Did we run too much? Did we lift our children up without engaging our core properly? Should we have done more pelvic floor exercises in our twenties?
It's important to stop that self-flagellation, so let's get things straight: leaks don’t happen because you failed at anything. They happen because bodies change, hormones shift and life has a habit of putting pressure on the bits we can’t see. Here's many of the reasons that our bladder may become weaker over time, and stress and urge incontinence can start...
Pregnancy and birth: the changes no one warns you about
We kind of know already that pregnancy puts the pelvic floor under steady, unavoidable pressure. How many of us felt that low, deep, dragging pressure in the later stages of pregnancy?
But it's not just about how heavy our baby is (or was). Vaginal birth can stretch both the muscles and the connective tissue that support the bladder and urethra – and even when everything goes smoothly, that’s a huge amount of physical change on our pelvis. And if we don't know, or haven't been told how to rehabilitate our pelvic floor after birth, then it's no wonder that there is a lasting impact.
If fact, for women who have had children, leaks can appear many years later but be traced back to childbirth and pregnancy – even if you didn’t have symptoms at the time.
Hormones and hormonal fluctuation over time
Oestrogen plays a big role in keeping the tissues around the bladder and urethra firm, elastic and able to close properly. As we enter perimenopause, our hormone levels start to decrease, and those tissues naturally lose some of that hormone support.
This is why laughing, coughing or a quick run suddenly feels riskier than it used to. It isn’t something you’ve done wrong, it’s simply a hormone shift.
If you can take HRT, it can help support your pelvic floor by restoring the oestrogen that keeps the bladder, urethra and surrounding tissues firm and responsive. Local (vaginal) oestrogen adds direct support to the vulva, vagina and urinary tissues, improving moisture, strength and comfort. Together, they can make leaks, urgency and irritation easier to manage alongside pelvic floor exercises and good bladder habits.
Everyday life – how our day-to-day all adds up
Running, weight training, long days carrying toddlers or grandchildren on your hip – and even returning to exercise too quickly after surgery (such as for hysterectomy) or birth can put ongoing strain on the pelvic floor. But these things don’t cause incontinence on their own, they simply highlight weaknesses that were already there.
Most women who leak haven’t done anything unusual. They’ve just lived normally busy, active lives.
What we do know is that lifestyle factors such as smoking, drinking alcohol, significant weight gain and consistent strain can all contribute to our bladder weakness. That's why at Jude, we support a lifestyle, holistic approach to our bladder health. By eating a bladder healthy diet, cutting back on triggers such as caffeine, spicy foods, and booze, and incorporating gentle movement into our day to day can be transformative for our bladder health.
But it could be down to your genes
Some of us are born with connective tissue that’s naturally stretchier or pelvic floor muscles that fatigue more easily. It affects how well things hold up over time, and unfortunately, we can’t see it and you can’t change it. It’s simply how your body is built.
There are, however, things we can do to support our body's natural state through diet, exercise and learning to pee correctly to help look after our bladder and pelvic floor.
Changing our habits over time
Our bladder health can be down to a few surprising habits we've picked up over the years. For example, holding your wee for hours because you’ve got too much to do, going “just in case”, unmanaged constipation, not drinking enough water through the day (or only gulping down glassfuls at a time), hovering over loo seats… these all influence how the bladder behaves.
These habits are things we do to cope with our busy lives, kind of 'survival tactics', rather than mistakes. Making a mental note of them can help us to adjust these little habits that are having a big impact on our bladder health.
So… did you do this to yourself?
No! Absolutely not. Leaks aren’t a punishment for stuff we've done or times we've been through. They don’t appear because we didn’t try hard enough. They happen because we’ve carried children, lived your life, moved your body and hit a stage where hormones shift and the pelvic floor needs a bit more support.
What we can do for ourselves is important. Our pelvic floor can strengthen, and bladder habits can change. Oestrogen can be supported both through HRT and naturally, if you prefer. And we absolutely can improve our bladder health, because leaks are simply a signal to pay attention, not a sign that the damage is done.
