The Two Main Types
Most urinary incontinence falls into one of two categories — and the right treatment depends on which one you have. (Many people have both, called "mixed incontinence.")
Stress Incontinence
Leakage triggered by physical exertion or pressure — coughing, sneezing, laughing, jumping, running, lifting. It happens when the pelvic floor muscles can't hold in urine against sudden abdominal pressure. Common in women post-childbirth, in athletes, and in men after prostate surgery.
Urge Incontinence (Overactive Bladder)
A sudden, strong, often unmistakable urge to urinate — sometimes followed by leakage before you can get to the bathroom. The bladder contracts when it shouldn't. Common in women in perimenopause and menopause, in men, and in anyone who's developed habits that train the bladder to be on high alert.
How We Treat It
1. Comprehensive Evaluation
Your first visit identifies which type of incontinence you have (or what mix), assesses pelvic floor strength and coordination, evaluates how your core, posture, and breath interact with bladder function, reviews your fluid intake and bathroom habits, and checks for related conditions like prolapse or constipation that may be contributing.
2. Pelvic Floor Strengthening (Done Right)
For incontinence, the foundation is rebuilding the strength, endurance, and reflexive function of the pelvic floor. We do this by building up the pelvic floor using exercises commonly called "Kegels". Most people who say "I did Kegels and they didn't work" were doing them incorrectly, were not training them correctly, or didn't need to do them in the first place. We teach you how to engage the right muscles, integrate them with breath and movement, and progress to load. We often use biofeedback to teach you the correct way to use and coordinate these muscles.
3. Bladder Retraining
For urge incontinence, we retrain your bladder. We work on calming the overactive signaling, lengthening time between bathroom trips, and breaking habits like "just in case" peeing that perpetuate the cycle. Most patients see substantial improvement within 4–6 visits.
4. Down-Training (When the Pelvic Floor Doesn't Relax)
Counterintuitively, some incontinence is caused by a pelvic floor that's too tight or doesn't fully relax. Engaging these muscles without teaching them how to "let go" can sometimes make symptoms worse. We assess tone carefully and treat accordingly — including manual therapy, biofeedback, breath work, and relaxation techniques.
5. Integration With Daily Life
Whether you're an athlete training for a race, a new mom returning to the gym, a man recovering from prostate surgery, or someone who just wants to laugh without worrying — we build your recovery around your actual life. We don't release you with "good luck and keep doing your kegels."
For Men: Incontinence After Prostate Surgery
Urinary incontinence after prostatectomy is common and very treatable with pelvic floor PT. We see men at every stage — pre-surgery to prepare, immediately post-catheter, weeks out struggling with leakage, and years out who were never told PT could help. Read more on our post-prostatectomy recovery page.
For Women: Post-Childbirth and Menopause
Post-childbirth leaking is the most common form of stress incontinence we see. Menopause-driven urge incontinence is the second. Both respond well — and the earlier we start, the faster the resolution. There's no minimum or maximum time after delivery or menopause onset to begin treatment.
What Most People Don't Realize
Urinary incontinence is treated with medication, pads, and (occasionally) surgery in the standard medical model. The American College of Physicians and other major medical organizations recommend pelvic floor PT as first-line treatment. It works on the muscle and coordination problems behind the leakage rather than masking them, and does so without the side effects that come with medication.
If you've been told "this is just part of aging" or "this is just part of having kids" — that advice is wrong. Both groups respond beautifully to PT.
What Your First Visit Looks Like
Your first appointment is a full 60-minute evaluation, one-on-one with your physical therapist. We start by listening: when the leaking happens, what triggers it, and how long it's been going on. Then we go through your bladder habits and fluid history — how often you go, what you drink and when, whether you're going "just in case."
Next we assess the whole body, not just the pelvic floor: back, hips, core, breath mechanics, and the movement patterns that put pressure on your bladder. If you're comfortable, we offer an internal assessment of pelvic floor strength, coordination, and timing — the most direct way to see what the muscles are actually doing. It's always optional and never required on a first visit.
You'll leave with an objective baseline, a clear explanation of what's driving the leaking, and the first steps of your plan. Read more about what to expect at your first visit.
How We Measure Progress
Incontinence is one of the most measurable conditions we treat. Depending on your case, we track progress with bladder diaries, biofeedback that shows your pelvic floor working in real time, and pad-weight testing — literally weighing pads to quantify how much urine you're losing. It's not based on feeling; it's based on objective data.
Frequently Asked Questions About Urinary Incontinence
Is leaking normal after childbirth or with age?
It's common — and common doesn't mean normal. Leaking is a sign that the system controlling your bladder isn't managing pressure the way it should, and that system responds to treatment at any age. Being decades past childbirth, or well into menopause, doesn't make you a lost cause.
Do I just need to do more Kegels?
Not necessarily. Kegels help when weakness is the real problem and when they're done correctly — most people we assess are doing them wrong. If your pelvic floor is actually too tight, Kegels can make leaking worse. That's why we assess before we prescribe anything.
How many visits will this take?
It depends on the type of incontinence and how long you've had it. Many patients notice meaningful change within the first several visits; longstanding or mixed cases take more time. Because we track objective measures from day one, you'll know early whether the plan is working.
Does insurance cover treatment?
We accept Medicare as a non-participating provider: you pay at the time of the visit, we submit the claim, and Medicare reimburses you directly. For other plans, we submit out-of-network claims automatically on your behalf, and HSA and FSA funds can be used.
I've had this for twenty years. Is it too late?
No. Muscles respond to training at every age, and bladder habits can be retrained whether the pattern is two years old or twenty. Longstanding incontinence may take longer to change, but the approach works the same way — and starting now beats waiting another year.