Stress Incontinence vs. Overactive Bladder: What’s the Difference?

Your bladder is c-r-a-n-k-y. That you know for sure. At the most inconvenient times—during an important business meeting, when you’re in line at the checkout counter, or even when you’re having sex—your bladder will just decide without warning or care that it needs to pee. Frankly, it’s awful.

You may assume your urges are symptoms of an overactive bladder, because hey, that’s what Google said it sounded like. The thing is, however, there are different conditions that can cause a high-maintenance bladder. If you’re not sure which one you’re dealing with, you may not get the right treatment to make it (and you) happy again.

“It’s very difficult to get the results you’re looking for with self-diagnosis and self-treatment,” says Lauri Romanzi, MD, a urogynecologist in New York City. Misdiagnosing yourself with a certain kind of incontinence or bladder problem may cause frustration and anxiety, especially if you’re trying to treat yourself and what you’re doing doesn’t seem to be working. “And, no surprise, the anxiety makes everything worse, particularly the overactive bladder,” says Dr. Romanzi.

The only way to know for sure what’s causing your bladder issues is to see your doctor. Still, knowing the three basic types of incontinence—stress incontinence, overactive bladder, and mixed incontinence—can help give you a clue to what’s going on down there. Here’s what each of them means, so you get on the right track to treat your symptoms.

1. Stress incontinence

“Stress incontinence is caused by a weakness in the urethral closure mechanism (sphincter), that allows urine to squirt out when there’s a lot of abdominal pressure,” says Dr. Romanzi. Typically, abdominal pressure increases when you sneeze, cough, change position, lift something heavy, or engage in high-impact physical activity, like running or jumping.

Stress incontinence is the most common type of incontinence in younger women, with the highest incidence occurring in women ages 45 to 49 years. Women who’ve been pregnant and had a vaginal delivery, or who have pelvic prolapse (when your bladder moves down from its normal place and pushes against the vagina) are also at increased risk for stress incontinence.  

2. Overactive bladder

“Overactive bladder is caused by a bladder that is literally going into a urination reflex when you’re not on the toilet—so it really is overactive,” says Dr. Romanzi. The textbook definition of overactive bladder is urinary urgency with or without urge incontinence; there are four basic symptoms:

• Urgency: Needing to go to the bathroom suddenly
• Frequency: Needing to go to the bathroom often
• Nighttime voiding: Needing to use the bathroom at night
• Urge incontinence: Leaking urine because you couldn’t get to the bathroom fast enough

Overactive bladder and urge incontinence are more common in older women and may be associated with certain conditions that occur with age, like menopause, or cognitive and nerve problems.

3. Mixed incontinence

Mixed incontinence is when women have elements of both stress incontinence and overactive bladder symptoms. This tends to be more common in women who’ve had a few children, says Dr. Romanzi.

How to Treat OAB, Mixed and Stress Incontinence

Treatments options for incontinence depend on how the symptoms affect your life, but they usually include one or a combination of the following: lifestyle or behavior changes (such as avoiding bladder-irritating foods, drinking the right amount of water, or starting a bladder diary), medication, or surgery.  

Kegel exercises can help treat overactive bladder, stress incontinence and mixed incontinence. “Kegel exercises can be done on your own, or you can get coaching with a pelvic floor physical therapist,” says Dr. Romanzi. Here’s more on how to do a Kegel exercise.

If Kegel exercises or lifestyle and behavioral modifications don’t work to alleviate your overactive bladder or stress incontinence, then your doctor may recommend surgery or medications. “Ultimately for stress incontinence you may have a surgical procedure, and with urge incontinence you’re more likely to end up on a chronic regimen of bladder medications,” says Dr. Romanzi.