Prevention: what you can do now

Keep a healthy weight

Extra weight presses constantly on the bladder and pelvic floor — a bit like a constant mild cough. In the study of women in Kazakhstan, a body mass index of 25 kg/m² or more was linked to twice the odds of urinary incontinence.

The good news is that it works the other way too. In the American PRIDE trial, overweight women who lost an average of 8% of their weight over six months had almost half as many leaks. Even 5–10% of your starting weight makes a noticeable difference.

Train your pelvic floor

Regular training strengthens the "hammock" that supports the bladder and urethra. It's good for everyone, but especially:

• during pregnancy — starting with the first;
• after birth, once your doctor says it's safe;
• around menopause;
• if you do sports involving jumping and running.

A few minutes 3 times a day is enough. See Pelvic floor muscle training for technique and a plan.

Avoid constipation

Every time you strain on the toilet, the pelvic floor is stretched and weakened, and a full bowel presses on the bladder. What helps:

• vegetables, fruit, pulses, wholegrain bread and cereals — sources of fibre;
• enough fluid;
• a daily walk or other activity;
• a good toilet position: a small footstool so your knees are higher than your hips, lean forward, breathe calmly without straining.

Drink enough, but not to extremes

Many women who notice leaks start drinking less. That's a mistake: concentrated urine irritates the bladder, increases urgency and raises the risk of infections and constipation. Drinking too much, on the other hand, sends you to the toilet more often.

For most adults, around 1.5–2 litres of fluid a day is a good guide, more in hot weather and with exercise. The best sign is pale, straw-coloured urine and no thirst. If you often get up at night, drink most of your fluid earlier in the day and cut down in the 2 hours before bed.

Watch caffeine and alcohol

Coffee, strong tea, energy drinks, cola and alcohol increase urine production and can irritate the bladder. International guidelines suggest that women with frequent or sudden urges try reducing caffeine. You don't have to cut it out completely: try swapping some coffee for water, weak or herbal tea, and observe for 2–3 weeks.

For some women, fizzy drinks, citrus juices, spicy food and artificial sweeteners also make urges worse — it's individual, and a diary helps.

Treat a cough and stop smoking

Every cough sends a spike of pressure through the abdomen, hitting the pelvic floor. A smoker's cough, bronchitis, asthma or allergies mean constant strain. Stopping smoking and treating a chronic cough reduces it. While the cough lasts, get into the habit of tightening your pelvic floor just before you cough or sneeze.

Lift correctly

• bend your knees, not your back;
• keep the load close to your body;
• tighten your pelvic floor before lifting and breathe out during the effort instead of holding your breath;
• split heavy loads where possible.

The same rule applies at the gym: breathe out on the effort. If you leak during exercise, it's a signal to reduce the load and seek advice.

Bladder habits

• Don't go "just in case". Frequent trips without an urge teach the bladder to empty at smaller volumes. Passing urine 4–7 times a day is normal.
• Don't hold on for too long. Regularly delaying for many hours isn't good either.
• Don't rush on the toilet: sit down (don't hover), relax and let the bladder empty fully.

Menopause

After menopause, lower oestrogen makes the tissues of the vagina and urethra thinner, which can increase urgency and leakage. If you notice dryness, burning or frequent urges, talk to a gynaecologist: local vaginal oestrogen works well for many women.

Early detection

If leaks have already started, don't wait for them to get worse. The earlier conservative treatment starts, the better the result usually is. Take the short ICIQ-SF test and discuss the result with your doctor at your next appointment.

Sources

1. NICE guideline NG123. 2019. nice.org.uk
2. Subak LL, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481–490.
3. Ryspayeva Zh, et al. IJERPH. 2026;23(7):893. mdpi.com
4. Woodley SJ, et al. Pelvic floor muscle training for preventing and treating urinary and faecal incontinence in antenatal and postnatal women. Cochrane Database Syst Rev. 2020;5:CD007471.