# Why Women Stay Silent About Incontinence and How to Treat It
There are topics that are whispered about, if discussed at all. Urinary incontinence in women is one of them. Although it is a condition that, according to estimates by the World Health Organization, affects up to one third of women during their lifetime, it remains shrouded in silence, shame, and unnecessary taboo. Women buy pads, adjust their clothing, limit outings, and avoid situations where "it might happen" – all while not confiding in their closest friend or even their gynaecologist. Why this is the case and what can be done about it are questions that deserve an open and straightforward answer.
The silence around incontinence is not accidental. We grow up in a culture where bodily control is associated with dignity and adulthood, and the loss of this control – even if only partial – evokes weakness or old age. Yet incontinence has no age. It affects twenty-year-old athletes after childbirth, forty-year-old women going through menopause, and older women who have led active lives their whole lives. It is a physiological condition, not a failure. And that is exactly how it should be discussed.
Try our natural products
What is actually happening in the body
In order to understand incontinence, it helps to know what causes it. Most commonly, it involves stress incontinence, in which urine leaks during physical exertion – when coughing, laughing, jumping, or running. The pelvic floor muscles, which hold the bladder in place and ensure closure of the urethra, are weakened or damaged. The second common form is urge incontinence, where a woman feels a sudden, uncontrollable urge to use the toilet and cannot make it in time. Sometimes both forms occur together – this is referred to as mixed incontinence.
There are many causes. Pregnancy and childbirth are among the most common, as the pelvic floor bears an enormous load during pregnancy and vaginal delivery can cause injury to it. Menopause also plays a key role – the decline in oestrogen levels causes the tissues in the pelvic region and urinary tract to lose their elasticity and firmness. Chronic constipation, obesity, recurrent urinary tract infections, and certain medications also contribute. It is important to know that incontinence is not an inevitable consequence of ageing – it is a condition that has causes and that can be treated.
Consider Markéta, a forty-four-year-old teacher and mother of two. After her second birth, she noticed that when jumping on a trampoline with her children or when coughing, she experienced a slight urine leak. At first she dismissed it, stopped going to aerobics, adjusted her choice of clothing, and started wearing pads every day. It took three years before she mentioned it to her gynaecologist – and only because the doctor asked herself. Markéta thought it was "normal after having children." She was not alone. There are thousands of stories like hers.
This very normalisation is one of the biggest problems. Women tell themselves that "it's just the way things are," that "all mothers go through this," or that "it comes with age." In doing so, however, they delay solutions that are, in many cases, surprisingly accessible and effective.
How to address incontinence – from exercise to modern aids
The good news is that there are truly many options for addressing or significantly reducing incontinence. It depends on the type, severity, and individual circumstances of each woman, but in the vast majority of cases there is a path that leads to an improved quality of life.
The first step that doctors almost always recommend is strengthening the pelvic floor. Kegel exercises – rhythmic contracting and releasing of the pelvic floor muscles – are a simple yet very effective method when performed correctly and regularly. The problem is that many women exercise incorrectly, because the pelvic floor is a muscle group that cannot be seen or easily felt. It is therefore ideal to start with an experienced physiotherapist specialising in the pelvic floor, who can use biofeedback or manual examination to verify that the woman is actually activating the muscles correctly. Results are not immediate – it usually takes eight to twelve weeks of regular exercise before noticeable improvement occurs – but studies published, for example, in the journal Neurourology and Urodynamics confirm that pelvic floor exercise is one of the most effective conservative treatment methods for stress incontinence.
Alongside exercise, lifestyle adjustments also play a role. Reducing body weight in overweight women can significantly decrease pressure on the pelvic floor and thereby reduce the frequency of leaks. Limiting caffeine and alcohol, which irritate the bladder, can help with urge incontinence. Proper hydration is also important – paradoxically, restricting fluid intake, which women with incontinence often resort to, worsens the situation, because urine becomes more concentrated and irritates the bladder more.
When conservative approaches are not sufficient, medical options are available. For urge incontinence, medications from the group of antimuscarinics or beta-3 agonists, which reduce bladder hypersensitivity, have proven effective. In some cases, botulinum toxin injected directly into the bladder wall is used, or the method of tibial nerve stimulation – stimulation of a nerve in the ankle area that influences the nervous control of the bladder. For more severe cases of stress incontinence, surgical procedures exist, such as TVT (tension-free vaginal tape), which have a high success rate.
Modern incontinence aids form a separate chapter and have changed significantly in recent years. While disposable pads and nappies once dominated, today there are fabric incontinence underwear, washable pads, and period pants with an absorbent layer that are also suitable for lighter incontinence. These products are not only more environmentally friendly and economical, but also more discreet and comfortable – they look like ordinary underwear and a woman feels normal in them, not like a patient. This kind of solution does not, of course, treat the underlying cause, but it significantly improves everyday comfort and gives women the freedom of movement without fear of an embarrassing situation.
There is also the vaginal pessary – a silicone device inserted into the vagina that mechanically supports the pelvic floor and can significantly reduce leaks during physical exertion. It is an unobtrusive, effective, and reversible solution that is commonly used in some countries, but remains little known in the Czech Republic.
As physiotherapist and pelvic floor specialist Markéta Krhutová said in an interview for a professional portal: "Women come in saying they are simply putting up with it. But incontinence is not a cross to be borne – it is a condition that can be worked with."
Why it is important to stop staying silent
The silence around incontinence has concrete consequences. Women who do not address their condition limit their physical activity – and thereby paradoxically contribute to further weakening of the pelvic floor and overall health. They avoid social situations, suffer from anxiety, and in more severe cases, depression as well. Research published in the International Journal of Environmental Research and Public Health showed that incontinence significantly reduces quality of life and is associated with higher rates of social isolation and psychological distress.
Yet a single honest conversation with a doctor or physiotherapist is all it takes to set things in motion. Gynaecologists and urologists are prepared for these topics – for them it is an everyday part of their work, not an awkward exception. The shame is unnecessary and treatment is more accessible than most women realise.
Awareness and open sharing of experiences can also play a major role. When one woman says aloud that she has incontinence and is dealing with it, she gives others permission to do the same. Online communities, support groups, or simply an open conversation with a friend can be the first step towards a woman realising that this is not a fate to be endured, but a condition that can be addressed.
Another important aspect is prevention. Ideally, caring for the pelvic floor should not begin only when the first urine leaks occur, but much earlier – during pregnancy, after childbirth, but also perfectly well at the age of thirty as part of overall health care. Just as we visit the dentist preventively, a visit to a physiotherapist specialising in the pelvic floor could become a standard part of women's healthcare. In some countries, such as France, pelvic floor physiotherapy after childbirth is even covered by health insurance as a standard part of postnatal care. The Czech Republic is still waiting for this approach, but awareness of its importance is gradually growing.
Urinary incontinence in women is widespread, treatable, and unnecessarily taboo. Every woman who reads this text and recognises her own story in it should know that she is not alone and that there are concrete steps she can take – whether that is pelvic floor exercise at home, a visit to a physiotherapist, a conversation with a gynaecologist, or purchasing comfortable and eco-friendly underwear that restores her sense of confidence. Quality of life matters. And every woman deserves it – regardless of age, number of births, or how ashamed she feels about talking about her body.
