A. Why Are Women More Likely to Experience Urinary Leakage?
Are women more prone to urinary incontinence than men? Why is that?
Clinically, women do experience urinary incontinence more frequently than men. This is mainly due to several factors:
First, women naturally have a shorter urethra.
Second, throughout their lifetime, women undergo pregnancy and childbirth. In addition, after menopause, declining hormone levels further affect pelvic floor support.
When the pelvic floor muscles and connective tissues become weakened or lose adequate support, increases in intra-abdominal pressure—such as during coughing or exertion—can more easily result in stress urinary incontinence.
There are also several well-recognized risk factors for urinary incontinence in women; please refer to the related article for further details.
B. Will Postpartum Urinary Leakage Resolve on Its Own?
As mentioned earlier, pregnancy and childbirth can lead to urinary incontinence. But will postpartum urinary leakage improve spontaneously?
This is one of the most common concerns among new mothers.
According to clinical data, urinary incontinence during pregnancy and after childbirth is very common, affecting approximately 40% of pregnant women.
Indeed, some women experience gradual improvement within a few months postpartum.
However, clinical observations show that in about 30% of women, urinary leakage persists and may significantly impact quality of life.
Therefore, postpartum urinary incontinence does not always resolve on its own. If symptoms persist, active intervention is recommended—whether through self-directed rehabilitation or by seeking professional medical care.
C. What Causes Postpartum Urinary Incontinence?
What Roles Do Pregnancy, Childbirth, and Parity Play?
Postpartum urinary incontinence is usually not caused by a single factor. During pregnancy, hormonal changes combined with progressive uterine enlargement place continuous stress on the pelvic floor.
During childbirth—particularly vaginal delivery—the pelvic floor muscles, nerves, fascia, and connective tissues may be stretched or injured.
Parity is another important factor. With increasing numbers of deliveries, the cumulative burden and fatigue on the pelvic floor muscles increase, thereby raising the risk of urinary incontinence.
For more details, please refer to the article discussing risk factors and mechanisms of injury.
D. Does Cesarean Delivery Prevent Urinary Incontinence?
Many women believe that choosing cesarean delivery can prevent postpartum urinary incontinence. Is this medically accurate? Is the risk truly that different between delivery modes?
This is a very common misconception. Women who undergo cesarean delivery can still develop urinary incontinence—it is not exclusive to vaginal delivery.
Statistically, vaginal delivery is associated with a higher risk of urinary incontinence than cesarean delivery; however, cesarean section does not completely eliminate the risk.
This is because pregnancy itself already places significant stress on the pelvic floor. Therefore, regardless of the mode of delivery, pelvic floor recovery after childbirth is important.
E. What Type of Urinary Incontinence Do You Have?
Before starting treatment, is there a simple way for women to roughly identify the type and severity of urinary incontinence at home?
Initial assessment can often be based on symptoms:
- If urine leakage occurs during coughing, sneezing, running, or lifting heavy objects—situations associated with increased abdominal pressure—it is most commonly stress urinary incontinence.
- If leakage occurs with a sudden, strong urge to urinate and an inability to reach the toilet in time, it is more suggestive of urge urinary incontinence.
- Some women experience both patterns, which is classified as mixed urinary incontinence.
Clinical Grading of Stress Urinary Incontinence
Stress urinary incontinence is clinically classified into four grades:
- Grade 1 (Mild): Occasional leakage only with sudden increases in abdominal pressure, such as forceful coughing, sneezing, jumping, or lifting heavy objects.
- Grade 2 (Moderate): Frequent leakage during activities that increase abdominal pressure, such as brisk walking, climbing stairs, running, or laughing.
- Grade 3 (Severe): Leakage occurs upon standing or during normal movements, such as walking, changing posture (from sitting to standing), or performing household chores.
- Grade 4 (Very Severe): Continuous leakage occurs regardless of posture, including while resting or turning over in bed.
If urinary leakage interferes with daily activities or occurs simply upon standing or walking, further medical evaluation and treatment are strongly recommended.
F. How Is Urinary Incontinence Treated?
How is urinary incontinence managed clinically? What treatment options are available?
Treatment options generally include the following:
a. Lifestyle Modifications
- e.g., Smoking cessation, Weight loss, Avoidance of alcohol and caffeine
b. Behavioral and Physical Therapies
- e.g., Bladder training (timed voiding), Pelvic floor muscle training (PFMT), Percutaneous tibial nerve stimulation
c. Pharmacological Management
- e.g., Antimuscarinic agents, β3-adrenergic receptor agonists, Topical estrogen therapy for postmenopausal women with stress urinary incontinence and vulvovaginal atrophy
d. Surgical Treatment
- e.g., Open or laparoscopic colposuspension, Autologous fascial sling procedures, Urethral bulking agents, Mid-urethral sling procedures (MUS), Artificial urinary sphincter, Adjustable compression devices (ACT©)
In addition to the above treatments, non-pharmacological and non-invasive high-intensity magnetic stimulation therapy is also available. This modality helps train pelvic floor muscles and promotes connective tissue repair while avoiding medication-related side effects and surgical risks. In recent years, it has become a treatment option that balances both safety and therapeutic effectiveness.
