• Weakened pelvic floor muscles — a common cause of stress incontinence, weak pelvic floor muscles reduce the bladder’s support and compromise urethral control. Pregnancy, childbirth, menopause, obesity, and chronic straining from constipation or heavy lifting can lead to muscle weakness, which increases the risk of leakage during physical activities such as coughing, sneezing, or exercising.
• Nerve damage — the brain, spinal cord, and peripheral nerves control bladder function, and any damage to these pathways can lead to incontinence. Neurological conditions such as multiple sclerosis, Parkinson’s disease, stroke, diabetes, or spinal cord injuries can interfere with bladder signals, causing either involuntary contractions (urge incontinence) or incomplete emptying (overflow incontinence).
• Hormonal changes — Oestrogen helps maintain the strength and elasticity of the bladder and urethral tissues. After menopause, declining oestrogen levels can weaken these structures, which makes them less effective in controlling urine flow. This hormonal shift is a common factor in stress and urge incontinence among postmenopausal women.
• Urinary tract infections — infections in the bladder can cause inflammation and irritation, leading to sudden urgency, frequent urination, and occasional leakage. Though usually temporary and treatable, recurrent infections can contribute to long-term bladder dysfunction, especially in older adults.
• Bladder obstruction — any blockage in the urinary tract can interfere with normal bladder emptying, resulting in overflow incontinence. In men, an enlarged prostate (benign prostatic hyperplasia) may obstruct the urethra, which makes urination difficult. Other causes include bladder stones, tumours, and scar tissue from previous surgeries, all of which can lead to urine retention and involuntary leakage.
• Certain medications — some medications affect bladder control by increasing urine production or altering nerve signals. Diuretics (water pills) stimulate excessive urine output, while sedatives, muscle relaxants, and some antidepressants can impair bladder contractions or reduce awareness of the urge to urinate, increasing the risk of incontinence.
• Lifestyle factors — daily habits can influence bladder health and contribute to incontinence. Caffeine, alcohol, and carbonated drinks act as bladder irritants, increasing urgency. Smoking can lead to chronic coughing, which weakens pelvic muscles over time. Excess body weight places additional pressure on the bladder, while frequent constipation can strain the pelvic floor, further exacerbating bladder control problems. 

While urinary incontinence can be distressing, identifying its cause allows for targeted treatments that significantly improve bladder control and quality of life.