women perform pelvic floor exercises incorrectly without professional guidance. Referral to a specialist women's health physiotherapist or a continence nurse specialist makes an enormous difference to outcomes.
What to tell your GP: "I leak when I cough, sneeze, or exercise. I'd like a referral for supervised pelvic floor rehabilitation and to discuss whether a continence nurse specialist appointment would be appropriate."
2. Urge Urinary Incontinence — The Sudden, Overwhelming Need to Go
Urge urinary incontinence (UUI) — often grouped under the broader umbrella of overactive bladder (OAB) — feels completely different. There is no cough, no sneeze, no physical trigger. Instead, a sudden, powerful urge to urinate arrives with little or no warning, and leakage happens before the woman can reach the toilet.
Women with UUI frequently describe the "key-in-the-door" phenomenon: the urgency surges the moment they put their key in the front door, hear running water, or even just think about needing the loo. Many also report nocturia — waking two or more times a night to urinate — which severely disrupts sleep and quality of life.
The underlying cause is an overactive or hypersensitive detrusor muscle (the smooth muscle of the bladder wall) that contracts involuntarily before the bladder is full. Bladder & Bowel UK explains that triggers can include caffeine, carbonated drinks, alcohol, constipation, and certain medications — but in many women, no obvious cause is found.
Why the right diagnosis matters: Giving pelvic floor exercises to a woman with pure urge incontinence and telling her that is sufficient treatment is a missed opportunity at best. NICE guidance recommends bladder retraining as the cornerstone of first-line treatment for UUI — a structured programme in which a woman progressively extends the intervals between voiding, teaching the bladder to tolerate greater volumes. Bladder retraining looks nothing like PFMT. If a GP suspects UUI, they can also consider referral for urodynamic testing, and anticholinergic or beta-3 agonist medications (such as oxybutynin, solifenacin, or mirabegron) may be appropriate if conservative measures are insufficient.
What to tell your GP: "I get a sudden, desperate urge to urinate that I cannot postpone, and I sometimes leak before I reach the toilet. It happens without any physical trigger like coughing. I'd like to discuss a bladder retraining programme."
3. Mixed Urinary Incontinence — When You Have Both
Mixed urinary incontinence is exactly what it sounds like: a combination of stress and urge incontinence occurring in the same woman. It is, in fact, the most common type in women over 60, according to NICE, and is considerably more prevalent than is often appreciated in primary care.
Many women with mixed incontinence find it difficult to describe their symptoms clearly, because their leakage appears inconsistent — sometimes brought on by a sneeze, sometimes by the sound of water, sometimes for no obvious reason at all. This can lead to confusion and frustration, both for the patient and for clinicians working within a short consultation window.
Sarah Brennan sees this regularly: "Women often come to me saying, 'My GP said it was just stress incontinence,' but when we do a thorough assessment, there's a very clear urge component as well. We then have to work on both pathways simultaneously, which requires a different, more tailored approach."
Why the right diagnosis matters: Treatment for mixed incontinence typically involves a combination of bladder retraining and pelvic floor rehabilitation, delivered in a specific sequence. NICE guidance suggests addressing the most bothersome symptom first. If urgency is the dominant complaint, bladder retraining takes priority; if leakage on exertion is worse, PFMT leads the programme. Treating only one component while ignoring the other often produces partial improvement at best. Your GP should ideally refer you for a specialist physiotherapy or continence nurse assessment rather than relying solely on first-line advice.
What to tell your GP: "I experience leakage both when I sneeze or exercise, and also when I have a sudden urgent need to go. I believe I may have mixed incontinence. Could you refer me to a specialist for a full assessment?"
4. Overflow Incontinence — The Type Most Often Missed in Women
Overflow incontinence is the least well-known of the four types, and it is frequently overlooked in women because it is more commonly associated with men (in whom an enlarged prostate is a frequent cause). However, it does affect women — and when it goes undiagnosed, it can signal an underlying condition that requires prompt investigation.
Overflow incontinence occurs when the bladder does not empty completely, gradually overfills, and urine dribbles or leaks out because the bladder has no further capacity. Symptoms are often subtle: a constant slight dampness, difficulty initiating urination, a weak or interrupted stream, and the persistent sensation that the bladder is never quite empty.
In women, common causes include:
- Neurological conditions such as multiple sclerosis, diabetes-related neuropathy, or spinal cord injury
- Severe pelvic organ prolapse obstructing the urethra
- Certain medications, particularly opioids, some antidepressants, and antihistamines
- Constipation — a frequently underestimated cause of bladder dysfunction
The NHS emphasises that because overflow incontinence often has an identifiable underlying cause, it should always be investigated rather than managed symptomatically. PFMT will not resolve it. Bladder retraining will not resolve it. The root cause must be identified and addressed.
Why the right diagnosis matters: Women with overflow incontinence may need referral to urology or neurology, intermittent self-catheterisation (which is far simpler and more manageable than it sounds), or review of their current medication list. Treating overflow incontinence as if it were stress incontinence not only wastes time but delays diagnosis of potentially serious underlying conditions.
What to tell your GP: "I have a constant, low-level dampness and the sensation that my bladder never fully empties. My stream feels weak. I'm concerned I may have overflow incontinence rather than stress or urge incontinence."
How to Prepare for Your GP Appointment
The most useful thing any woman can bring to a GP appointment about incontinence is a bladder diary — a two- to three-day record of fluid intake, toilet visits, urgency episodes, and leakage incidents. Bladder & Bowel UK offers a free, downloadable bladder diary on their website that is widely recognised by NHS clinicians. A completed diary takes a short appointment from guesswork to evidence-based decision-making in minutes.
You are also entitled to ask for:
- A referral to a continence nurse specialist — an NHS-funded specialist who can carry out a comprehensive bladder assessment
- A referral to a women's health physiotherapist for supervised pelvic floor rehabilitation
- A urine dipstick test to rule out infection, which can mimic or exacerbate urge symptoms
- A review of any medications that may be contributing to your symptoms
If your GP seems uncertain or dismissive, you can reference NICE clinical guideline CG171 (Urinary incontinence in women) by name. You have every right to access the care that guideline recommends.
Managing Day-to-Day Whilst You Wait for Treatment
NHS waiting lists for specialist physiotherapy and urology can be lengthy, and in the meantime, protecting your skin, your dignity, and your daily confidence matters. Single-use disposable products are widely available but generate significant environmental waste and ongoing cost over months or years.
Washable incontinence knickers are a more sustainable, cost-effective alternative that many women find far more comfortable than disposable pads — particularly for moderate to heavy leakage. Orykas UK produces a range of washable incontinence knickers made from OEKO-TEX Standard 100 certified bamboo fibre, which is naturally antibacterial, breathable, and gentle on sensitive skin.
- Women's Washable Incontinence Pants for Heavy Leakage — designed for heavier stress or urge leakage, with a discreet, fitted silhouette under everyday clothing.
- Women's High-Waisted Washable Incontinence Pants — full coverage with a comfortable high waistband, ideal for post-surgical recovery or during bladder retraining.
- Women's Lace-Waistband Washable Incontinence Pants — a more feminine option that does not look or feel like a medical product.
All Orykas UK washable incontinence knickers are machine-washable at 40°C and designed to last two to three years with regular use — making them significantly more economical than disposable alternatives over time. Women with chronic incontinence may also be eligible for UK VAT relief on these products under the HMRC disability-products scheme, which can be applied at checkout.
Related Orykas UK Advice
- Urinary incontinence in women: natural treatment, what really works
- Urinary Leaks in Women: Causes, Types, and When to See a Doctor
- How to stop urinary leaks in women: complete solutions
- Urinary protection for women: complete 2026 guide
Frequently Asked Questions
Can I have more than one type of incontinence at the same time?
Yes — mixed urinary incontinence, which combines stress and urge incontinence, is the most common type in women over 60. It is important that both components are identified and addressed in treatment, rather than assuming it is one or the other.
Will my GP take me seriously if I bring this up?
They should. Urinary incontinence is a well-recognised medical condition with clear NHS and NICE treatment pathways. Bringing a completed bladder diary to your appointment significantly strengthens your case for referral. If you feel dismissed, you can ask specifically to be referred to a continence nurse specialist and cite NICE guideline CG171.
Are pelvic floor exercises useful for all types of incontinence?
Pelvic floor muscle training is highly effective for stress urinary incontinence and plays a supporting role in mixed incontinence. For pure urge incontinence, bladder retraining is the primary first-line treatment. For overflow incontinence, pelvic floor exercises are generally not the appropriate intervention — identifying and treating the underlying cause takes priority.
Is it normal for incontinence to get worse around the menopause?
Very common, yes. The decline in oestrogen during perimenopause and menopause weakens the urethral sphincter and thins the vaginal and urethral tissue, increasing susceptibility to both stress and urge leakage. Local oestrogen therapy (a topical cream or pessary applied vaginally) is recommended by NICE as a safe, effective option for postmenopausal women with incontinence related to genitourinary syndrome. Speak to your GP about whether this is appropriate for you.
How long does it take to see improvement with the right treatment?
NICE recommends a minimum of three months of supervised pelvic floor rehabilitation before assessing results for stress incontinence, and a similar duration for bladder retraining programmes targeting urge incontinence. Many women notice meaningful improvement within six to eight weeks if their exercises are performed correctly and consistently. Progress tends to be faster with specialist guidance than with self-directed exercise alone.
Sources and further reading: NHS (nhs.uk) — Urinary incontinence overview; NICE Clinical Guideline CG171 — Urinary incontinence in women: management (updated 2019); Bladder & Bowel UK (bladderandbowel.org); Pelvic, Obstetric and Gynaecological Physiotherapy (POGP) — guidance on pelvic floor rehabilitation. The information in this article is intended for general educational purposes and does not constitute medical advice. Always consult your GP or a qualified healthcare professional regarding your individual symptoms and treatment options.
Share:
Menopause and Your Bladder: What Changes After 45 and What the NHS Offers
Lace Incontinence Knickers: Can Leak-Proof Underwear Actually Look Beautiful?