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Bladder Leakage in Women Over the Age of 50

Bladder leakage is common. It is especially common in women due to our anatomy, but you don't have to live with bladder leakage!

There are two main types of bladder leakage.

  1. Stress Urinary incontinence, meaning bladder leakage with physical stress such as running, jumping, laughing, coughing or sneezing.

  2. Urge incontinence, meaning bladder leakage when you have the urge to go pee, or on the way to the bathroom.

In women over the age of 50, urge incontinence is the main type of bladder leakage. Sometimes there is a mix of both, but after menopause it is most commonly urge incontinence.

There are a few main reasons for urge incontinence after menopause:

  1. Hormonal changes

    1. During and after menopause the body stops producing estrogen. The vaginal tissues have estrogen receptors and when the tissues aren't filled with estrogen they get thinner and drier and this decreases the thickness of the tissues supporting the bladder.

  2. A lifetime of habits

    1. For many of my clients they have a habit of going to the bathroom often and this becomes a problem later in life if they have had these habits for many years.

This combination of less bladder support from the external vaginal (vulvar) tissues and many years of going to the bathroom more often than necessary, combine to contribute to bladder urgency, frequency and incontinence.

What can I do to help my bladder leakage?

Often women think the only answer is medication or surgery, because that is what doctors have to offer, and usually we go to the doctor first for any health problems.

Medication for Overactive Bladder

There is a medication for overactive bladder, if you feel like you constantly need to run to the bathroom. It has a side effect of constipation, so now you have a different problem.

I've seen this medication help some of my clients, but many of them get better without this medication.


There are a few surgeries such as getting a bladder lift, bladder sling or a surgery to help support the urethra (where the pee comes out). These surgeries may be necessary for some people, but they shouldn't be the first option for treatment of bladder leakage.


Kegels are usually the only thing we hear about when we think about pelvic floor therapy or bladder problems.

Kegels usually aren't the answer here either. Sometimes kegels can help, but there is more to work on than just kegels for bladder leakage or overactive bladder.

Pelvic Floor Therapy

Pelvic floor therapy can very often help with overactive bladder, urge incontinence or urinary frequency and urgency.

In pelvic floor therapy we might use a combination of kegels and bladder habit training.

If the pelvic floor muscles are weak, then I will have my clients do kegels to strengthen the muscles and help prevent bladder leakage.

Sometimes their pelvic floor muscles are actually tight. When the muscles are tight they press on the bladder and make it feel like the bladder is full and needs to be emptied. If this is the case they should not be doing kegels and instead we work on stretches and relaxation exercises like deep breathing.

Very often in the clinic when I test women who are over the age of 50 their pelvic floor muscles are functioning just fine. If that is the case they don't need to do kegels or stretches and instead we focus on bladder habits.

Bladder Re-Training

Bladder retraining is a big part of my pelvic floor therapy clinical practice. Bladder issues are usually not just due to muscle weakness and doing more kegels. Most of the time I use a combination of exercises and bladder retraining.

What is bladder retraining?

It is just like it sounds. We retrain our bladder habits.

That means learning to differentiate between what is an urge because the bladder is full and what is just a habit. Or, is the client just going to the bathroom out of habit or "just in case." This might trace back to a time when they had bladder leakage and so now they go more often so that doesn't happen again. Completely understandable why people do this, but over time it creates another problem.

Once the client learns how to tune into what the bladder urge means and if the bladder really is full, then we work on going to the bathroom at predictable intervals. This helps in two ways.

  1. It helps the bladder to be able to hold more urine. If for many years you went to the bathroom frequently, then the bladder shrinks and holds less urine, making you need to go more often and creating a viscous cycle.

  2. It gives your bladder and brain a predictable time period to know when it will go to the bathroom next. This way the bladder learns to hold a certain amount of urine and it knows it can hold this amount because it knows it will be able to empty in a certain amount of time. This helps you eventually increase the time interval by small increments once it becomes predictable.

For many women over the age of 50 bladder retraining is the main thing they can do to help their bladder urgency, frequency and leakage. This all can be done without medication, surgery or even seeing a pelvic floor therapist. As long as you have the proper tools, you can do it on your own.

I realized this after treating a lot of women in my office. Just because they didn't need to do kegels didn't mean I couldn't help them, they just needed some education and guidance on their bladder habits.

Online Resources For Bladder Retraining

I created an online course to help these women so they can get better from the privacy of their own home. They don't need to have embarrassing conversations with their doctor or be dismissed by their doctor. They don't even need to see a pelvic floor therapist in person. Once they learn how to track their bladder habits and how to start improving those habits, they can make improvements on their own.

I want to help you with this, too. Start with my free introductory class where you can learn 3 ways to decrease bladder leakage without doing more kegels. This will get you started and introduce you to the concepts in the online course.

You don't have to leak. You don't have to take medication to help your bladder issues. You can get better by improving your bladder habits.

Start here with my free introductory bladder class.

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