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 pee, 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 cannot 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.

Find out more about the symptoms of urinary incontinence.

When to seek medical advice

See a GP if you have any type of urinary incontinence. Urinary incontinence is a common problem and you should not 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 a GP, who will ask about your symptoms and may do a pelvic or rectal examination, depending on whether you have a vagina or a penis.

The GP may also suggest you keep a diary in which you note how much fluid you drink and how often you have to urinate.

Find out 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 in your bladder, which prevents it from emptying fully.

Total incontinence may be caused by a problem with the bladder from birth, a spinal injury, or a small, tunnel like hole that can form between the bladder and a nearby area (fistula).

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

  • pregnancy and vaginal birth
  • obesity
  • a family history of incontinence
  • increasing age – although incontinence is not an inevitable part of ageing

Find out more about the causes of urinary incontinence.

Treating urinary incontinence

Non-surgical treatments

Initially, a 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, where you strengthen your pelvic floor muscles by squeezing them
  • bladder training, where you learn ways to wait longer between needing to urinate and passing urine

You may also benefit from the use of incontinence products, such as absorbent pads and handheld urinals.

Medicine may be recommended if you're still unable to manage your symptoms.

Find out more about non-surgical treatments for urinary incontinence.

Surgical treatments

Surgery may also be considered. The procedures that are suitable for you will depend on the type of incontinence you have.

Surgical treatment for stress incontinence, such as a sling procedure, is used to reduce pressure on the bladder or strengthen the muscles that control urination.

Surgery to treat urge incontinence includes enlarging the bladder or implanting a device that stimulates the nerve that controls the detrusor muscles.

Find out more 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 happening.

These include:

  • maintaining a healthy weight
  • avoiding or cutting down on alcohol
  • staying active – in particular, ensuring that your pelvic floor muscles are strong

Healthy weight

Being obese can increase your risk of urinary incontinence. You may be able to lower your risk by maintaining a healthy weight through regular exercise and healthy eating.

Use the healthy weight calculator to see if you are a healthy weight for your height.

Get more information and advice about losing weight.

Drinking habits

Depending on your particular bladder problem, a 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 limit for alcohol consumption is 14 units.

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

Find out more about alcohol units.

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.

Find out more about exercise during pregnancy.

Everyone may benefit from strengthening their pelvic floor muscles with pelvic floor exercises.

Find out more about pelvic floor exercises.

Social care and support guide

If you:

  • 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 social care and support explains your options and where you can get support.

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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 a GP if you have urinary incontinence. It's a common problem and seeing a 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

Stress incontinence is when you leak urine when your bladder is put under sudden extra pressure – for example, when you cough. It's not related to feeling stressed.

Other 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 sometimes 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're unable to delay going to the toilet. There are 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 a group of symptoms called overactive bladder syndrome, which is when the bladder muscle is more active than usual.

As well as sometimes causing urge incontinence, overactive bladder syndrome can mean you need to pass urine very frequently, including several times during the night.

Other 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.

Overflow incontinence

Overflow incontinence, also called chronic urinary retention, is 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.

Total incontinence

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. Or you may pass large amounts of urine only occasionally and leak smaller amounts in between.

Lower urinary tract symptoms (LUTS)

The lower urinary tract includes the bladder and the tube that urine passes through as it leaves the body (urethra).

Lower urinary tract symptoms (LUTS) are common as people get older.

They can include:

  • problems with storing urine, such as an urgent or frequent need to pass urine or feeling like you need to go again 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.

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Learn more about urinary incontinence: causes

Urinary incontinence is when the normal process of storing and passing urine is disrupted. This can happen for several 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 is when the pressure inside your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. Your urethra is the tube that urine passes through to leave the body.

Any sudden extra pressure on your bladder, such as laughing or sneezing, can cause urine to leak out of your urethra if you have stress incontinence.

Your urethra may not be able to stay closed if the muscles in your pelvis (pelvic floor muscles) are weak or damaged, or if your urethral sphincter – the ring of muscle that keeps the urethra closed – is damaged.

Problems with these muscles may be caused by:

  • damage during childbirth – particularly if your baby 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), or removal of the prostate gland
  • 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 medicines

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 your 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
  • not drinking enough fluids – this can cause strong, concentrated urine to collect in your bladder, which can irritate the bladder and cause symptoms of overactivity
  • constipation
  • conditions affecting the lower urinary tract (urethra and bladder) – such as urinary tract infections (UTIs) or tumours in the bladder
  • neurological conditions
  • certain medicines

Causes of overflow incontinence

Overflow incontinence, also called chronic urinary retention, is often caused by a blockage or obstruction affecting your bladder.

Your bladder may fill up as usual, but because of an obstruction, you will not be able to empty it completely, even when you try.

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

Your bladder can be obstructed by:

Overflow incontinence may also be caused by your detrusor muscles not fully contracting, which means your bladder does not completely empty when you urinate. 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 medicines

Causes of total incontinence

Total incontinence is when your bladder cannot store any urine at all. It can mean you either pass large amounts of urine constantly, or you pass urine occasionally with frequent leaking in between.

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

Medicines that may cause incontinence

Some medicines can disrupt the normal process of storing and passing urine or increase the amount of urine you produce.

These include:

Stopping these medicines, if advised to do so by a doctor, may help resolve your incontinence.

Risk factors

In addition to common causes, 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 the problem
  • increasing age – urinary incontinence becomes more common in middle age and is very common in people who are 80 or older
  • having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and urethra
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Learn more about urinary incontinence: diagnosis

If you experienced urinary incontinence, see a GP so they can diagnose the type of urinary incontinence you have.

Try not to be embarrassed when speaking to the GP about your condition. Urinary incontinence is a common problem and it's likely the GP has seen many people with the same problem.

A GP will ask you questions about your symptoms and medical history, including:

  • whether the urinary incontinence happens 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 medicine
  • how much fluid, alcohol or caffeine you drink

Bladder diary

The 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:

  • 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 have
  • 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 the GP can confirm or rule out things that may be causing incontinence.

Physical examination

A GP may examine you to assess the health of your urinary system. If you have a vagina, the GP will do a pelvic examination, which usually involves undressing from the waist down. You may be asked to cough to see if any urine leaks.

The GP may also examine your vagina. In many cases of stress incontinence, part of the bladder may bulge into the vagina, which is called a cystocele.

The GP may place their finger inside your vagina and ask you to squeeze your pelvic floor muscles.

These are the muscles that surround your bladder and urethra (the tube that urine passes through to leave your body). Damage to your pelvic floor muscles can lead to urinary incontinence.

If you have a penis, the GP may check the health of your prostate gland, which is located between the penis and bladder and surrounds the urethra.

You may need a digital rectal examination. This will involve the GP inserting their finger into your bottom so they can feel your prostate gland.

If you have an enlarged prostate gland, it can cause symptoms of urinary incontinence, such as a frequent need to urinate.

Dipstick test

If the GP thinks your symptoms may be caused by a urinary tract infection (UTI), 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 for blood and protein in your urine.

Residual urine test

If the GP thinks you 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 pee.

This usually involves an ultrasound scan of your bladder, although occasionally the amount of urine left in your bladder may be measured after your bladder is drained using a catheter.

A catheter is a thin, flexible tube that's inserted into your urethra and passed through to your bladder.

Further tests

Further tests may be necessary if the cause of your urinary incontinence is not clear. The GP will usually start treating you first and may suggest further tests if treatment is not effective.

Cystoscopy

A cystoscopy involves using a thin tube with a camera attached to it (endoscope) to look inside your bladder and urinary tract. A cystoscopy can identify abnormalities that may be causing incontinence.

Urodynamic tests

These are a group of tests used to check the function of your bladder and urethra. You may be asked to keep a bladder diary for a few days then have several tests at a hospital or clinic.

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
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Learn more about urinary incontinence: non-surgical treatment

Your treatment will depend on the type of urinary incontinence you have and the severity of your symptoms.

If urinary incontinence is caused by an underlying condition, you may receive treatment for this alongside incontinence treatment.

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

  • lifestyle changes
  • pelvic floor muscle training (Kegel exercises)
  • bladder training

After this, medicine or surgery may be considered.

This page is about non-surgical treatments for urinary incontinence. Find out about surgery and procedures for urinary incontinence.

Lifestyle changes

A GP may suggest you make simple changes to your lifestyle to improve your symptoms, regardless of the type of urinary incontinence you have.

For example, the GP may recommend:

  • reducing your intake of caffeine, which is found in tea, coffee and cola, as caffeine can increase the amount of urine your body makes
  • altering how much fluid you drink each day, as 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

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.

Pelvic floor muscle training

Your pelvic floor muscles surround the bladder and urethra (the tube that carries urine from your bladder out of your body) and control the flow of urine as you pee.

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often recommended.

A GP may refer you to a specialist to start a programme of pelvic floor muscle training.

The 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 exercise programme based on your assessment.

Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last for at least 3 months. If the exercises are helping after this time, you can keep on doing them.

Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.

Find out more about pelvic floor exercises.

Electrical stimulation

If you're unable to contract your pelvic floor muscles, using electrical stimulation may be recommended.

A small probe will be inserted into the vagina, or into the anus (if you have a penis). 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, but it may be beneficial if you're unable to complete pelvic floor muscle contractions without it.

Biofeedback

Biofeedback is a way to monitor how well you do 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, or the anus (if you have a penis), which 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 is not 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 do their exercises.

Speak to your specialist if you would like to try biofeedback.

Vaginal cones

Vaginal cones may be used 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.

Bladder training

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.

Incontinence products

While incontinence products are not a treatment for urinary incontinence, you might find them useful for managing your condition while you're waiting to be assessed or waiting for treatment to start helping.

Incontinence products include:

  • absorbent products, such as 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

Find out more about incontinence products, and information about getting free incontinence products on the NHS.

Medicine for stress incontinence

If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be recommended as the next step.

However, if you're unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant medicine called duloxetine. This can help increase the muscle tone of the urethra, to help keep it closed.

You'll need to take duloxetine tablets 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:

Do not suddenly stop taking duloxetine, as this can also cause unpleasant side effects. A GP will reduce your dose gradually.

Duloxetine is not suitable for everyone, however, so a GP will discuss any other medical conditions you have to determine if you can take it.

Medicines for urge incontinence

Antimuscarinics

If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called an antimuscarinic.

Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the frequent urge to urinate that can happen with or without urinary incontinence.

The most common types of antimuscarinic medicines used to treat urge incontinence include:

  • oxybutynin
  • tolterodine
  • darifenacin

These are usually taken as a tablet that you swallow, 2 or 3 times a day, although oxybutynin also comes as a patch that you place on your skin twice a week.

You will usually start taking a low dose to minimise any possible side effects. The dose can be increased until the medicine is effective.

Possible side effects of antimuscarinics include:

  • dry mouth
  • constipation
  • blurred vision
  • extreme tiredness (fatigue)

In rare cases, antimuscarinics can lead to a build-up of pressure within the eye (glaucoma), called angle closure glaucoma.

You'll be assessed after 4 weeks to see if the medicine is helping, and every 6 to 12 months thereafter if the medicine continues to be effective.

A GP will discuss any other medical conditions you have to determine which antimuscarinic is suitable for you.

Mirabegron

If antimuscarinics are unsuitable for you, they have not helped urge incontinence, or have unpleasant side effects, you may be offered an alternative medicine called mirabegron.

Mirabegron causes the bladder muscle to relax, which helps the bladder fill up with and store urine. It usually comes as a tablet or capsule that you swallow once a day.

Side effects of mirabegron can include:

The GP will discuss any other medical conditions you have to determine whether mirabegron is suitable for you.

Medicine for nocturia

A low-dose version of a medicine 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 medicine 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 the medicine may not have undergone clinical trials to see if it's effective and safe in the treatment of nocturia.

However, a GP or specialist may suggest an unlicensed medicine if they think it's likely to be effective and the benefits of treatment outweigh any associated risk.

If a GP is considering prescribing a loop diuretic, they should tell you it's unlicensed and discuss the possible risks and benefits with you.

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Learn more about urinary incontinence: surgery and procedures

If non-surgical 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 keep a detailed record of the type of surgery they do, including any complications you get after you have had surgery. You should be given a copy of this record.

If you plan to have a pregnancy, this will affect your options. The physical strain of pregnancy and childbirth can sometimes cause surgical treatments to fail.

You may wish to wait until after you have had children before you choose surgery.

Surgery and procedures for stress incontinence

Colposuspension

Colposuspension involves making a cut in your lower tummy (abdomen), lifting the neck of your bladder, and stitching it in this lifted position.

If you have a vagina, a colposuspension can help prevent involuntary leaks from stress incontinence.

There are 2 types of colposuspension:

  • open colposuspension – where surgery is done through a large cut
  • laparoscopic (keyhole) colposuspension – where surgery is done 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 done by an experienced laparoscopic surgeon.

Problems that can happen after colposuspension include difficulty emptying the bladder completely when peeing, urinary tract infections (UTIs) that keep coming back, and discomfort during sex.

Sling surgery

Sling surgery involves making a cut in your lower tummy (abdomen) and vagina so a sling can be placed around the neck of the bladder to support it and prevent urine leaking. If you have a penis, this surgery involves making a cut between the scrotum and anus to put a sling around part of the urethral bulb (the enlarged end of the urethra).

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. It is made from 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 completely when peeing.

A small number of people who have the procedure also find they develop urge incontinence afterwards.

Vaginal mesh surgery (tape surgery)

At the moment, it is not possible to have vaginal mesh surgery for urinary incontinence on the NHS unless there's no alternative and the procedure cannot be delayed, and after detailed discussion between you and a doctor.

Vaginal mesh surgery is where a strip of synthetic mesh is inserted behind the tube that carries urine out of your body (urethra) to support it.

Vaginal mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in the 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 people need to stay in hospital overnight.

A few people have had serious complications after mesh surgery. Some, but not all, of these complications can also happen after other types of surgery.

Problems include:

  • long-lasting pain
  • permanent nerve damage
  • incontinence
  • constipation
  • sexual problems
  • mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel

If you're concerned about vaginal mesh surgery

If you have previously had vaginal mesh or tape inserted for incontinence and you think you're having complications, speak to a GP or your 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 at GOV.UK.

Find out more about the rules for when to use vaginal mesh surgery.

Urethral bulking agents

A urethral bulking agent is a substance that's injected into the walls of the urethra in people with stress incontinence who have a vagina.

This increases the size of the urethral walls and allows the urethra to stay closed with more force.

Several different bulking agents are available, and there's no evidence 1 is more beneficial than another.

This is less invasive than surgical treatments for stress incontinence in people with a vagina, as it does not usually require any cuts.

The substance is usually injected through a cystoscope (a thin camera) inserted into the urethra.

Urethral bulking agents are generally less effective than other procedures. The effectiveness of a urethral bulking agent will also reduce with time and you may need the injection to be repeated.

Many people experience a slight burning sensation or bleeding when they pass urine for a short period after a bulking agent is injected.

Artificial urinary sphincter

The urinary sphincter is a ring of muscle that prevents 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 treatment is used more often for people who have a penis rather than a vagina.

An artificial sphincter has 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 people who have a penis) that contains a 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 pee.

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 completely 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 urine 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 this treatment.

The long-term effects of this treatment are not yet known.

Sacral nerve stimulation

The sacral nerves are located at the base 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 urge incontinence is the result of your detrusor muscles contracting too often, sacral nerve stimulation, also known as sacral neuromodulation, may be recommended.

A device is inserted near 1 of your sacral nerves, usually in 1 of your buttocks. An electrical current is sent from the device into the sacral nerve.

This should improve the way signals are sent between your brain and your detrusor muscles and 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 the urge to pee.

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 30 minutes, 1 week apart.

Some studies have shown that this treatment can offer relief from urge incontinence and overactive bladder syndrome 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.

Augmentation cystoplasty

In rare cases, an operation known as augmentation cystoplasty may be recommended to treat urge incontinence.

This involves making your bladder bigger by adding a piece of tissue from your intestine into the bladder wall.

After augmented cystoplasty you may not be able to pass urine normally and may need to use a catheter. 

Because of this, augmentation cystoplasty is only considered if you're willing to use a catheter.

The difficulties passing urine can also mean that people who have augmentation cystoplasty can get urinary tract infections (UTIs) that keep coming back.

Urinary diversion

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 in a bag, without it flowing into your bladder.

Urinary diversion should only be done if other treatments have been unsuccessful or are not suitable.

It can cause several complications, such as a bladder infection, and sometimes further surgery is needed to correct any problems that happen.

Catheterisation for overflow incontinence

There are 2 types of catheterisation for overflow incontinence, clean intermittent catheterisation and indwelling catheterisation.

Clean intermittent catheterisation (CIC)

Clean intermittent catheterisation (CIC) is 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 pass a catheter through your urethra and into your bladder. Urine will then flow through the catheter and into the toilet.

Using a catheter can feel a bit painful or uncomfortable at first, but discomfort should ease over time.

How often CIC will need to be done will depend on your circumstances.

For example, you may only need CIC once a day, or you may need to use it several times a day.

Regular use of a catheter increases the risk of urinary tract infections (UTIs).

Indwelling catheterisation

If using a catheter occasionally is not enough to treat overflow incontinence, you can have an indwelling catheter fitted instead.

This is a catheter that's inserted in the same way as CIC, but left in place. A bag is attached to the end of the catheter to collect urine.

Find out more about urinary catheterisation

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Learn more about urinary incontinence: incontinence products

Incontinence pads and other products and devices can make life easier for you if you're waiting for a diagnosis or for a treatment to work.

A wide range of products and devices are available for urinary incontinence.

They include:

  • pads and pants
  • bed and chair protection
  • catheters and penile sheaths
  • skin care and hygiene products
  • specially adapted clothing and swimwear

Pads and pull-up pants

The most popular incontinence products are absorbent pads that are worn inside underwear to soak up urine.

Pads and pull-up pants use the same technology as babies' nappies and have a "hydrophobic" layer which draws urine away from the surface of the product, so your skin stays dry.

If you have mild to moderate incontinence you can buy thin, discrete pads or pull-up pants for men and women from many supermarkets and pharmacies.

For people with severe leaks, continence clinics and district nurses can supply incontinence pads on the NHS, but these tend to be big and bulky.

"I would not recommend that people with urinary incontinence use pads without advice from a doctor or continence adviser," says Karen Logan, consultant continence nurse at Gwent Healthcare NHS Trust.

"But as a temporary measure, they can really improve your quality of life and save you from being housebound or spending all your time in the toilet."

Avoid sanitary pads for incontinence

"Many women use sanitary pads instead of incontinence pads because they're cheaper, but they do not have the same technology. They stay damp and they can make your skin sore," says Logan.

"I recommend paying the extra for incontinence pads as they're much more effective and comfortable."

Using tampons for stress incontinence

Placing a tampon in your vagina puts pressure on the neck of your bladder to stop leaks on exertion. However, do not regularly use super-size tampons to prevent sudden leaks if you have stress incontinence.

The National Institute for Health and Care Excellence (NICE) does not recommend using tampons for the routine management of urinary incontinence in women.

However, tampons can be used occasionally, when necessary, to prevent leaks. For example, during exercise.

Appliances and bedding

Other useful incontinence products for more severe leaks include urinals (devices that collect urine), or sheaths and drainage systems (if you have a penis).

A variety of incontinence bedding is also available, such as washable bed pads which sit on top of the mattress and soak up any overnight leaks. The pads stay dry to the touch and they can be useful for trips away from home.

Can I get incontinence products on the NHS?

You may be able to get incontinence products on the NHS depending on your local clinical commissioning group. To qualify for NHS products you may need to be assessed by a healthcare professional.

Find out more about how to get incontinence products on the NHS.

Where to buy incontinence products

The charity Bladder & Bowel UK gives independent advice on products that can help manage bladder and bowel problems.

For more information on products and how to order them, call its helpline on 0161 607 8219 or visit the Bladder & Bowel UK website.

The Continence Product Advisor gives independent and evidence-based advice on how to choose and use suitable incontinence products.

Content supplied by the NHS website

Learn more about urinary incontinence: 10 ways to stop leaks

For many people with urinary incontinence, the following self-help tips and lifestyle changes are enough to relieve symptoms.

Do daily pelvic floor exercises

Pelvic floor exercises can be effective at reducing leaks, but it's important to do them properly. Find out how to do pelvic floor exercises.

You may have to do pelvic floor exercises for 3 months before you see any benefits.

Stop smoking

If you smoke, you put yourself at risk of incontinence, because coughing puts strain on your pelvic floor muscles.

Find out about NHS Smokefree support services, or call the Smokefree National Helpline to speak to a trained adviser on 0300 123 1044 from Monday to Friday 9am to 8pm and Saturday and Sunday 11am to 4pm.

Find out more about how to stop smoking.

Do the right exercises

High-impact exercise and sit-ups put pressure on your pelvic floor muscles and can increase leaks.

To strengthen your pelvic floor to relieve symptoms, replace high-impact exercise, such as jogging and aerobics, with strengthening exercise, such as pilates.

Pilates strengthens your core muscles, which is beneficial for stress incontinence.

Avoid lifting

Lifting puts strain on your pelvic floor muscles, so avoid it whenever you can.

When you do need to lift something, such as picking up children or shopping bags, tighten your pelvic floor muscles before and during the lift.

Lose excess weight

Being overweight can weaken your pelvic floor muscles and cause incontinence because of the pressure of fatty tissue on your bladder.

Your symptoms may improve, and could go away completely, if you lose any excess weight.

Use the healthy weight calculator to check you're a healthy weight for your height.

Find out more about how to lose weight.

Treat constipation promptly

Straining to poo weakens your pelvic floor muscles and makes urinary incontinence worse.

Never ignore the urge to poo. If you have constipation, it may help to change your diet and lifestyle.

Eating more fibre and exercising more can help. It may also help if you change the way you sit and use your muscles to empty your bowels. A specialist physiotherapist can advise you on this.

Find out more about how to have a healthy diet.

Cut down on caffeine

Caffeine irritates the bladder and can make incontinence worse.

Coffee has the biggest effect, so stop drinking it or switch to decaffeinated coffee.

Fizzy drinks, tea, green tea, energy drinks and hot chocolate also contain caffeine, so cut down on these too and replace them with water and herbal or fruit teas.

Cut down on alcohol

Alcohol is a diuretic, which makes you urinate more often. Cutting down may help incontinence symptoms.

Find out more about how to cut down on alcohol.

Drink plenty of water

Drink 6 to 8 glasses of fluid a day (but no more) unless your doctor advises you otherwise.

Many people with urinary incontinence avoid drinking fluids, as they feel it causes more problems. However, limiting your fluid intake makes incontinence worse, because it reduces your bladder's capacity.

Not drinking enough fluid can also cause constipation or make it worse.

Find out which are the healthiest drinks.

Eat the right foods

Avoid spicy and acidic foods, such as curries and citrus fruits, as they can irritate the bladder and make leaks and other incontinence symptoms worse.

Content supplied by the NHS website