Urinary incontinence means leaking urine when you do not mean to, or not being able to control when you go to the toilet. It happens when the bladder muscles and the muscles that keep the bladder closed do not work together as they should. You might leak just a few drops, or a larger amount. Everyday things like laughing, coughing, sneezing or exercising can bring it on.

Urinary incontinence can affect a woman at any age, but it becomes more common with age and around menopause. More than 1 in 3 women have some form of it, so there is no need to feel embarrassed. It is very common. Just as important: leaking urine is not a normal part of ageing that you simply have to accept — it can be treated or improved.

The signs depend on the type of incontinence, but they can include:

• Leaking urine when you cough, sneeze, laugh, lift or exercise
• A sudden, strong urge to pass urine that is hard to hold back
• Going to the toilet more than 8 times a day, or more than twice a night
• Leaking on the way to the toilet
• Wetting the bed

If leaking urine is affecting your day-to-day life, your sleep or your confidence, it is worth having it checked. Simple, everyday care often makes a real difference.

There are a few different types, and knowing which one you have helps guide treatment.

Stress incontinence is leaking when there is sudden pressure on your bladder — when you cough, sneeze, laugh, lift something or exercise. It happens when the pelvic floor muscles that support the bladder are weakened, often after pregnancy and childbirth, or around menopause. This is the most common type in younger and midlife women.

Urge incontinence is a sudden, strong need to pass urine that you cannot easily put off, and you may leak before you reach the toilet. It is caused by the bladder muscle squeezing when it should be relaxed. You might feel the urge often, and at times you do not expect — during sleep, after drinking, or even when you hear running water. Some women reach the toilet in time but find there is little to pass. This type becomes more common with age.

Some women have both stress and urge incontinence at the same time. This is called mixed incontinence, and it is common. Treatment usually works on both parts together.

Urinary incontinence is not a disease in itself. It is a sign that something is affecting the bladder or the muscles and nerves around it. Women are more likely than men to have it, because pregnancy, childbirth and menopause all put strain on the pelvic floor. Women also have a shorter urethra (the tube urine passes through), so any weakness is more likely to lead to leaking.

• Pregnancy and childbirth, which can stretch or weaken the pelvic floor. This is common after giving birth and often improves with pelvic floor exercises over time
• Menopause, as lower oestrogen affects the tissues around the bladder
• Being above a healthy weight, which puts extra pressure on the bladder
• Long-term constipation, as straining over time can weaken the pelvic floor
• Nerve conditions, such as diabetes or multiple sclerosis, that affect bladder control
• Some pelvic surgery, including hysterectomy, that can affect the pelvic floor
• A prolapse, where the bladder or other pelvic organs press down because their support has weakened — your doctor can explain whether this is playing a part

Some causes come and go, and settle once they are treated:

• A urinary tract infection (a bladder or urine infection), which can cause urgency and leaking — this is different from an STI, and a simple urine test tells them apart
• Pregnancy, when the growing baby presses on the bladder
• Some medicines
• Too much caffeine, which makes the bladder fill and empty more quickly

Working out the type of incontinence and what is causing it guides the right treatment. Dr Mahadik will ask about your symptoms and history, and examine you to look for anything that might be contributing. Depending on what is found, tests may include:

• A urine test to check for infection
• An ultrasound to look at the bladder and pelvic organs
• A simple test where you cough or bear down while the doctor checks for leaking
• A bladder function test (urodynamics), which measures the pressure in your bladder and how much it holds
• A cystoscopy, where a thin tube with a small camera is used to look inside the bladder

Not everyone needs every test. Your doctor will suggest only the ones that help in your situation.

You may be asked to keep a bladder diary for a few days. In it, you note when you pass urine, how much you drink, and when any leaks happen. This helps show a pattern and points to what is causing the problem, which makes it easier to choose the right treatment.

Treatment depends on the type of incontinence and how much it affects you. It often starts with simple, everyday steps and pelvic floor exercises, which help many women. It can take a few weeks or longer to notice a change, and sometimes more than one approach is used together. Your doctor will talk through what suits you.

Small changes can ease symptoms and support other treatments:

• Reaching or keeping a healthy weight, to lower the pressure on your bladder
• Cutting back on caffeine and alcohol, which can irritate the bladder
• Treating constipation, so you are not straining
• Stopping smoking, as a long-term cough can make leaking worse
• Drinking a normal amount of fluid — cutting back too much can make urgency worse, not better

Pelvic floor exercises strengthen the muscles that support the bladder, and they are a first step for stress incontinence. A common guide is to hold each squeeze for 3 to 8 seconds, and to do 8 to 10 squeezes, three times a day. Focus on control rather than counting. Many women notice a change within 6 to 8 weeks, with more improvement over about 12 weeks of regular practice. A pelvic floor physiotherapist or a nurse continence specialist can check your technique, which makes the exercises work better. Dr Mahadik can refer you if that would help.

Bladder training helps most with urge incontinence and an overactive bladder. The idea is to gradually stretch the time between toilet visits so the bladder learns to hold more. It is usually guided by a continence physiotherapist or nurse and often uses a bladder diary alongside pelvic floor exercises. Bladder training usually takes up to about 3 months, and many women find they go less often and feel more in control.

While you work on treatment, you may want to use pads made for urinary leaking, or protective underwear, so you feel comfortable and confident. These manage the leaking rather than treat it, but they can help day to day.

If everyday changes and exercises are not enough, there are other options, and the right one depends on the type of incontinence:

• For an overactive bladder, medicines can help calm the bladder muscle. As with any medicine, do not start or stop it without medical advice.
• After menopause, vaginal oestrogen is sometimes used to help the tissues around the bladder — your doctor can explain whether it is suitable for you.
• If a prolapse is contributing, your doctor may discuss a pessary (a support placed in the vagina) or, in some cases, surgery.
• For stress incontinence that does not settle with exercises, your doctor may talk through further options, including surgery.

Dr Mahadik will explain which options fit your type of incontinence, and what each involves, so you can decide together.