34 min read

Urinary incontinence

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What is urinary incontinence?

Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect millions of people worldwide.

Urinary incontinence affects about twice as many women as men and becomes more common with age.

What are the symptoms of urinary incontinence?

The symptoms of urinary incontinence depend on the type of condition you have.

There are several types of urinary incontinence, but the most common are:

  • stress incontinence – when the pelvic floor muscles are too weak to prevent urination, causing urine to leak when your bladder is under pressure, for example when you cough or laugh
  • urge incontinence – when urine leaks as you feel an intense urge to pass urine, or soon afterwards

These two types of urinary incontinence are thought to be responsible for over 9 out of 10 cases. It is also possible to have a mixture of both stress and urge urinary incontinence.

Read more about the symptoms of urinary incontinence.

What causes urinary incontinence?

The causes of urinary incontinence depend on the type of condition.

Stress incontinence is usually the result of the weakening or damaging of the muscles that are 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.

Certain things can increase the chances of urinary incontinence developing, including:

  • pregnancy and vaginal birth
  • obesity
  • family history of incontinence
  • increasing age

Read more about the causes of urinary incontinence.

How is it diagnosed?

Urinary incontinence can usually be diagnosed after a consultation with your doctor, who will ask about your symptoms and may carry out a pelvic examination.

Your doctor may suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.

If your doctor thinks a urinary infection might be the underlying cause, they will test a sample of your urine.

Read more about diagnosing urinary incontinence.

How is urinary incontinence treated?

Urinary incontinence can be an uncomfortable and upsetting problem. Though it is more common as you get older, many people wrongly believe that it is an inevitable part of ageing.

There are several forms of effective treatment, including:

  • lifestyle changes, such as losing weight
  • pelvic floor muscle training ([exercising your pelvic floor muscles] by squeezing them)
  • bladder training, so you can wait longer between needing to urinate and passing urine

If these measures are not effective, medication may be used to treat stress and urge incontinence.

You may also benefit from the use of incontinence products, such as absorbent pads and hand-held urinals (urine collection bottles).

Read more about non-surgical treatments for urinary incontinence.

If these treatments are not successful, a number of different surgical techniques can be considered.

Surgical treatments for stress incontinence, such as tape or sling procedures, are used to reduce pressure on the bladder, or strengthen the muscles that control urination.

Operations to treat urge incontinence can include the enlargement of the bladder or the implanting of a device that stimulates the nerve that controls the detrusor muscles.

Read more about surgical treatments for urinary incontinence.

Preventing urinary incontinence

It is not always possible to prevent urinary incontinence, but there are some steps you can take to reduce the chance of the condition developing, such as:

  • controlling your weight
  • reducing or stopping your alcohol consumption
  • keeping fit

Read more about preventing urinary incontinence.

Urinary incontinence symptoms

Having urinary incontinence means you pass urine unintentionally because of a loss of bladder control.

When and how this happens varies depending on the type of urinary incontinence you have.

Common types of urinary incontinence

Over 9 out of 10 cases of urinary incontinence are stress incontinence or urge incontinence.

Stress incontinence

Stress incontinence is when you leak urine when your bladder is put under extra sudden pressure, for example when you cough. It is not related to feeling stressed. Other physical activities that may cause urine to leak include:

  • sneezing
  • laughing
  • heavy lifting
  • exercise

The amount of urine passed is usually small, but stress incontinence can also cause you to pass larger amounts, particularly if your bladder is very full.

Urge incontinence

Urge incontinence, or urgency incontinence, is when you feel a sudden and very intense need to pass urine and you are unable to delay going to the toilet. There is 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.

If you have urge incontinence, you may need to pass urine very frequently and you may need to get up several times during the night to urinate.

Less common types of urinary incontinence

Mixed 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.

Overactive bladder syndrome (OAB)

OAB is similar to urge incontinence as it causes an urgent and frequent need to pass urine. However, many people with OAB only have symptoms of urgency and frequency and do not have incontinence as well.

Overflow incontinence

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.

Overflow incontinence is common in men who have an enlarged prostate gland. This is a small gland located between the penis and the bladder which can obstruct the bladder if it is enlarged.

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.

Total incontinence

Urinary incontinence that is severe and continuous is sometimes known as total incontinence. It usually occurs:

  • as a result of a bladder disorder that is present from birth
  • after surgery
  • following an injury

Total incontinence may cause you to constantly pass large amounts of urine, even at night. Or, you may pass large amounts of urine only sometimes, and leak small amounts in between.

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, and certain factors may also increase your chance of developing urinary incontinence.

Causes of stress incontinence

Stress incontinence happens 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 through which urine passes out of your body).

Your urethra may not be able to stay closed if:

  • your pelvic floor muscles are weak or damaged
  • your urethral sphincter (the ring of muscle that keeps the urethra closed) is damaged

Any sudden extra pressure on your bladder, such as laughing or sneezing, can cause urine to leak out of your urethra. The loss of strength in your urethra may be caused by:

  • nerve damage during childbirth
  • increased pressure on your tummy, for example because you are pregnant or very overweight
  • a lack of the hormone oestrogen in women (less oestrogen is produced after the menopause)
  • 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 called detrusor overactivity. The reason your detrusor muscles contract too often may not be clear, but possible causes include:

Some of these possible causes will lead to short-term urinary incontinence; others may cause a long-term problem.

If the cause can be treated, this may cure your incontinence.

Causes of overflow incontinence

Overflow incontinence, also called chronic urinary retention, is often caused by a blockage or obstruction to your bladder. Your bladder may fill up as usual, but as it is obstructed you will not be able to empty it completely, even when you try.

At the same time, pressure from the urine that is still in your bladder builds up behind the obstruction, causing frequent leaks.

Your bladder can become obstructed by:

Overflow incontinence may also be caused by your detrusor muscles not fully contracting, which means that your bladder does not completely empty when you go to the toilet. As a result, the bladder becomes stretched. Your detrusor muscles may not fully contract if:

  • there is damage to your nerves, for example as a result of surgery to part of your bowel or a spinal cord injury
  • you are taking certain medications (see box, top left)

Causes of total incontinence

Total incontinence occurs when your bladder cannot 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, which can disrupt the nerve signals between your brain and your bladder
  • a bladder fistula, which is a small tunnel-like hole that can form between the bladder and a nearby area, such as the vigina, in women

Risk factors

Risk factors are not the same as causes. Risk factors are things that increase your chance of developing a condition.

Risk factors in women

Risk factors for urinary incontinence in women include:

  • pregnancy – if you developed stress incontinence during pregnancy, or in the six weeks after birth, you are more likely to have stress incontinence five years after the birth
  • vaginal birth – giving birth vaginally, rather than with a caesarean, may be associated with stress incontinence
  • obesity – having a body mass index (BMI) of 30 or more may also be associated with urinary incontinence
  • family history – there may be a genetic link to urinary incontinence, particularly stress incontinence
  • disability – conditions affecting your brain or spinal cord, such as multiple sclerosis or dementia, may increase your risk of urinary incontinence
  • increasing age – urinary incontinence becomes more common as you reach middle age and is most common in women over 70
  • lower urinary tract symptoms (LUTS) – symptoms that affect the bladder and urethra (read about the symptoms of urinary incontinence for more information)

Risk factors in men

Risk factors for urinary incontinence in men include:

  • increasing age – urinary incontinence becomes more common as you get older
  • family history – there may be a genetic link to urinary incontinence, particularly stress incontinence
  • disability – conditions affecting your brain or spinal cord, such as multiple sclerosis or dementia, may increase your risk of urinary incontinence
  • prostatectomy – an operation to remove your prostate gland, for example if you have prostate cancer, may increase your risk of urinary incontinence
  • lower urinary tract symptoms (LUTS) – symptoms that affect the bladder and urethra (read about the symptoms of urinary incontinence for more information)

Diagnosing urinary incontinence

If you experience urinary incontinence, see your doctor so they can determine the type of condition you have.

Do not be embarrassed to speak to your doctor about your condition.

Your doctor 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 are currently taking any medications
  • how much fluid, alcohol or caffeine you drink

Bladder diary

Your doctor may suggest that you keep a diary of your bladder habits for at least three days, so you can give them as much information as possible about your condition. This should include details such as:

  • 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 that your doctor can confirm or rule out external factors that may be causing your incontinence. Some of these are explained below.

Physical examination

Your doctor may examine you physically to assess the health of your urinary system.

If you are female, your doctor 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 doctor may also examine your vagina. In over half of women with stress incontinence, part of the neck of the bladder may bulge into the vagina.

Your doctor 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 through which urine passes out of the body). Damage to your pelvic floor muscles can lead to urinary incontinence.

If you are male, your doctor may check whether your prostate gland is enlarged. The prostate gland is located between the penis and bladder, and surrounds the urethra. If it is enlarged, it can cause symptoms of urinary incontinence, such as a frequent need to urinate.

Your doctor may carry out a digital rectal examination to check the health of your prostate gland. This will involve your doctor inserting their finger into your bottom.

Dipstick test

If your doctor thinks that your incontinence may be caused by an infection, a sample of your urine may be tested for bacteria. A small, chemically treated stick will be 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 doctor thinks you may have overflow incontinence, also called chronic urinary retention, they may suggest a residual urine test.

A residual urine test involves inserting a thin, flexible hollow tube, called a catheter, into your urethra and feeding it through to your bladder. Any urine that is left in your bladder will drain out through the catheter and the amount can be measured.

Further tests

Some further tests may be necessary if the cause of your urinary incontinence is not clear. Your doctor will usually start treating you first and could then suggest these tests if treatment is not effective.

Bladder ultrasound scan

An ultrasound scan uses high-frequency sound waves to create an image of the inside of your body. An ultrasound scan of your bladder can show how much urine is left in your bladder after you go to the toilet.


A cystoscopy involves using a flexible viewing tube, known as an endoscope, to look inside your bladder and urinary system.

This test can identify abnormalities that may be causing incontinence.

Urodynamic tests

Urodynamic tests 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 (see above) and then attending an appointment at a hospital or clinic for some tests. These could include:

  • measuring the pressure in your bladder by inserting a catheter into your urethra
  • measuring the pressure in your abdomen by inserting a catheter into your bottom
  • asking you to urinate into a special machine that measures the amount and flow of the urine

Urinary incontinence 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, such as an enlarged prostate gland in men, you will receive treatment for this first.

Conservative treatments, which do not involve medication or surgery, are tried first. These include:

  • lifestyle changes
  • pelvic floor muscle training
  • bladder training

After this, medication or surgery may be considered.

Read more about surgical treatments for urinary incontinence.

Incontinence products

There are several incontinence products that you might find useful for managing your urinary incontinence while you are waiting to be assessed or waiting for treatment to start.

[Incontinence products] include:

  • absorbent products, such as incontinence pants or pads
  • hand-held urinals (urine collection bottles)
  • 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

Lifestyle changes

Your doctor may suggest that you make some simple changes to your lifestyle to reduce your incontinence. These changes can help improve your condition, regardless of the type of urinary incontinence you have.

For example, your doctor may recommend:

  • reducing your caffeine intake – caffeine is found in tea, coffee and cola and can increase the amount of urine your body produces
  • drinking 1-1.5 litres (six to eight glasses) of fluid a day – drinking too much or too little can cause symptoms that affect the lower urinary tract (bladder and urethra)
  • losing weight if you are overweight or obese

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 to outside the body).

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often one of the first treatments recommended.


Your doctor may refer you to a specialist to start a programme of pelvic floor muscle training. Depending on what services are available in your area, you could be referred to:

  • a continence adviser
  • a urogynaecologist – a nurse who specialises in problems with the urinary system in women
  • a physiotherapist – a healthcare professional trained in using physical methods to promote healing
  • a specially trained practice nurse at your doctor surgery

Your specialist will assess whether you are able to squeeze (contract) your pelvic floor muscles and by how much. If you can contract your pelvic floor muscles, you will be given an individual exercise programme based on your assessment. It should include:

  • doing a minimum of eight muscle contractions at least three times a day
  • doing these exercises for at least three months
  • continuing with these exercises after three months if they are helping

Research suggests that women who complete pelvic floor muscle training experience fewer leaking episodes and report a better quality of life. Studies from around the world show that, with proper supervision, conservative treatment such as pelvic floor muscle training can improve stress or mixed urinary incontinence in women by two-thirds.

In men, some studies have shown that pelvic floor muscle training can reduce urinary incontinence particularly after surgery to remove the prostate gland.

Electrical stimulation

If you are 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 to 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 are unable to complete pelvic floor muscle contractions without it.


Biofeedback is a way to monitor how well you are 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 feeds the information to a computer screen.
  • Electrodes (sticky electrical patches) could be attached to the skin of your abdomen or around the anus. These sense when the muscles are squeezed and feed the information to a computer screen.

Some research has found that biofeedback did not benefit women carrying out pelvic floor muscle training for urinary incontinence. However, the feedback may motivate some women.

For men, there is not much evidence to indicate whether biofeedback should be used. It may depend on what you and your specialist prefer, and what is available.

If you wish to try biofeedback, talk to your specialist.

Vaginal cones

Vaginal cones may be used by women to assist with pelvic floor muscle training. Vaginal cones are small weights that 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 want to try using vaginal cones, speak to your specialist.

Bladder training

If you have 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 stress or mixed urinary incontinence.

Bladder training 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 six weeks.

If you have any problems with your memory, for example you have dementia, you may be given specific training to prevent leakages. This may involve a carer reminding you to go to the toilet at set times.

Medication for stress incontinence

If stress incontinence does not significantly improve after the measures outlined above, medication may be used.

Medication for stress incontinence aims to increase the muscle tone of the urethra, which should help keep it closed.

You will need to take duloxetine twice a day and will be assessed after two to four weeks to see if the medicine is beneficial or if it is causing any side effects.

Duloxetine should not be taken or should be used with caution by:

  • elderly people
  • people with coronary heart disease
  • people with uncontrolled hypertension (high blood pressure)
  • people with liver or kidney problems
  • women who are pregnant or breastfeeding

Your doctor will discuss any other medical conditions you have to determine if you can take duloxetine.

Side effects

There are many possible side effects of duloxetine, including:

Do not suddenly stop taking duloxetine as this can also cause unpleasant effects. Your doctor will reduce your dose gradually if you are going to stop taking duloxetine.

For more information see our [medicines information guide for urinary incontinence].

Medication for urge incontinence and overactive bladder syndrome

If bladder training is not an effective treatment for your urge incontinence, your doctor may prescribe an antimuscarinic. Antimuscarinics may also be prescribed if you have overactive bladder syndrome (OAB), which is the frequent urge to urinate with or without urinary incontinence.

The first antimuscarinic that may be tried is called oxybutynin. There are two different types of oxybutynin tablets, and it is also available as a patch that you stick to your skin. If oxybutynin is not effective or unsuitable, other antimuscarinics that may be prescribed include:

  • darifenacin
  • fesoterodine
  • flavoxate
  • propiverine
  • solifenacin
  • tolterodine
  • trospium

Your doctor 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.

You will be assessed after six weeks to see how you are getting on with the medication, and again after three to six months to see if you still need it.

Antimuscarinics should not be taken or should be used with caution by:

  • people with an untreated eye condition called angle closure glaucoma
  • people with myasthenia gravis, a condition that causes some muscles around your body to become weak
  • people with severe ulcerative colitis, a long-term condition that affects the colon

Your doctor will discuss any other medical conditions you have to determine which antimuscarinics are suitable for you.

Side effects

There are many possible side effects of antimuscarinics, including:

  • dry mouth
  • constipation
  • indigestion and heartburn
  • blurred vision
  • dry eyes

For more information see our [medicines information guide for urinary incontinence].

Medication for nocturia

A medication called desmopressin may be used to treat noctuira, which is the frequent need to get up during the night to urinate.

Another type of medication taken late in the afternoon, called a loop diuretic, may also prevent you from 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.

Desmopressin is licensed to treat bedwetting at night but is not licensed to treat nocturia. Loop diuretics are also not licensed to treat nocturia.

This means that the manufacturers of the medication have not applied for a license for their medication to be used in treating nocturia. In other words, the medication may not have undergone clinical trials (a type of research that tests one treatment against another) to see if it is effective and safe in the treatment of nocturia.

However, your doctor or specialist may suggest an unlicensed medication if they think the medication is likely to be effective and the benefits of treatment outweigh any associated risk.

If your doctor is considering prescribing desmopressin or a loop diuretic, they should tell you that it is unlicensed and will discuss the possible risks and benefits with you.

Kate's story

Kate first had symptoms of stress incontinence after having a hysterectomy. She coped alone for eight years before she sought help.

At first, Kate ignored her symptoms because they were mild and she thought they were a natural part of ageing. However, her symptoms became progressively worse and began to have a huge impact on her life.

She’d always been sporty and enjoyed going to aerobics classes, but she felt unable to continue with her old exercise regime for fear of leaking. She became nervous about the types of clothing she wore.

Finally, fed up with the condition and especially not knowing when she was going to leak, Kate told her doctor. She was referred to a physiotherapist who taught her how to do pelvic floor muscle exercises. For a while she managed by wearing pads, hoping the exercises would help. When that didn’t work, Kate went back to her doctor and was prescribed medication to control her symptoms.

“There are several different routes for treating stress incontinence,” Kate says. “They vary depending on the individual, but the medication wasn’t for me."

Kate's medication had a number of side effects, such as loss of libido, feeling tired and raised blood pressure. It was also not 100% successful in stopping the leaking.

“I decided to have an operation to insert a vaginal tape,” she says. “It was very quick, with minimal scarring and just a little discomfort for a few days afterwards.”

Six weeks later, Kate felt better than she had in years. “I’m able to run, cough and laugh without fear of leakage. I’m back at the gym, doing Pilates, and I feel really positive. It takes longer to pee, but it's great not to fear leaking or having to get up in the middle of the night.

“Women should not feel embarrassed about having stress incontinence or feel as if it's their fault,” she says. “After talking to my friends about stress incontinence, I realise how common it is.”

Preventing urinary incontinence

It is not always possible to prevent urinary incontinence, but a healthy lifestyle can reduce the chances of the condition developing.


Being obese increases your risk of urinary incontinence. Maintain a healthy weight by eating a balanced diet.


Depending on your particular bladder problem, your doctor can advise you about the amount of fluids that you should drink.

If you have urinary incontinence, cut down on alcohol and drinks that contain caffeine, such as tea, coffee and cola. These can cause your kidneys to produce more urine and irritate your bladder.

The recommended daily limits for alcohol consumption are:

  • three to four units a day for men
  • two to three units a day for women

A unit of alcohol is roughly half a pint of normal-strength lager, a small glass of wine or a single measure (25ml) of spirits.

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.


Keeping active is a very important part of leading a healthy lifestyle and can help prevent several serious health conditions, including urinary incontinence. Do a minimum of 30 minutes of exercise at least five times a week.

Being pregnant and giving birth can weaken the muscles that control the flow of urine from your bladder. If you are pregnant, strengthening your pelvic floor muscles can help prevent urinary incontinence.

Read more about [staying active during pregnancy].

Men can also benefit from strengthening their pelvic floor muscles by doing pelvic floor exercises. Find out more about [pelvic floor exercises].

Surgical treatment

If other treatments for urinary incontinence are unsuccessful, 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.

If you are a woman and plan to have children, this will affect your decision, because the physical strain of pregnancy and childbirth can sometimes cause surgical treatments to fail. Therefore, you may wish to wait until you no longer want to have any more children before having surgery.

Surgery and procedures for stress incontinence

Sling procedures

Sling procedures involve making an incision in your lower abdomen and inserting a sling around the neck of the bladder to support it. The sling could be made of:

  • a synthetic material
  • tissue taken from another part of your body (an autologous fascial sling)
  • tissue donated from another person (an allograft sling)
  • tissue taken from an animal (a xenograft sling), such as cow or pig tissue

Autologous fascial slings are a long-term treatment for stress incontinence and may be the most effective.

Synthetic slings may carry long-term risks of causing difficulty urinating or urge incontinence.

Urethral bulking agents

A urethral bulking agent is a substance that is injected into the walls of your urethra (the tube that carries urine from the bladder to outside the body). 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 is no evidence that one is more beneficial than another.

This is less invasive than other surgical treatments as it does not require any incisions. However, it is less effective than the other options. The effectiveness of the bulking agents will reduce with time and you may need repeated injections.


Colposuspension involves making an incision in your lower abdomen and lifting up the neck of your bladder. Stitches through the walls of the bladder neck hold it in place.

There are two types of colposuspension:

  • an open colposuspension – when surgery is carried out through a large incision
  • a laparoscopic colposuspension – when surgery is carried out through a small incision using special, small surgical instruments (keyhole surgery)

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.

Tape procedures for women

Tape procedures can be used for women with stress incontinence. A piece of tape is inserted through an incision inside the vagina and threaded behind the urethra. The middle part of the tape supports the urethra, and the two ends are threaded through two incisions in either the:

  • tops of the inner thigh – this is called a transobturator tape procedure (TOT)
  • abdomen – this is called a retropubic tape procedure or tension-free vaginal tape procedure (TVT)

Some studies have suggested that TVT may be more effective than TOT in some cases. There is a higher risk of injury to the bladder during TOT, and a higher risk of injury to the urethra during TVT. TOT may also cause thigh pain.

Artificial urinary sphincter for men

The urinary sphincter is a ring of muscle that stays closed to prevent urine flowing from the bladder into your urethra. If another type of surgery has not been successful, it may be suggested that you have an artificial urinary sphincter fitted to treat your incontinence.

However, an artificial urinary sphincter can cause a number of side effects, such as the pump that controls the sphincter failing, or not being able to urinate. In such cases, the device commonly needs to be removed or fixed.

This treatment is rarely used in women.

Surgery and procedures for urge incontinence or overactive bladder syndrome

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 (OAB).

Although the symptoms of incontinence may improve after the injections, you may not be able to pass urine normally, so you will need to insert a catheter (a thin, flexible tube) to drain the urine from your bladder.

Botulinum toxin A is not currently licensed to treat urge incontinence or OAB, 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, but it may be of benefit when other treatments have not worked.

Some limited evidence suggests that botulinum toxin A may cure incontinence or improve symptoms by 90%. The effects can last for up to 12 months.

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 that are 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 (detrusor overactivity), sacral nerve stimulation, also known as sacral neuromodulation, may be recommended.

During the operation, a device is inserted near one of your sacral nerves, for example in one of your buttocks. An electrical current is sent to the device that stimulates the sacral nerve. This should improve the way signals are sent between your brain and your detrusor muscles, and so reduce your urges to urinate.

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 and is found near your ankle. It contains some nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor. It is thought that stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pass urine.

During the procedure, a very thin needle is inserted through the skin of your ankle and an electrode is attached to your foot. A mild electric current is sent though the needle and electrode, causing a tingling feeling and causing your foot to move. You may need 12 sessions of stimulation, each lasting around half an hour, one week apart.

In a number of different studies, at least half of people reported improvements in their symptoms, with some people being free from symptoms immediately after the 12 weeks of treatment. However, the results do not last long and you may need more stimulation sessions.

Posterior tibial nerve stimulation can also cause side effects, such as foot or toe pain, minor bleeding and headaches. Some people may also find the stimulation too uncomfortable to continue with.

Augmentation cystoplasty

In a procedure known as augmentation cystoplasty, your bladder is made larger by adding a piece of tissue from your intestine (part of the digestive system) into the bladder wall.

After the procedure, you may not be able to pass urine normally and you may need to use a catheter (a thin tube that is passed through your bladder and into your urethra). Because of this, augmentation cystoplasty will only be considered if you are willing to use a catheter.

Urinary tract infections are common among people who use a catheter. Read about urinary catheterisation for more information.

Urinary diversion

Urinary diversion is a procedure where the ureters (the tubes that lead from your kidneys to your bladder) are redirected to the outside of your body. The urine is 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.

Urinary diversion can cause a number of complications, such as a bladder infection, and it is common to need further surgery to correct any problems that occur.

Surgery for other types of incontinence

Clean intermittent catherisation for overflow incontinence

Clean intermittent catherisation (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 urine will flow 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 urinary tract infections.

Indwelling catheterisation for overflow incontinence

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 urine.

Surgery for LUTS in men

Lower urinary tract symptoms (LUTS) may be treated with surgery if it is thought that your symptoms are caused by an enlarged prostate gland. This is a small gland, found only in men, that surrounds the urethra and is located between the penis and bladder.

One possible type of surgery is a transurethral resection of the prostate (TURP). This involves cutting away a section of the prostate gland.

Another possible type of surgery is holmium laser enucleation of the prostate (HoLEP). This is a relatively new procedure and may only be available in some specialist centres. It involves using a laser to remove some of the prostate tissue.

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