Leaking a little urine when you cough, laugh, sneeze or go for a run is something a lot of women deal with quietly, often for years, before they ask for help. It is called stress urinary incontinence (or SUI), and it is one of the most common pelvic floor issues affecting Australian women. It is also one of the most treatable. Pelvic health physiotherapy is recommended as a first step for managing stress incontinence, and for many women it makes a real and lasting difference.
What is Stress Urinary Incontinence?
Stress urinary incontinence is the accidental leaking of urine that happens during moments of increased physical stress on your bladder. This might show up as a small dribble when you sneeze or laugh, or as a bigger leak when you are running, jumping or lifting something.
This is different from urge incontinence, which involves a sudden, strong need to get to the toilet, sometimes with very little warning. Some women experience a combination of both, which is known as mixed incontinence.
Why does Stress Incontinence happen?
To understand stress incontinence, it helps to picture how your bladder normally stays in control. To maintain continence, there needs to be enough pressure around the urethra (the tube that carries urine out of the body) to keep it closed. This closing pressure comes from multiple things including the pelvic floor muscles, connective tissue, urethral sphincters and hormone levels. When there is not enough strength or support in this system, urine can escape.
Pregnancy and Childbirth
Pregnancy and childbirth are among the most common reasons the pelvic floor becomes weaker. Regardless of how the baby gets delivered, the hormonal changes of pregnancy and the additional weight in the uterus, places extra strain on the pelvic floor and surrounding tissue. Additionally, labour and the pushing stage of birth can stretch and weaken them further.
Menopause and Hormonal Change
As oestrogen levels fall during perimenopause and menopause, the tissues supporting your bladder and urethra can lose some of their strength and elasticity. This is one of the reasons stress incontinence becomes more common as women move through midlife.
Other Contributing Factors
A number of other factors can also play a part. These include a long-term cough from conditions such as asthma or smoking, constipation and straining on the toilet, carrying extra body weight, high impact exercise or heavy lifting, and the natural changes that come with ageing. Often several of these factors overlap, which is why a personalised assessment is so useful.
How Common is Stress Urinary Incontinence in Australia?
Urinary incontinence is far more common than many women realise. Around one in three Australian women will experience some form of urinary incontinence in their life, and stress incontinence is the type most often reported. Data from the Australasian Menopause Society suggests roughly one in five women experience stress incontinence, with the likelihood rising to around one in three among women who have had a baby, compared with about one in ten among women who have not.
It is a common myth that leaking is simply something you have to put up with after having children or as you get older. While these life stages do increase your risk, stress incontinence is not something you need to accept as inevitable. With the right support, symptoms can improve, and for many women, resolve.
Signs you might have Stress Incontinence
Stress incontinence can look different for every woman. You might notice a few drops of urine when you sneeze, laugh or cough. You might find you leak while running, jumping, doing a workout or playing sport. Some women notice it when lifting something heavy, such as a toddler or the shopping. The amount can range from a small dampness you barely notice to enough that you feel you need to change your underwear or wear a pad. However it shows up for you, it is worth having it properly assessed rather than simply working around it.
How is Stress Urinary Incontinence diagnosed?
A good starting point is a conversation with your GP or a women’s health physiotherapist. They will usually ask about your symptoms, your birth and medical history, and when leaking tends to happen. A physical examination often follows, which may include being asked to cough or gently bear down so your clinician can see what is happening with your pelvic floor. You might also be asked to keep a simple bladder diary for a few days, recording your fluid intake and when leaking occurs, as this helps identify patterns.
At Active Women’s Health, your physiotherapist will complete a detailed interview and offer a thorough physical assessment of your pelvic floor, sometimes using real time ultrasound to help you see and feel your muscles working. In more complex cases, your GP may refer you on for further testing, such as urodynamic studies, or to a specialist urogynaecologist.
How Physiotherapy Helps with Stress Incontinence
Pelvic health physiotherapy is widely recommended as an early and effective way to manage stress incontinence, and for many women it is enough on its own to see real improvement.
Learning to Activate Your Pelvic Floor Correctly
Many women assume they are doing pelvic floor exercises correctly, but a large number are not activating the right muscles, or are using their thighs, buttocks or tummy instead. A physiotherapist can check that you are contracting and relaxing your pelvic floor properly. This is the essential first step before any strengthening program can be effective.
A Personalised Strengthening Program
Once you can feel and control your pelvic floor, your physiotherapist will guide you through a tailored exercise program built around your symptoms, lifestyle and goals. This usually covers both the strength and endurance side of pelvic floor training, alongside broader advice on general fitness and movement.
The Knack Technique
One practical strategy your physiotherapist may teach is sometimes called the knack. This involves gently squeezing and lifting your pelvic floor just before you cough, sneeze, laugh or lift something, which helps support your bladder neck at the exact moment pressure increases.
Bladder and Lifestyle Habits
Treatment is not only about exercises. Your physiotherapist can also help with practical strategies around fluid intake, toilet habits and managing your personal triggers, alongside guidance on how to stay active safely while your pelvic floor rebuilds strength.
Getting Started with Pelvic Floor Exercises
Finding your pelvic floor muscles is the first step. A common way to locate them is to imagine trying to stop yourself passing wind, while also gently lifting as though stopping the flow of urine, without tightening your buttocks, thighs or stomach. Once you can feel this lifting sensation, you can begin practising a gentle contract, hold and release pattern, always breathing normally rather than holding your breath. Many women notice some improvement within a matter of weeks with regular practice, though it often takes several months of consistent training to see the full benefit. Because every woman’s pelvic floor is different, a personalised program from a pelvic health physiotherapist gives you the best chance of doing these exercises correctly and effectively.
When Pelvic Floor Exercises are Not Enough
For most women, pelvic floor physiotherapy is the recommended first line treatment for stress incontinence. If symptoms do not improve with a supervised exercise program, your GP or physiotherapist may talk with you about other options. These can include a continence pessary for extra support, or a referral to a specialist urogynaecologist to discuss further medical or surgical options. Surgery is generally only considered once physiotherapy and other conservative approaches have been tried without enough improvement.
When Should You See a Pelvic Health Physiotherapist?
It is worth booking an assessment if you notice any leaking with coughing, sneezing, laughing, exercise or lifting, even if it feels minor. You should also seek support if you cannot feel your pelvic floor muscles working, if you notice a bulge or heaviness in your vagina, if exercises feel painful, or if your symptoms have not improved after a few weeks of trying on your own. Support after birth or pelvic surgery is valuable too, even without symptoms, as an assessment can help protect your long term pelvic health.
Frequently Asked Questions
Stress incontinence happens when there is an increased physical pressure in the abdomen, such as coughing or exercise, which results in leaking. Urge incontinence involves a sudden, strong need to urinate that can be hard to control in time. Some women experience both together, which is known as mixed incontinence.
Many women see significant improvement with pelvic floor physiotherapy, and for some, symptoms resolve completely. Others find their symptoms are well managed even if they do not disappear entirely. Your physiotherapist can give you a realistic picture based on your individual assessment.
Yes. Pelvic floor exercises are considered a first line treatment for stress incontinence. Doing them correctly, with guidance from a pelvic health physiotherapist, gives you the best chance of a good outcome.
Some women notice small improvements within a few weeks of consistent practice, but it often takes several months to build the strength and control needed for lasting change. Your physiotherapist will help you track your progress along the way.
Leaking after having a baby is common, but that does not mean it is something you have to accept permanently. Pelvic floor changes after birth often improve with time and the right support, and a physiotherapy assessment can help guide your recovery.
Yes. While pregnancy and childbirth increase the risk, stress incontinence can also affect women who have never had children, particularly with high impact exercise, a long term cough, or as part of the changes around menopause.
Your physiotherapist will talk with you about your symptoms and history, then offer a physical assessment of your pelvic floor. This may include real time ultrasound to help you see your muscles working. From there, they will work with you to build a treatment plan suited to your goals.
Not necessarily. Your physiotherapist can help you understand what is happening and adjust your exercise routine while you build strength, rather than having to give up the activities you enjoy.
It is worth seeking support any time leaking affects your confidence or daily life, or if it has not improved within a few weeks of trying pelvic floor exercises on your own. Early assessment often leads to better outcomes.
This article is general information only and does not replace individual medical advice. Every woman’s pelvic floor and symptoms are different, so please speak with your GP or a qualified pelvic health physiotherapist for an assessment and treatment plan suited to you.
References
Active Women’s Health – Continence Physiotherapy for Women
Jean Hailes for Women’s Health – Bladder Health
Australasian Menopause Society – Urinary Incontinence in Women
The Royal Women’s Hospital – Urinary Incontinence
Continence Health Australia – Stress Incontinence; Pelvic Floor Exercises for Women
healthdirect Australia – Pelvic Floor Exercises
Prepared by Plain Speaking Health | August 2026
Contributing authors: Dipthi Samalia; Bethan Perel; Danielle Morrison
