If you’ve ever laughed a little too hard, sprinted across the street, or simply gotten older, you may have noticed your bladder has developed opinions of its own. You’re suddenly chagrined to discover that you’ve developed more than a passing acquaintance with urinary incontinence. Since my own prostate surgery, a little over 10 years ago, I’ve become all too familiar with the inconvenience and the embarrassment of urinary incontinence.
It’s one of those conditions that’s extraordinarily common and yet still gets talked about in whispers, if it gets talked about at all. That’s a shame, because it’s rarely something people simply have to live with. Roughly six in ten women and about one in seven men will deal with some form of it at some point. The reasons range from childbirth to prostate surgery to the ordinary business of getting older.
The bladder is essentially a muscular storage reservoir. As urine enters the bladder, the bladder muscle—the detrusor—normally remains relaxed while the urinary sphincter and pelvic floor help keep the outlet closed. When we decide to urinate, a coordinated neurologic process causes the bladder to contract and the sphincter to relax.
Incontinence is a disruption, either structural or physiological, of this process.
Let’s walk through the main types, how the picture differs for men and women, what surgery can do to bladder control, and why aging tilts the odds toward leakage without making it inevitable.
The Main Types, and Why the Distinction Matters
Doctors sort urinary incontinence into a handful of categories, and getting the category right matters because the treatments diverge from one type to the next.
Stress incontinence is the leakage that shows up during a cough, a sneeze, a laugh, or a heavy lift. It can occur at any moment when pressure inside the abdomen spikes and overwhelms a weakened sphincter or a poorly supported urethra.
Urge incontinence is a different animal entirely. It’s the sudden, hard-to-ignore need to go, often followed by leakage before you can get to a bathroom. It traces back to a bladder muscle that contracts on its own schedule rather than yours.
Plenty of people have some of both, which is fittingly called mixed incontinence and is in fact the most common pattern among women with bladder symptoms.
Then there’s overflow incontinence, a steady dribble that happens when the bladder never quite empties and eventually overflows. Frequently something, often an enlarged prostate in men, is partially blocking the outlet.
Functional incontinence isn’t really a bladder problem at all It happens when the bladder and urethra work fine but a physical or cognitive barrier, arthritis, dementia, an unfamiliar building, keeps you from reaching a toilet in time.
Reflex incontinence, less commonly discussed, involves the bladder contracting without any warning sensation at all, usually the result of nerve damage from conditions like multiple sclerosis or spinal cord injury.
How the Picture Differs Between Women and Men
Sex matters quite a bit here, both in how common incontinence is and in which type shows up. In women, stress incontinence is the single most common variety, and pregnancy and vaginal childbirth are the biggest reasons why. They stretch and sometimes injure the pelvic floor muscles and connective tissue that ordinarily keep the urethra snugly closed.
Menopause adds another layer, since declining estrogen thins the urethral lining and can weaken sphincter function further. Cleveland Clinic data estimate roughly 62 percent of women age twenty and older experience some form of incontinence, a striking number that reflects just how common, and how underreported, this condition is.
Men have a lower overall rate, on the order of 14 percent, but their pattern looks different. Because men don’t have the childbirth-related stresses on the pelvic floor, stress incontinence in men is less common on its own and shows up mainly after prostate surgery, which we’ll get to shortly.
Overflow incontinence is proportionally more of a male problem, since an enlarging prostate gland can squeeze the urethra and prevent the bladder from emptying completely.
Urge incontinence and overactive bladder symptoms affect both sexes and become more common with age regardless of gender.
What Hysterectomy Does to Bladder Control
Hysterectomy is one of the most common major surgeries performed on women, and extensive research has looked at what it does to the bladder over the years following surgery. The short version: removing the uterus appears to modestly raise the long-term risk of stress incontinence, likely because the surgery can disturb the nerves, ligaments, and connective tissue that support the bladder neck and urethra. These structures sit close to the uterus and cervix.
A large systematic review found that during the first decade after hysterectomy, women faced a higher likelihood of urinary incontinence of any type, and stress incontinence specifically, compared with women who hadn’t had the surgery. Beyond ten years out, the gap widens further for stress incontinence.
A nationwide Finnish cohort that followed five thousand women for over a decade found that about one in fifty ultimately needed a surgical procedure to correct stress incontinence, with the risk running somewhat higher after vaginal or laparoscopic hysterectomy than after the abdominal approach.
It’s worth remembering that most women who have a hysterectomy never develop significant incontinence. Surgery is often the right choice for the underlying problem being treated, whether that’s fibroids, heavy bleeding, or cancer. But the association is real enough that it belongs in the conversation that women have with their surgeons beforehand. Particularly if they have already had vaginal deliveries, since that appears to carry extra risk.
What Prostatectomy Does to Bladder Control
For men, radical prostatectomy, the surgical removal of the prostate gland, most often performed for prostate cancer, is by a wide margin the leading cause of urinary incontinence. Nearly every man leaks to some degree immediately after the catheter comes out, which sounds alarming but reflects basic anatomy. The prostate normally works alongside the external sphincter to hold urine back, and removing it shifts the entire job onto that external sphincter, which needs time to adapt to the extra workload.
Continence rates climb steadily over the following year, with studies reporting roughly a quarter to half of men fully continent by three months, somewhere around two-thirds to three-quarters by six months, and the large majority continent by twelve months.
The American Urological Association’s guidelines note that incontinence is expected in the short term and generally improves toward baseline by a year after surgery, though for a minority, often cited as around a third of patients, some degree of leakage persists longer and occasionally requires further treatment such as pelvic floor therapy or, less often, a surgical procedure. Surgical technique matters too: preserving the nerve bundles that run alongside the prostate and maintaining a longer stretch of urethra during the operation are both associated with faster, more complete recovery of continence.
Late onset urinary incontinence effects approximately 10 to 15 percent of men who regained continence after a radical prostatectomy. It can begin anywhere from 5 to 15 years after surgery. This is frequently believed to be exacerbated by age-related changes.
The Effects of Ordinary Aging
Even without surgery in the picture, the bladder changes as we get older, and those changes tilt the odds toward incontinence for both sexes. Bladder capacity tends to shrink somewhat, meaning it fills to an uncomfortable point sooner.
The detrusor muscle, the smooth muscle that squeezes urine out, becomes more prone to firing off contractions on its own rather than only when you decide it’s time to go. This is a big part of what drives urge incontinence in later life.
The bladder also tends to leave more urine behind after each trip to the bathroom, called increased residual volume, raising the risk of both overflow symptoms and urinary tract infections that can trigger or worsen leakage.
The details diverge a bit by sex. In women, the drop in estrogen after menopause thins and shortens the urethral lining, loosening the seal the sphincter can form and compounding whatever pelvic floor weakening already occurred from childbirth.
In men, incontinence related to aging alone tends to show up later, generally after the seventh decade of life, and often travels alongside prostate enlargement. This is a nearly universal feature of male aging that can produce overflow-type symptoms even without prior surgery.
Incontinence prevalence rises sharply after age 65, and some nursing-home studies put rates as high as two-thirds among residents in their late eighties. Women’s rates consistently outpace men’s at every stage of later life.
None of this means incontinence is simply the toll of aging and that nothing can be done about it. While the physiological changes make leakage more likely, they don’t make it unavoidable. The same toolkit used with younger patients, pelvic floor exercises, bladder training, medications, and in some cases surgery, works for older adults too.
The bigger obstacle tends to be that people, especially older adults, often wait years before mentioning symptoms to a doctor, quietly reorganizing their lives around bathroom access instead of asking for help that’s readily available.
The Bottom Line
Urinary incontinence is sometimes dismissed as an embarrassing inconvenience, but its consequences can be substantial. People may stop exercising, traveling, attending social events, or even leaving home because they are worried about finding a bathroom. Older adults rushing to the toilet at night may also increase their risk of falling.
While urinary incontinence is common, it’s rarely discussed as openly as it deserves to be, and it is seldom explained to patients in plain language.
The consistent message across the research is that this is a treatable condition rather than a life sentence, and the first step toward treatment is usually just being willing to bring it up.
Illustration generated by author using ChatGPT
Medical Disclaimer
The information provided in this article is intended for general educational and informational purposes only and does not constitute medical advice. It should not be used as a substitute for professional medical advice, diagnosis, or treatment.
Always seek the guidance of a qualified healthcare provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay seeking it because of something you have read here.
If you are experiencing a medical emergency, call 911 or your local emergency number immediately.
The author of this article is a licensed physician, but the views expressed here are solely those of the author and do not represent the official position of any hospital, health system, or medical organization with which the author may be affiliated.
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Why Is Everyone Talking About Socialism Again?
By John Turley
On August 22, 2026
In Commentary, Politics
For much of the late twentieth century, “socialism” was almost a forbidden word in American politics. Republicans used it as an accusation, Democrats generally avoided it, and politicians who actually described themselves as socialists occupied a small place on the political fringe.
Things have changed dramatically. Today, politicians on both the right and the left talk about socialism—although they usually mean entirely different things.
On the right, “socialism” has become a broad warning label applied to proposals ranging from universal health insurance to government regulation and higher taxes. On the left, a growing number of politicians and activists have reclaimed the word, associating it with economic equality, stronger labor rights, universal public services, and restraints on corporate power.
The interesting question may be less whether America is becoming socialist than why Americans are suddenly arguing about the meaning of socialism.
Socialism Originally Meant Something Specific
Historically, socialism was not simply another word for government spending. It developed during the nineteenth century largely in response to industrial capitalism. Although socialist thinkers disagreed considerably among themselves, they generally believed that the production resources of society—factories, mines, transportation systems, land, and eventually large corporations—should be owned collectively or controlled by workers rather than by private investors.
Karl Marx advocated a transformation by revolution. Other socialists eventually pursued democratic and parliamentary approaches.
That distinction matters because many policies routinely described as “socialist” in American political debate do not meet the traditional definition at all. A government can tax corporations, regulate banks, provide health insurance, and maintain a generous welfare system while leaving most businesses privately owned. Economists would normally describe such a country as a mixed capitalist economy or social democracy, rather than a socialist economy.
What the American Right Means by Socialism
For many conservatives, socialism has acquired a much broader meaning. The term is frequently applied to policies that increase government involvement in the economy such as progressive taxation, environmental regulation, student-debt relief, subsidized health care, expanded welfare benefits, government-supported child care, or other programs that redistribute income or provide services collectively.
In this usage, socialism is less a precise economic system than a direction of travel. Conservatives argue that as government assumes greater responsibility for allocating resources and providing benefits, individual choice and private markets become less important.
There is a legitimate philosophical argument here. There has always been a debate over where the boundary should lie between private markets and collective responsibility.
But calling every government economic intervention “socialism” stretches the word almost beyond recognition. By that definition, nearly every modern industrial democracy—including the United States—has been partly socialist for generations.
The political usefulness of the word helps explain its persistence. For Americans who remember the Cold War, “socialism” may evoke the Soviet Union, communist Eastern Europe, Cuba, or more recently Venezuela. Calling an opponent socialist therefore does more than criticize a particular tax or health-care proposal. It associates that proposal with an entire political system many Americans regard as oppressive and economically unsuccessful.
Polling illustrates how powerful that association remains. Pew Research Center found in 2022 that only 14 percent of Republicans and Republican-leaning independents had a positive impression of socialism. Republicans were also much more likely than Democrats to associate socialism with restrictions on individual freedom.
What the American Left Means by Socialism
The situation on the left is considerably more complicated because there is no single left-wing definition of socialism.
Many Americans who describe themselves favorably toward “socialism” appear to mean something closer to social democracy: a basically capitalist economy combined with universal health care, stronger unions, affordable higher education, progressive taxation, extensive social insurance, and stronger regulation of corporations.
Their preferred models are often Scandinavian countries such as Denmark and Finland. Yet those countries retain private businesses, private property, financial markets, entrepreneurship, and international corporations. They are heavily regulated capitalist welfare states, not classical socialist economies.
Pew’s research demonstrates this ambiguity. When Americans favorable toward socialism were asked what they liked about it, many emphasized fairness, meeting basic needs, and combining elements of capitalism and socialism rather than eliminating capitalism altogether.
Other people on the American left mean something more substantial when they use the term. The Democratic Socialists of America, for example, explicitly says democratic socialism should go beyond merely regulating capitalism. The organization advocates greater democratic control of workplaces and collective ownership of important parts of the economy, including areas such as energy and transportation. That position is much closer to the traditional meaning of socialism.
Consequently, it is misleading to assume that a liberal Democrat supporting Medicare expansion and a democratic socialist advocating worker control of corporations necessarily have the same economic philosophy.
They may support some of the same immediate policies while disagreeing profoundly about the ultimate economic system they want.
Why Has Socialism Suddenly Returned?
First was the financial crisis of 2008. Younger Americans watched banks and financial institutions receive extraordinary government assistance while millions of ordinary Americans lost jobs, savings, and homes. That experience weakened the assumption that an essentially unregulated market produces fair outcomes.
Then came decades of concern about wage stagnation, college debt, housing affordability, medical expenses, and growing concentrations of wealth. For some younger Americans, “capitalism” increasingly came to mean not neighborhood businesses and entrepreneurship but enormous corporations, billionaires and now trillionaires, expensive housing, and economic insecurity.
Bernie Sanders accelerated the transformation during his presidential campaigns in 2016 and 2020. By openly calling himself a democratic socialist while attracting millions of votes, Sanders helped remove some of the Cold War stigma surrounding the word.
Generational change matters as well. Younger Americans did not experience the Cold War in the same way their parents and grandparents did. Pew found striking age differences in its 2022 survey. Americans under 30 were roughly as likely to have an exclusively positive view of socialism as an exclusively positive view of capitalism. Older Americans remained considerably more favorable toward capitalism.
The political right has responded by emphasizing the word even more strongly. That makes strategic sense. If progressive Democrats increasingly accept the socialist label—or propose policies Republicans can associate with it—Republicans have an incentive to connect those policies with a word that remains deeply unpopular among conservative and many older voters.
The result is a feedback loop: the left talks more about socialism because the word has become less frightening to some voters, while the right talks more about socialism precisely because it hopes to make the word frightening again.
Is America Already Partly Socialist?
The answer depends almost entirely upon our definition.
Under the traditional definition—collective ownership of the means of production—the United States is overwhelmingly capitalist. Most farms, factories, banks, hospitals, restaurants, stores, technology companies, media companies, and other productive enterprises are privately owned.
But America has never operated as a completely laissez-faire capitalist economy either.
The federal government operates Social Security, for example, which the Social Security Administration itself describes as a social insurance program. Workers and employers contribute through payroll taxes, and benefits provide partial income replacement after retirement, disability, or death. About 96 percent of American jobs are covered.
Medicare and Medicaid place government deeply into health-care financing while most hospitals, physician practices, pharmaceutical manufacturers, and medical suppliers remain private.
The government also insures private bank deposits through the FDIC. Deposits at insured banks are generally protected up to $250,000 per depositor, per bank, per ownership category, backed by the federal government.
Public schools, public universities, highways, libraries, police departments, fire departments, water systems, parks, and numerous municipal utilities provide goods and services collectively rather than through ordinary private markets.
The United States even owns or operates certain enterprises directly. The Postal Service, for example, is an independent establishment within the executive branch that provides a nationwide public service while simultaneously operating in a competitive marketplace.
These arrangements contain elements of collective provision, social insurance, public ownership, or economic regulation, but calling all of them “socialism” creates more confusion than clarity.
A public fire department is not evidence that America has adopted a socialist economic system any more than a privately owned grocery store proves that government has no role in the economy.
America Has a Mixed Economy—and Always Has
Perhaps the greatest problem with the current socialism debate is the assumption that capitalism and socialism exist as two completely separate boxes and that a country must choose one or the other. Modern economies rarely work that way.
The United States relies primarily on private ownership, competition, investment, and markets to produce goods and services. At the same time, Americans have repeatedly decided that certain risks and services should be handled collectively.
Even organized labor introduces an element of collective economic power into a capitalist system, although union membership has declined substantially. In 2025, 10 percent of American wage and salary workers belonged to unions, compared with 20.1 percent in 1983.
The real political disagreement is rarely capitalism versus socialism in their pure theoretical forms. It is about where to draw the line between the market and the community.
Should health insurance operate primarily as a commercial product or a public service? Should housing be left largely to market forces or should government intervene to make it more affordable? Should corporations answer primarily to shareholders, or should workers have greater influence over corporate decisions? How progressive should taxation be? Which industries, if any, should be publicly owned? How much inequality should society tolerate in exchange for the incentives created by private enterprise?
A surprising twist is that some of the loudest recent “socialism” accusations are coming from conservatives — aimed at their own president. Since returning to office, the Trump administration has taken direct equity stakes in Intel, secured a “golden share” in U.S. Steel, arranged profit-sharing with Nvidia and AMD on chip sales to China, imposed sweeping tariffs, and directed the Pentagon to prioritize coal — an unprecedented degree of direct federal involvement in private enterprise for a Republican administration. Commentators across the spectrum — from the Council on Foreign Relations to the Wall Street Journal — have reached for terms like “state capitalism” or “state capitalism with American characteristics,” an explicit echo of the Chinese Communist Party’s own “socialism with Chinese characteristics”. One economist with more than three decades of market-watching called it plainly “the most economically interventionist government of my lifetime”.
Those are legitimate political questions. Calling one side “capitalist” and the other “socialist” obscures more than it explains.
The Word May Matter Less Than the Argument
There is one particularly revealing finding in the polling. Americans do not necessarily treat capitalism and socialism as opposites. Pew found people who expressed favorable opinions of both, suggesting that many Americans interpret capitalism as representing markets and opportunity while interpreting socialism as representing economic security and fairness.
That may tell us something important about the current debate. It appears that Americans want the vitality of capitalism tempered by the compassion of socialism.
The renewed interest in socialism doesn’t indicate that millions of Americans suddenly want the government to seize factories and abolish private enterprise. Instead, it reflects dissatisfaction with how the existing economic system distributes opportunity, security, wealth, and political power.
Conservative warnings about socialism often reflect a genuine concern that expanding government responsibility can gradually reduce economic freedom, increase taxation, and shift decisions from individuals and markets toward political institutions.
Those are fundamentally different concerns—and both become difficult to discuss when the same word means entirely different things to the people using it.
The question is not whether America should become “socialist,” it is what kind of capitalism we want.
That argument has been with us throughout American history. Only the vocabulary has changed.
For an additional discussion of the elements of socialism, see my post Three Shades of Left, published on November 10th 2025.
Image generated by author using ChatGPT.
Sources