Learn more about urinary incontinence: introduction
Urinary incontinence is the unintentional passing of urine. It's a common problem thought to affect millions of people.
There are several types of urinary incontinence, including:
- stress incontinence – when urine leaks out at times when your bladder is under pressure; for example, when you cough or laugh
- urge incontinence – when urine leaks as you feel a sudden, intense urge to pass urine, or soon afterwards
- overflow incontinence (chronic urinary retention) – when you're unable to fully empty your bladder, which causes frequent leaking
- total incontinence – when your bladder can't store any urine at all, which causes you to pass urine constantly or have frequent leaking
It's also possible to have a mixture of both stress and urge urinary incontinence.
Read about the symptoms of urinary incontinence.
When to seek medical advice
See your GP if you have any type of urinary incontinence. Urinary incontinence is a common problem and you shouldn't feel embarrassed talking to them about your symptoms.
This can also be the first step towards finding a way to effectively manage the problem.
Urinary incontinence can usually be diagnosed after a consultation with your GP, who will ask about your symptoms and may carry out a pelvic examination (in women) or rectal examination (in men).
Your GP may also suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.
Read about diagnosing urinary incontinence.
Causes of urinary incontinence
Stress incontinence is usually the result of the weakening of or damage to the muscles used to prevent urination, such as the pelvic floor muscles and the urethral sphincter.
Urge incontinence is usually the result of overactivity of the detrusor muscles, which control the bladder.
Overflow incontinence is often caused by an obstruction or blockage to your bladder, which prevents it emptying fully.
Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a bladder fistula.
Certain things can increase the chances of urinary incontinence developing, including:
- pregnancy and vaginal birth
- a family history of incontinence
- increasing age – although incontinence is not an inevitable part of ageing
Read about the causes of urinary incontinence.
Treating urinary incontinence
Initially, your GP may suggest some simple measures to see if they help improve your symptoms.
These may include:
- lifestyle changes – such as losing weight and cutting down on caffeine and alcohol
- pelvic floor exercises – exercising your pelvic floor muscles by squeezing them, taught by a specialist
- bladder training – where you learn ways to wait longer between needing to urinate and passing urine, guided by a specialist
You may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals.
Medication may be recommended if you're still unable to manage your symptoms.
Read about non-surgical treatments for urinary incontinence.
Surgery may also be considered. The specific procedures suitable for you will depend on the type of incontinence you have.
Surgical treatments for stress incontinence, such as sling procedures, are used to reduce pressure on the bladder or strengthen the muscles that control urination.
Operations to treat urge incontinence include enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles.
Read about surgery and procedures for urinary incontinence.
Preventing urinary incontinence
It's not always possible to prevent urinary incontinence, but there are some steps you can take that may help reduce the chance of it developing.
- controlling your weight
- avoiding or cutting down on alcohol
- keeping fit – in particular, ensuring that your pelvic floor muscles are strong
Use the healthy weight calculator to see if you are a healthy weight for your height.
Get more information and advice about losing weight.
Depending on your particular bladder problem, your GP can advise you about the amount of fluids you should drink.
If you have urinary incontinence, cut down on alcohol and drinks containing caffeine, such as tea, coffee and cola. These can cause your kidneys to produce more urine and irritate your bladder.
The recommended weekly limits for alcohol consumption are 14 units for men and women.
A unit of alcohol is roughly half a pint of normal-strength lager or a single measure (25ml) of spirits.
Read more about drinking and alcohol.
If you have to urinate frequently during the night (nocturia), try drinking less in the hours before you go to bed. However, make sure you still drink enough fluids during the day.
Pelvic floor exercises
Being pregnant and giving birth can weaken the muscles that control the flow of urine from your bladder. If you're pregnant, strengthening your pelvic floor muscles may help prevent urinary incontinence.
Read more about staying active during pregnancy.
Men may also benefit from strengthening their pelvic floor muscles with pelvic floor exercises.
Find out more about pelvic floor exercises.
Social care and support guide
- need help with day-to-day living because of illness or disability
- care for someone regularly because they're ill, elderly or disabled - including family members
Our guide to care and support explains your options and where you can get support.
Learn more about urinary incontinence: symptoms
Having urinary incontinence means you pass urine unintentionally.
When and how this happens varies depending on the type of urinary incontinence you have.
It's a good idea to see your GP if you have urinary incontinence. It's a common problem, and seeing your GP can be the first step towards finding a way to effectively manage it.
Common types of urinary incontinence
Most people with urinary incontinence have either stress incontinence or urge incontinence.
Stress incontinence is when you leak urine when your bladder is put under extra sudden pressure – for example, when you cough. It's not related to feeling stressed.
Other activities that may cause urine to leak include:
- heavy lifting
The amount of urine passed is usually small, but stress incontinence can sometimes cause you to pass larger amounts, particularly if your bladder is very full.
Urge incontinence, or urgency incontinence, is when you feel a sudden and very intense need to pass urine and you're unable to delay going to the toilet. There's often only a few seconds between the need to urinate and the release of urine.
Your need to pass urine may be triggered by a sudden change of position, or even by the sound of running water. You may also pass urine during sex, particularly when you reach orgasm.
This type of incontinence often occurs as part of group of symptoms called overactive bladder syndrome, which is where the bladder muscle is more active than usual.
As well as sometimes causing urge incontinence, overactive bladder syndrome can also mean you need to pass urine very frequently and you may need to get up several times during the night to urinate.
Other types of urinary incontinence
Mixed incontinence is when you have symptoms of both stress and urge incontinence. For example, you may leak urine if you cough or sneeze, and also experience very intense urges to pass urine.
Overflow incontinence, also called chronic urinary retention, occurs when the bladder cannot completely empty when you pass urine. This causes the bladder to swell above its usual size.
If you have overflow incontinence, you may pass small trickles of urine very often. It may also feel as though your bladder is never fully empty and you cannot empty it even when you try.
Urinary incontinence that's severe and continuous is sometimes known as total incontinence.
Total incontinence may cause you to constantly pass large amounts of urine, even at night. Alternatively, you may pass large amounts of urine only occasionally and leak small amounts in between.
Lower urinary tract symptoms (LUTS)
The lower urinary tract comprises the bladder and the tube urine passes through out of the body (urethra).
Lower urinary tract symptoms (LUTS) are common in men and women as they get older.
They can include:
- problems with storing urine, such as an urgent or frequent need to go to the toilet, or feeling like you need to go straight after you've just been
- problems with passing urine, such as a slow stream of urine, straining to pass urine, or stopping and starting as you pass urine
- problems after you've passed urine, such as feeling that you've not completely emptied your bladder or passing a few drops of urine after you think you've finished
Experiencing LUTS can make urinary incontinence more likely.
Learn more about urinary incontinence: causes
Urinary incontinence occurs when the normal process of storing and passing urine is disrupted. This can happen for a number of reasons.
Certain factors may also increase your chance of developing urinary incontinence.
Some of the possible causes lead to short-term urinary incontinence, while others may cause a long-term problem. If the cause can be treated, this may cure your incontinence.
Causes of stress incontinence
Stress incontinence occurs when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. The urethra is the tube urine passes through out of your body.
Any sudden extra pressure on your bladder, such as laughing or sneezing, can then cause urine to leak out of your urethra.
Your urethra may not be able to stay closed if the muscles in your pelvis (pelvic floor muscles) are weak or damaged, or your urethral sphincter – the ring of muscle that keeps the urethra closed – is damaged.
These problems may be caused by:
- damage during childbirth – particularly if the child was born vaginally, rather than by caesarean section
- increased pressure on your tummy – for example, because you are pregnant or obese
- damage to the bladder or nearby area during surgery – such as the removal of the womb (hysterectomy) in women, or removal of the prostate gland in men
- neurological conditions – that affect the brain and spinal cord, such as Parkinson's disease or multiple sclerosis
- certain connective tissue disorders – such as Ehlers-Danlos syndrome
- certain medications
Causes of urge incontinence
The urgent and frequent need to pass urine can be caused by a problem with the detrusor muscles in the walls of the bladder.
The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.
Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. This is known as having an overactive bladder.
The reason your detrusor muscles contract too often may not be clear, but possible causes include:
- drinking too much alcohol or caffeine
- poor fluid intake – this can cause strong, concentrated urine to collect in your bladder, which can irritate the bladder and cause symptoms of overactivity
- conditions affecting the lower urinary tract (urethra and bladder) – such as urinary tract infections (UTIs) or tumours in the bladder
- neurological conditions
- certain medications
Causes of overflow incontinence
Overflow incontinence, also called chronic urinary retention, is often caused by a blockage or obstruction of your bladder.
Your bladder may fill up as usual, but as it's obstructed you won't be able to empty it completely, even when you try.
At the same time, pressure from the urine that's still in your bladder builds up behind the obstruction, causing frequent leaks.
Your bladder can become obstructed as a result of:
Overflow incontinence may also be caused by your detrusor muscles not fully contracting, which means your bladder doesn't completely empty when you go to the toilet. As a result, the bladder becomes stretched.
Your detrusor muscles may not fully contract if:
- there's damage to your nerves – for example, as a result of surgery to part of your bowel or a spinal cord injury
- you're taking certain medications
Causes of total incontinence
Total incontinence occurs when your bladder can't store any urine at all. It can result in you either passing large amounts of urine constantly, or passing urine occasionally with frequent leaking.
Total incontinence can be caused by:
- a problem with your bladder from birth
- injury to your spinal cord – this can disrupt the nerve signals between your brain and your bladder
- a bladder fistula – a small, tunnel-like hole that can form between the bladder and a nearby area, such as the vagina, in women
Medications that may cause incontinence
Some medicines can disrupt the normal process of storing and passing urine, or increase the amount of urine you produce.
- angiotensin-converting enzyme (ACE) inhibitors
- some antidepressants
- hormone replacement therapy (HRT)
Stopping these medications, if advised to do so by a doctor, may help resolve your incontinence.
In addition to the causes mentioned above, some things can increase your risk of developing urinary incontinence without directly being the cause of the problem. These are known as risk factors.
Some of the main risk factors for urinary incontinence include:
- family history – there may be a genetic link to urinary incontinence, so you may be more at risk if other people in your family have experienced the problem
- increasing age – urinary incontinence becomes more common as you reach middle age, and is particularly common in people over the age of 80
- having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and urethra; read about the symptoms of urinary incontinence for more information
Learn more about urinary incontinence: diagnosis
If you experience urinary incontinence, see your GP so they can determine the type of condition you have.
Try not to be embarrassed about speaking to your GP about your incontinence. Urinary incontinence is a common problem and it's likely your GP has seen many people with the condition.
Your GP will ask you questions about your symptoms and medical history, including:
- whether the urinary incontinence occurs when you cough or laugh
- whether you need the toilet frequently during the day or night
- whether you have any difficulty passing urine when you go to the toilet
- whether you're currently taking any medication
- how much fluid, alcohol or caffeine you drink
Your GP may suggest that you keep a diary of your bladder habits for at least 3 days so you can give them as much information as possible about your condition.
This should include details like:
- how much fluid you drink
- the types of fluid you drink
- how often you need to pass urine
- the amount of urine you pass
- how many episodes of incontinence you experience
- how many times you experience an urgent need to go to the toilet
Tests and examinations
You may also need to have some tests and examinations so your GP can confirm or rule out things that may be causing your incontinence. Some of these are explained below.
Your GP may examine you to assess the health of your urinary system. If you're female, your GP will carry out a pelvic examination, which usually involves undressing from the waist down. You may be asked to cough to see if any urine leaks out.
Your GP may also examine your vagina. In over half of women with stress incontinence, part of the bladder may bulge into the vagina.
Your GP may place their finger inside your vagina and ask you to squeeze it with your pelvic floor muscles.
These are the muscles that surround your bladder and urethra, the tube urine passes through out of the body. Damage to your pelvic floor muscles can lead to urinary incontinence.
If you're male, your GP may check whether your prostate gland is enlarged. The prostate gland is located between the penis and bladder, and surrounds the urethra.
If it's enlarged, it can cause symptoms of urinary incontinence, such as a frequent need to urinate.
You may also need a digital rectal examination to check the health of your prostate gland. This will involve your GP inserting their finger into your bottom.
If your GP thinks your symptoms may be caused by a urinary tract infection, a sample of your urine may be tested for bacteria.
A small chemically treated stick is dipped into your urine sample. It will change colour if bacteria are present. The dipstick test can also check the blood and protein levels in your urine.
Residual urine test
If your GP thinks you may have overflow incontinence, they may suggest a test called a residual urine test to see how much urine is left in your bladder after you go for a wee.
This is usually done by carrying out an ultrasound scan of your bladder, although occasionally the amount of urine in your bladder may be measured after it's been drained using a catheter.
A catheter is a thin, flexible tube that's inserted into your urethra and passed through to your bladder.
Some further tests may be necessary if the cause of your urinary incontinence isn't clear. Your GP will usually start treating you first and may suggest these tests if treatment isn't effective.
A cystoscopy involves using an instrument called an endoscope to look inside your bladder and urinary system. This test can identify abnormalities that may be causing incontinence.
These are a group of tests used to check the function of your bladder and urethra. This may include keeping a bladder diary for a few days and then attending an appointment at a hospital or clinic for tests.
Tests can include:
- measuring the pressure in your bladder by inserting a catheter into your urethra
- measuring the pressure in your tummy (abdomen) by inserting a catheter into your bottom
- asking you to urinate into a special machine that measures the amount and flow of urine
Learn more about urinary incontinence: non-surgical treatment
The treatment you receive for urinary incontinence will depend on the type of incontinence you have and the severity of your symptoms.
If your incontinence is caused by an underlying condition, you may receive treatment for this alongside your incontinence treatment.
Conservative treatments, which don't involve medication or surgery, are tried first. These include:
- lifestyle changes
- pelvic floor muscle training (Kegel exercises)
- bladder training
After this, medication or surgery may be considered.
This page is about non-surgical treatments for urinary incontinence. Find out about surgery and procedures for urinary incontinence.
Your GP may suggest you make simple changes to your lifestyle to improve your symptoms. These changes can help improve your condition, regardless of the type of urinary incontinence you have.
For example, your GP may recommend:
- reducing your caffeine intake – caffeine is found in tea, coffee and cola, and can increase the amount of urine your body produces
- altering how much fluid you drink a day – drinking too much or too little can make incontinence worse
- losing weight if you are overweight or obese – use the healthy weight calculator to find out if you're a healthy weight for your height
Pelvic floor muscle training
Your pelvic floor muscles are the muscles you use to control the flow of urine as you urinate. They surround the bladder and urethra, the tube that carries urine from the bladder outside the body.
Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.
Your GP may refer you to a specialist to start a programme of pelvic floor muscle training.
Your specialist will assess whether you're able to squeeze (contract) your pelvic floor muscles and by how much.
If you can contract your pelvic floor muscles, you'll be given an individual exercise programme based on your assessment.
Your programme should include doing a minimum of 8 muscle contractions at least 3 times a day and the recommended exercises for at least 3 months. If the exercises are helping after this time, you can keep on doing them.
Research suggests women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life.
In men, some studies have shown pelvic floor muscle training can reduce urinary incontinence, particularly after surgery to remove the prostate gland.
The British Association of Urological Surgeons (BAUS) has more information on:
If you're unable to contract your pelvic floor muscles, using a device that measures and stimulates the electrical signals in the muscles may be recommended. This is called electrical stimulation.
A small probe will be inserted into the vagina in women or the anus in men. An electrical current runs through the probe, which helps strengthen your pelvic floor muscles while you exercise them.
You may find electrical stimulation difficult or unpleasant to use, but it may be beneficial if you're unable to complete pelvic floor muscle contractions without it.
Biofeedback is a way to monitor how well you're doing the pelvic floor exercises by giving you feedback as you do them.
There are several different methods of biofeedback:
- a small probe could be inserted into the vagina in women or the anus in men – this senses when the muscles are squeezed and sends the information to a computer screen
- electrodes could be attached to the skin of your tummy (abdomen) or around the anus – these sense when the muscles are squeezed and send the information to a computer screen
There isn't much good evidence to suggest biofeedback offers a significant benefit to people using pelvic floor muscle training for urinary incontinence, but the feedback may help motivate some people to carry out their exercises.
Speak to your specialist if you would like to try biofeedback.
Vaginal cones may be used by women to assist with pelvic floor muscle training. These small weights are inserted into the vagina.
You hold the weights in place using your pelvic floor muscles. When you can, you progress to the next vaginal cone, which weighs more.
Some women find vaginal cones uncomfortable or unpleasant to use, but they may help with stress or mixed urinary incontinence.
If you've been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training.
Bladder training may also be combined with pelvic floor muscle training if you have mixed urinary incontinence.
It involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least 6 weeks.
While incontinence products aren't a treatment for urinary incontinence, you might find them useful for managing your condition while you're waiting to be assessed or for treatment to take effect.
Incontinence products include:
- absorbent products, such as incontinence pants or pads
- handheld urinals
- a catheter, a thin tube that is inserted into your bladder to drain urine
- devices that are placed into the vagina or urethra to prevent urine leakage – for example, while you exercise
For more information, see Can I get incontinence products on the NHS?
Medication for stress incontinence
If stress incontinence doesn't significantly improve, surgery for urinary incontinence will often be recommended as the next step.
However, if you're unsuitable for surgery or want to avoid having an operation, you may benefit from a medication called duloxetine. This can help increase the muscle tone of the urethra, which should help keep it closed.
You'll need to take duloxetine by mouth twice a day, and will be assessed after 2 to 4 weeks to see if the medicine is beneficial or causing any side effects.
Possible side effects of duloxetine can include:
Don't suddenly stop taking duloxetine, as this can also cause unpleasant side effects. Your GP will reduce your dose gradually.
Duloxetine isn't suitable for everyone, however, so your GP will discuss any other medical conditions you have to determine if you can take it.
Medication for urge incontinence
If bladder training isn't an effective treatment for your urge incontinence, your GP may prescribe a type of medication called an antimuscarinic.
Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can occur with or without urinary incontinence.
A number of different antimuscarinic medications can be used to treat urge incontinence, but common ones include oxybutynin, tolterodine and darifenacin.
These are usually taken by mouth 2 or 3 times a day, although an oxybutynin patch that you place on your skin twice a week is also available.
Your GP will usually start you at a low dose to minimise any possible side effects. The dose can then be increased until the medicine is effective.
Possible side effects of antimuscarinics include:
- dry mouth
- blurred vision
In rare cases, antimuscarinic medication can also lead to a type of glaucoma, a build-up of pressure within the eye, called angle-closure glaucoma.
You'll be assessed after 4 weeks to see how you're getting on with the medication, and every 6 to 12 months thereafter if the medication continues to help.
Your GP will discuss any other medical conditions you have to determine which antimuscarinics are suitable for you.
If antimuscarinics are unsuitable for you, they haven't helped your urge incontinence or have caused unpleasant side effects, you may be offered an alternative medication called mirabegron.
Mirabegron causes the bladder muscle to relax, which helps the bladder fill up with and store urine. It is usually taken by mouth once a day.
Side effects of mirabegron can include:
- urinary tract infections (UTIs)
- a fast or irregular heartbeat
- suddenly noticeable heartbeats (palpitations)
- a rash
Your GP will discuss any other medical conditions you have to determine whether mirabegron is suitable for you.
Medication for nocturia
A low-dose version of a medication called desmopressin may be used to treat nocturia, which is the frequent need to get up during the night to urinate, by helping to reduce the amount of urine produced by the kidneys.
Another type of medication taken late in the afternoon, called a loop diuretic, may also prevent you getting up in the night to pass urine.
Diuretic medicine increases the production and flow of urine from your body. By removing excess fluid from your body in the afternoon, it may improve symptoms at night.
Loop diuretics are not licensed to treat nocturia. This means that the medication may not have undergone clinical trials, a type of research that tests one treatment against another, to see if it's effective and safe in the treatment of nocturia.
However, your GP or specialist may suggest an unlicensed medication if they think it's likely to be effective and the benefits of treatment outweigh any associated risk.
If your GP is considering prescribing a loop diuretic, they should tell you it's unlicensed and discuss the possible risks and benefits with you.
NHS continence services
NHS continence services are centres staffed by specialist nurses, sometimes called continence advisers, and specialist physiotherapists. They should be able to diagnose your condition and start treating you.
You can usually book an appointment without a referral from a GP. You can find more information about local services on the Bladder & Bowel Community website.
Learn more about urinary incontinence: surgery and procedures
If other treatments for urinary incontinence are unsuccessful or unsuitable, surgery or other procedures may be recommended.
Before making a decision, discuss the risks and benefits with a specialist, as well as any possible alternative treatments.
Your doctor must also keep detailed records about the type of surgery they do, including any complications you get after you have had your surgery. You should be given a copy of this record.
If you're a woman and plan to have children, this will affect your decision. The physical strain of pregnancy and childbirth can sometimes cause surgical treatments to fail.
You may wish to wait until you no longer want to have any more children before having surgery.
Surgery and procedures for stress incontinence
Colposuspension involves making a cut in your lower tummy (abdomen), lifting up the neck of your bladder, and stitching it in this lifted position.
This can help prevent involuntary leaks in women with stress incontinence.
There are 2 types of colposuspension:
- open colposuspension – where surgery is carried out through a large cut
- laparoscopic (keyhole) colposuspension – where surgery is carried out through 1 or more small cuts using small surgical instruments
Both types of colposuspension offer effective long-term treatment for stress incontinence, although laparoscopic colposuspension needs to be carried out by an experienced laparoscopic surgeon.
Problems that can occur after colposuspension include difficulty emptying the bladder fully when going to the toilet, recurrent urinary tract infections (UTIs), and discomfort during sex.
Sling surgery involves making a cut in your lower tummy and vagina so a sling can be placed around the neck of the bladder to support it and prevent accidental urine leaks.
The sling can be made of:
- tissue taken from another part of your body (autologous sling)
- tissue donated from another person (allograft sling)
- tissue taken from an animal (xenograft sling), such as cow or pig tissue
In many cases, an autologous sling is used and will be made using part of the layer of tissue that covers the abdominal muscles (rectus fascia).
These slings are generally preferred because more is known about their long-term safety and effectiveness.
The most commonly reported problem associated with the use of slings is difficulty emptying the bladder fully when going to the toilet.
A small number of women who have the procedure also find they develop urge incontinence afterwards.
Vaginal mesh surgery (tape surgery)
This is where a strip of synthetic mesh is inserted behind the tube that carries urine out of your body to support it in a sling.
Mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in your body permanently.
You'll be asleep during the operation. It's often done as day surgery so you do not need to stay in hospital. Some women need to stay in hospital overnight.
A few women have had serious complications after mesh surgery. Some, but not all, of these complications can also happen after other types of surgery.
- long-lasting pain
- permanent nerve damage
- sexual problems
- mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel
Because of these possible complications, it's very important that you talk to your doctor about the risks and benefits of vaginal mesh surgery before you decide to go ahead with it.
You may want to ask some of these questions:
- What are the alternatives?
- What are the chances of success with the use of mesh versus use of other procedures?
- What are the pros and cons of using mesh, and what are the pros and cons of alternative procedures?
- What experience have you had with implanting mesh?
- How successful has it been for the people you have treated?
- What has been your experience in dealing with any complications?
- What if the mesh does not correct my problems?
- If I have a complication related to the mesh, can it be removed and what are the consequences associated with this?
- What happens to the mesh over time?
For the time being, vaginally inserted tapes and meshes will only be used when there's no alternative and the procedure cannot be delayed, and after detailed consultation between you and your doctor.
If you're on a waiting list for a tape procedure, your hospital will be in touch with you to discuss what will happen next.
If you're concerned about vaginal mesh
If you have previously had vaginal mesh or tape for incontinence inserted and think you're having complications, speak to a GP or surgeon.
If you're not having any complications, there's no need to do anything. Many women have had these types of surgery without developing any problems afterwards.
You can report a problem with a medicine or medical device on GOV.UK.
Urethral bulking agents
A urethral bulking agent is a substance that can be injected into the walls of the urethra in women with stress incontinence.
This increases the size of the urethral walls and allows the urethra to stay closed with more force.
A number of different bulking agents are available, and there's no evidence 1 is more beneficial than another.
This is less invasive than other surgical treatments for stress incontinence in women as it does not usually require any cuts.
Instead, the substances are normally injected through a cystoscope inserted directly into the urethra.
But this procedure is generally less effective than the other options available.
The effectiveness of the bulking agents will also reduce with time and you may need repeated injections.
Many women experience a slight burning sensation or bleeding when they pass urine for a short period after the bulking agents are injected.
Artificial urinary sphincter
The urinary sphincter is a ring of muscle that stays closed to prevent urine flowing from the bladder into your urethra.
In some cases, it may be suggested that you have an artificial urinary sphincter fitted to relieve your incontinence.
This tends to be used more often as a treatment for men with stress incontinence and is only rarely used in women.
An artificial sphincter consists of 3 parts:
- a circular cuff that's placed around the urethra – this can be filled with fluid when necessary to compress the urethra and prevent urine passing through it
- a small pump placed in the scrotum (when used in men) that contains the mechanism for controlling the flow of fluid to and from the cuff
- a small fluid-filled reservoir in the tummy – the fluid passes between this reservoir and the cuff as the device is activated and deactivated
The procedure to fit an artificial urinary sphincter often causes short-term bleeding and a burning sensation when you pass urine.
In the long term, it's not uncommon for the device to eventually stop working, in which case further surgery may be needed to remove it.
Surgery and procedures for urge incontinence
Botulinum toxin A injections
Botulinum toxin A (Botox) can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome.
This medicine can sometimes help relieve these problems by relaxing your bladder.
This effect can last for several months and the injections can be repeated if they help.
Although the symptoms of incontinence may improve after the injections, you may find it difficult to fully empty your bladder.
If this happens, you'll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the pee from your bladder.
Botulinum toxin A is not currently licensed to treat urge incontinence or overactive bladder syndrome, so you should be made aware of any risks before deciding to have the treatment.
The long-term effects of this treatment are not yet known.
Sacral nerve stimulation
The sacral nerves are located at the bottom of your back. They carry signals from your brain to some of the muscles used when you go to the toilet, such as the detrusor muscle that surrounds the bladder.
If your urge incontinence is the result of your detrusor muscles contracting too often, sacral nerve stimulation, also known as sacral neuromodulation, may be recommended.
During this operation, a device is inserted near 1 of your sacral nerves, usually in 1 of your buttocks. An electrical current is sent from this device into the sacral nerve.
This should improve the way signals are sent between your brain and your detrusor muscles, and so reduce your urges to pee.
Sacral nerve stimulation can be painful and uncomfortable, but some people report a substantial improvement in their symptoms or the end of their incontinence completely.
Posterior tibial nerve stimulation
Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor.
It's thought that stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pee.
During the procedure, a very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and your foot to move.
You may need 12 sessions of stimulation, each lasting around half an hour, 1 week apart.
Some studies have shown that this treatment can offer relief from overactive bladder syndrome and urge incontinence for some people, although there's not enough evidence yet to recommend tibial nerve stimulation as a routine treatment.
Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medicine and you do not want to have botulinum toxin A injections or sacral nerve stimulation.
In rare cases, a procedure known as augmentation cystoplasty may be recommended to treat urge incontinence.
This procedure involves making your bladder bigger by adding a piece of tissue from your intestine into the bladder wall.
After the procedure, you may not be able to pass urine normally and may need to use a catheter.
Because of this, augmentation cystoplasty will only be considered if you're willing to use a catheter.
The difficulties passing urine can also mean that people who have augmentation cystoplasty can experience recurrent UTIs.
Urinary diversion is a procedure where the tubes that lead from your kidneys to your bladder (ureters) are redirected to the outside of your body.
The urine is then collected directly without it flowing into your bladder.
Urinary diversion should only be carried out if other treatments have been unsuccessful or are not suitable.
It can cause a number of complications, such as a bladder infection, and sometimes further surgery is needed to correct any problems that occur.
Catheterisation for overflow incontinence
Clean intermittent catheterisation
Clean intermittent catheterisation (CIC) is a technique that can be used to empty the bladder at regular intervals and so reduce overflow incontinence, also known as chronic urinary retention.
A continence adviser will teach you how to place a catheter through your urethra and into the bladder.
Your pee flows out of your bladder, through the catheter and into the toilet.
Using a catheter can feel a bit painful or uncomfortable at first, but any discomfort should subside over time.
How often CIC will need to be carried out will depend on your individual circumstances.
For example, you may only need CIC once a day, or you may need to use the technique several times a day.
Regular use of a catheter increases the risk of developing UTIs.
If using a catheter every now and then is not enough to treat your overflow incontinence, you can have an indwelling catheter fitted instead.
This is a catheter inserted in the same way as for CIC, but left in place. A bag is attached to the end of the catheter to collect the pee.
There are several incontinence products that you might find useful for managing your urinary incontinence while you're waiting for surgery.
- absorbent products, such as incontinence pants or pads
- handheld urinals
- a catheter
- devices that are placed into the vagina or urethra to prevent pee leaking while you exercise, for example