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Stress incontinence Content Supplied by NHS Choices
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
  • obesity
  • 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 tape or 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.

These include:

  • controlling your weight
  • avoiding or cutting down on alcohol
  • keeping fit - in particular, ensuring that your pelvic floor muscles are strong

Healthy weight

Being obese can increase your risk of developing urinary incontinence. You may therefore 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, 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 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 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.


'Women should not feel embarrassed'

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."

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

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:

  • 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'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

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, 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.

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. 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.


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
  • constipation
  • 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.

These include:

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

Risk factors

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

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

Bladder diary

Your GP 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 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.

Physical examination

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.

Dipstick test

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.

Further tests

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.

Cystoscopy

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.

Urodynamic tests

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

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.

The various non-surgical treatments for urinary incontinence are outlined below.

You can also read a summary of the pros and cons of the non-surgical treatments for urinary incontinence, allowing you to compare your treatment options.

Lifestyle changes

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 eight muscle contractions at least three times a day and the recommended exercises for at least three 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:

Pelvic floor exercises in women (PDF, 163kb)

Pelvic floor exercises in men (PDF, 174kb)

Electrical stimulation

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

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

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.

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 six weeks.

Incontinence products

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 two to four 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

Antimuscarinics

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 two or three 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
  • constipation
  • blurred vision
  • fatigue

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 four 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.

Mirabegron

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:

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

Medication for nocturia

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.

Desmopressin is licensed to treat bedwetting, but isn't licensed to treat nocturia. Loop diuretics are also 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 desmopressin or a loop diuretic, they should tell you it's unlicensed and discuss the possible risks and benefits with you.

Treatment-surgical

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.

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.

The various surgical treatments for urinary incontinence are outlined below.

You can also read a summary of the pros and cons of the surgical treatments for urinary incontinence, allowing you to compare your treatment options.

Surgery and procedures for stress incontinence

Tape procedures

Tape procedures can be used for women with stress incontinence. A piece of plastic tape is inserted through a cut (incision) inside the vagina and threaded behind the tube that carries urine out of the body (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)
  • tummy (abdomen) - this is called a retropubic tape procedure or tension-free vaginal tape procedure (TVT)

By holding the urethra up in the correct position, the piece of tape can help reduce the leaking of urine associated with stress incontinence.

The effectiveness of these tape procedures is similar, with around two in every three women not experiencing any leaking afterwards.

Even those who still have some leaking after surgery often find this is less severe than it was before the operation.

However, it's not uncommon for women to need to go to the toilet more frequently and urgently after this procedure, and some find they're unable to completely empty their bladder when they go to the toilet.

In some cases, the tape can wear away or move over time and further surgery may be needed at a later stage to adjust it - for example, to make it looser - or remove it.

Colposuspension

Colposuspension involves making an incision in your lower 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 two types of colposuspension:

  • open colposuspension - where surgery is carried out through a large incision
  • laparoscopic (keyhole) colposuspension - where surgery is carried out through one or more small incisions using special 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 procedures

Sling procedures involve making an incision in your lower abdomen 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:

  • a synthetic material
  • 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.

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 one is more beneficial than another.

This is less invasive than other surgical treatments for stress incontinence in women as it doesn't usually require any incisions.

Instead, the substances are normally injected through a cystoscope inserted directly into the urethra.

However, 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 three parts:

  • a circular cuff that is 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 abdomen - 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 medication 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 urine from your bladder.

Botulinum toxin A isn't 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 one of your sacral nerves, usually in one 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 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 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 pass urine.

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, one week apart.

Some studies have shown that this treatment can offer relief from overactive bladder syndrome and urge incontinence for some people, although there isn't 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 hasn't improved with medication and you don't want to have botulinum toxin A injections or sacral nerve stimulation.

Augmentation cystoplasty

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 urinary tract infections.

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 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 urine 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 urinary tract infections (UTIs).

Indwelling catheterisation

If using a catheter every now and then isn't 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.

Read more about urinary catheterisation.

Incontinence products

There are several incontinence products that you might find useful for managing your urinary incontinence while you're waiting for surgery.

These include:

  • absorbent products, such as incontinence pants or pads
  • handheld urinals
  • a catheter
  • devices that are placed into the vagina or urethra to prevent urine leakage while you exercise, for example

For more information, see Can I get incontinence products on the NHS


 
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