45% of menopausal women leak. Fifty percent. Half of us.
Most of them do nothing.
It’s embarrassing. It’s stressful. And frankly? It’s fixable.
You know the types. Stress incontinence—that little spill when you laugh, cough, or step off a curb. Urge incontinence—the panic sprint because you feel like you’ll lose it now. Overflow, where the bladder just won’t empty. Functional issues, where your body or the house itself keeps you from the bathroom in time. Or a mixed bag of the above.
A meta-analysis looked at nearly 84,00 women. Fewer than 3 out of 10 sought medical help. Why? Shame. Fear of exams. Fear of side effects.
Leslie Rickey, MD, sees it every day at Yale. “Women have a lot of options,” she says.
We keep messing it up, though. Here is how.
The ‘Just Part of Getting Older’ Lie
It’s convenient. Menopause strips away estrogen. Tissues get drier, weaker. Leaking becomes more common after 50. So we accept it. We buy the pads we see advertised on TV and assume this is the natural order of things.
Abigail Abbott, a pelvic floor PT in Mexico, sees women who have suffered in silence for years.
“If you have to wear a pad daily,” Abbott says, “that is not normal.”
It is not a badge of honor. It is not a rite of passage. It is a signal that something is wrong with the mechanics of your body, not your age.
Silence is a Self-Fulfilling Prophecy
Your doctor should ask. They usually don’t.
Most women won’t bring it up anyway. They sit on their hands (or worse, on a pad) and endure it. Abbott says you should just say it out loud. To the doctor. To your friends.
“You won’t be the first case,” Rickey notes.
These specialists do this day in and day out. They aren’t judging you. They’re fixing it. Talk to your friends too. If you mention it, you’ll get a nod. A I-know-what-you-mean nod.
Why is urine harder to talk about than a migraine? A broken toe? It’s not. But we act like it is.
You Are Too Tense, Not Too Weak
Here is the plot twist.
Everyone thinks they need to strengthen loose muscles. The problem is often that the pelvic floor is clenched shut. Too tight.
Socialization plays a role—sitting with legs crossed for decades. Unprocessed emotions tighten the core, including down there. Imagine holding your fist tight for hours. Then imagine trying to open it.
If you keep squeezing a muscle that’s already cramping, you’ll leak.
Physical therapists know this. They use breath work. They teach you how to relax, not just squeeze.
Kegels Are Probably Done Wrong
You know the name. Kegel. You’ve probably heard it a million times.
“Almost everyone does them incorrectly,” Abbott says.
Most people push down. Like they are pooping. That is the exact opposite of what you want to do.
Visualize squatting over a box of tissues. Pull a tissue out with your vagina. Or imagine sucking up a tiny blueberry with your pelvic floor. Short. Sharp. Internal.
Do quick flicks—30 to 40 a day. Hold long squeezes for 10 seconds. No more. Any longer and you’re just fatiguing the muscle.
And breathe. Long. Slow.
Stop doing Kegels when the surrounding muscles (abs, hips, back) are strong. The pelvic floor will learn its job on its own. It’s an introductory phase, not a lifetime sentence.
Surgery Is Not The End
It’s the last resort. Not the first thought.
Rickey tells patients: don’t suffer because you’re scared of the OR.
Start with PT. One to six visits can change the game if you do the home exercises. If that doesn’t work, there are meds. Low-dose vaginal estrogen. Mirabegron. Botox shots into the bladder. Nerve stimulation electrodes.
Surgery exists for stress incontinence (the sling procedure) or nerve issues for urge incontinence. Most are minimally invasive now. But it’s specific. One isn’t a cure-all.
“When people come to me,” Rickey says, “we discuss options. Risks. Benefits.”
You choose.
So, here you are. Knowing the stats. Knowing the anatomy. Knowing that silence costs more than the visit.
Are you going to wear another pad, or are you going to call a doctor?
That’s up to you. 🤷♀️
