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Women's Health
Urinary Incontinence
Urinary incontinence is a common and treatable condition affecting up to 1 in 3 women. Effective solutions are available to help you regain confidence and control.
Clinically Reviewed By
Honorary Associate Professor Jeremy Ockrim MD BSc(Hons) FRCS(Urol)
Consultant Urological Surgeon · Reviewed May 2026 · Review due May 2027
What is Urinary Incontinence?
Urinary incontinence is the involuntary leakage of urine. It is an extremely common condition that affects approximately one in three women at some point during their lives. While it becomes more prevalent with age, it is not an inevitable or untreatable part of ageing.
The condition can range from occasional minor leaks when you cough or sneeze, to a sudden and overwhelming urge to urinate that makes it difficult to reach the toilet in time. For many women, incontinence causes embarrassment, anxiety, and a significant reduction in quality of life, limiting professional practices, social activities, exercise, and intimate relationships.
The most important thing to understand is that urinary incontinence is not something you simply have to live with. A wide range of effective treatments is available, from conservative measures and physiotherapy through to medication and minimally invasive surgical procedures. With proper assessment and an individualised treatment plan, the vast majority of women can achieve cure or significant improvement in their symptoms.
Source: NICE NG123
You are not alone
Many women suffer in silence with urinary incontinence, often for years, because they feel too embarrassed to seek help or believe nothing can be done. In reality, effective treatments are available for every type and severity of incontinence. The first step is a confidential assessment with a specialist.
Types of Urinary Incontinence
Understanding the type of incontinence you experience is essential for selecting the most appropriate treatment. There are four main types:
Stress Incontinence
Stress urinary incontinence (SUI) is defined by the International Continence Society (ICS) as "the complaint of any involuntary loss of urine on effort or physical exertion."
Leakage occurs during physical activities that increase abdominal pressure, such as coughing, sneezing, laughing, lifting, or exercise. The pelvic floor muscles and urethral sphincter are weakened and cannot maintain closure under pressure. This is the most common type of incontinence after childbirth, but it can occur in younger women without children.
Urge Incontinence
Urge urinary incontinence (UUI) is defined by the International Continence Society (ICS) as the complaint of involuntary leakage of urine accompanied by, or immediately preceded by, a sudden, compelling desire to pass urine that is difficult to defer.
A sudden, intense urge to urinate is followed by involuntary leakage before you can reach the toilet. This is caused by spasms of the bladder muscle (detrusor overactivity), which contracts inappropriately. Often associated with overactive bladder syndrome (OAB).
Mixed Incontinence
A combination of both stress and urge incontinence. This is extremely common, particularly in women over 50. Treatment is directed at the predominant component first, with a staged approach to address both elements.
Overflow Incontinence
Overflow incontinence is defined by the International Continence Society (ICS) as the complaint of involuntary urine loss associated with an excessively full bladder.
It occurs when the bladder cannot empty properly, leading to chronic retention and constant or frequent dribbling of urine. This is less common in women than in men, but can be caused by an underactive bladder, neurological conditions, or obstruction following pelvic surgery.
What Causes Urinary Incontinence?
Urinary incontinence in women is often multifactorial. The pelvic floor, bladder, urethra, and nervous system must all work together to maintain continence. Disruption to any of these can lead to leakage.
Pregnancy & Childbirth
Vaginal delivery can stretch and damage the pelvic floor muscles, the urethral sphincter (valve), the pelvic nerves, and the supportive tissues that allow their normal function. Prolonged labour, large babies, and instrumental delivery increase the risk.
Menopause & Hormonal Changes
Declining oestrogen levels after menopause lead to thinning and weakening of the urethral and vaginal tissues, reducing their ability to maintain a watertight seal.
Pelvic Surgery
Hysterectomy and other pelvic operations can alter the anatomy and nerve supply of the pelvic floor, potentially leading to incontinence.
Obesity
Excess body weight increases intra-abdominal pressure, placing chronic strain on the pelvic floor. Even modest weight loss can significantly improve stress incontinence.
Chronic Cough
Conditions such as chronic bronchitis, asthma, or smoking-related cough cause repeated spikes in abdominal pressure, gradually weakening the pelvic floor.
Neurological Conditions
Multiple sclerosis, Parkinson's disease, stroke, spinal cord injury, and diabetes can all disrupt the nerve signals that control bladder function.
How is Incontinence Diagnosed?
A thorough, step-by-step assessment allows us to identify the type and severity of your incontinence and create a personalised treatment plan.
Clinical History & Symptom Review
A detailed conversation about your symptoms, their triggers, duration, and impact on your daily life. We will also review your medical, surgical, gynaecological and obstetric history, as well as current medications.
Bladder Diary
You will be asked to keep a record of fluid intake, voiding times, volumes, and episodes of leakage over three days. This provides invaluable objective data about your bladder behaviour.
Pelvic Examination
A gentle examination (with a chaperone present) is performed to assess pelvic floor muscle strength, check for pelvic organ prolapse, evaluate vaginal tissue quality, and reproduce stress leakage if present. Other pathologies of the vagina and cervix can also be excluded and evaluated.
Urodynamic Studies
Specialised tests that measure bladder pressure, capacity, and flow rate during filling and voiding. Urodynamics can precisely identify and quantify both the type and severity of incontinence, and are particularly valuable when considering surgical treatment.
Cystoscopy (if needed)
A thin, flexible camera is passed into the bladder to examine the lining. This is not required for all patients but may be recommended if there are additional symptoms such as blood in the urine or recurrent infections.
Imaging (MRI, CT or Ultrasound, if needed)
Radiological imaging is sometimes used to assess for anatomical or functional issues that may contribute to incontinence.
Treatment for Urinary Incontinence
Treatment is tailored to the type of incontinence, its severity, and your individual circumstances. There are multiple options, and your clinician will discuss the appropriate treatments with you — weighing benefits, risks, and alternatives — so that a joint, informed decision can be made. In most cases we begin with the least invasive approach and escalate only if needed.
1 Conservative Management
Pelvic Floor Exercises
Supervised pelvic floor muscle training (Kegel exercises) is the first-line treatment for stress incontinence. A specialist physiotherapist teaches you to correctly identify, contract, and strengthen these muscles over a 3-6 month programme.
Bladder Training
A structured programme to gradually increase the time between voids, retraining the bladder to hold more urine comfortably. This is the first-line approach for urge incontinence and overactive bladder (OAB).
Lifestyle Changes
Weight loss, reducing caffeine and alcohol intake, managing fluid consumption, treating constipation, and stopping smoking can all make a meaningful difference to incontinence symptoms.
2 Medical Treatment
Anticholinergics
Medications such as solifenacin and tolterodine help relax the overactive bladder muscle, reducing urgency and frequency. Anticholinergics as a class are generally avoided in older women due to an increased risk of cognitive side effects. Your specialist will discuss the most appropriate choice.
Beta-3 Agonists
Medications such as mirabegron and vibegron. Beta-3 agonists work through a different mechanism to anticholinergics — they relax the bladder muscle during filling, improving capacity without the dry mouth and constipation side effects of older drugs.
Duloxetine
This medication is not commonly used now. However, duloxetine can still be offered for stress urinary incontinence when surgery is not suitable or preferred. It works by increasing the tone of the urethral sphincter. Side effects (including nausea) are discussed before prescribing.
Topical Oestrogens
Low-dose vaginal oestrogen (cream, pessary, or ring) restores tissue health in post-menopausal women and is commonly used to reduce the risk of recurrent infections. Its use specifically for incontinence has not been fully established, although in selected cases it may improve urethral closure and reduce urinary symptoms. Vaginal oestrogens are generally safe for long-term use in most patients.
3 Minimally Invasive Procedures
Botox Injections
Botulinum toxin is injected into the bladder wall via cystoscopy. It relaxes the overactive muscle for 6-12 months. An effective option when oral medications have not been sufficient.
Sacral Neuromodulation
A small device is implanted into the sacral nerves at the level of the sacrum (bottom of the spine) to modulate the signals between the bladder and brain — like a bladder pacemaker. Sacral neuromodulation is licensed for refractory urge incontinence as well as voiding dysfunction (Fowler's syndrome). It is performed as a two-stage procedure with a 2–3 week trial phase before a permanent implant is placed.
Tibial Nerve Stimulation
A non-invasive outpatient treatment in which a fine needle near the ankle delivers gentle electrical impulses to the tibial nerve (electroacupuncture), which shares neural pathways with the bladder. Typically given as weekly sessions over 12 weeks.
4 Surgical Options
Urethral Bulking Agents
A minimally invasive option for stress incontinence. A bulking agent (such as Bulkamid) is injected around the urethra under cystoscopic guidance to improve closure and reduce leakage. It is performed as a day-case procedure and may need to be repeated over time.
TVT / TOT Slings
Tension-free vaginal tape (TVT) and trans-obturator tape (TOT) are established mid-urethral sling procedures. Their use in the UK has been under a pause (suspension) since 2020 due to the risks of mesh erosion and pain (mesh complications), although they are still in use in continental Europe and the USA.
They may only be offered under highly regulated conditions at specialist centres. Your specialist will discuss all available options, including mesh-related considerations, to help you make a fully informed decision.
Autologous Fascial (Non-Mesh) Sling
A strip of your own tissue (fascia) is harvested — most commonly from the abdominal wall via a small bikini-line incision — and used to create a sling supporting the urethra. This avoids the use of synthetic mesh entirely, making it an excellent option for women concerned about mesh-related complications.
Colposuspension
The bladder neck is lifted and secured using stitches placed in the tissues beside the vagina and attached to the ligaments behind the pubic bone. Colposuspension can be performed as open or laparoscopic (robotic) surgery.
Artificial Urinary Sphincter
In rare cases of severe sphincter weakness or injury (intrinsic sphincter deficiency), an artificial sphincter device can be implanted. A prosthetic cuff placed around the urethra is controlled by a pump positioned under the skin of the labia, allowing you to open the urethra when you are ready to void.
When Should You See a Specialist?
While mild, occasional leakage is common, you should consider a specialist referral if you experience any of the following:
- ✓ Incontinence that limits your daily activities, exercise, or social life
- ✓ Needing to wear pads or protective underwear regularly
- ✓ Waking more than once at night to pass urine
- ✓ Recurrent urinary tract infections alongside incontinence
- ✓ Blood in your urine (haematuria)
- ✓ Pelvic floor exercises have not improved symptoms after 3 months
- ✓ A feeling of incomplete bladder emptying or difficulty passing urine
- ✓ Pain associated with urination or incontinence
Meet your Specialists
Assessment and treatment of female urinary incontinence is led by our experienced consultant urologists. Your care will be personally overseen by one of our senior specialists.
Key Takeaways
Urinary incontinence is common, but it is not something you have to accept.
- Affects 1 in 3 women — you are not alone and should not feel embarrassed to seek help.
- Accurate diagnosis through clinical assessment and urodynamic studies is the foundation of effective treatment.
- A full range of treatments is available — from physiotherapy and medication to Botox, neuromodulation, and surgery.
- Multiple (non-mesh) surgical options are available for women who prefer to avoid synthetic materials.
Further Reading — BAUS Patient Information
Frequently Asked Questions
Urinary incontinence is the involuntary loss of urine. It is a very common problem that affects millions of women in the United Kingdom, and it can significantly impact quality of life. The main types are stress incontinence (leakage when coughing, laughing, or exercising), urge incontinence (a sudden strong need to urinate followed by leakage), and mixed incontinence (both types together). Effective treatment options are available for all forms.
The most common causes are childbirth (particularly vaginal delivery), menopause and hormonal changes, previous pelvic surgery, obesity, chronic cough, and neurological conditions. The pelvic floor muscles weaken over time, and the sphincter mechanism that controls urine flow may become less effective. In many cases, several factors contribute together.
Treatment depends on the type and severity of incontinence. Options range from lifestyle changes and pelvic floor physiotherapy through to surgical procedures. Surgical options for stress incontinence include bulking injections, colposuspension, autologous fascial sling, and artificial urinary sphincter implantation. For urge incontinence and overactive bladder, options include Botox injections and sacral neuromodulation.
Non-mesh surgical techniques for stress urinary incontinence use the patient’s own tissue rather than synthetic mesh materials. The main non-mesh options are colposuspension (Burch procedure) and autologous fascial sling. These techniques have excellent long-term outcomes and avoid the mesh-related complications that have been widely reported. Honorary Associate Professor Jeremy Ockrim at London Urology Specialists was among the first surgeons in the United Kingdom to pioneer non-mesh surgical approaches.
Many women can be completely cured of urinary incontinence with the right treatment, and almost all will experience significant improvement. Cure rates depend on the type of incontinence, the treatment approach chosen, and individual factors. Surgery for stress incontinence has cure rates typically between 80–95% at long-term follow-up. Success is highest when patients are treated by specialists in female and functional urology.
You should see a urologist or urogynaecologist if urinary incontinence is affecting your quality of life, interfering with work or social activities, or if you’ve tried lifestyle changes and pelvic floor exercises without improvement. Early specialist assessment gives access to the widest range of treatment options. There is no need to accept incontinence as an inevitable part of ageing or motherhood — effective treatments exist.
Concerned About Urinary Incontinence?
Whether your symptoms are occasional or have become part of your daily life, our women's health specialists can provide an expert assessment, identify the underlying cause, and develop a personalised treatment plan to help you regain confidence and improve your quality of life.