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Incontinence, Urinary - NHS Choices

Urinary incontinence is the unintentional passing of urine. It is a very common problem and is thought to affect more than 50 million people in the developed world.

How the bladder works

The bladder is a stretchy, muscular bag that collects and stores urine. It is located in the pelvis at the lowest point in the abdomen, immediately behind the pubic bone.

The bladder receives urine from the kidneys, which filter waste products from the blood and mix them with water to create urine. This is passed down to the bladder through tubes called ureters.

Urine is stored in the bladder, which is supported in the pelvis by pelvic floor muscles. Some of this muscle wraps around the urethra, the tube that runs from the bladder to outside the body, to help keep it closed until you need to pass urine.

Once the bladder is full, a signal is sent to the brain that you need to pass urine. When you are ready, the brain tells the pelvic floor muscles to relax and open the urethra. The muscles around the bladder contract and push the urine out.

A problem in any part of this process can result in urinary incontinence.

Types of urinary incontinence

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

• stress incontinence, when the pelvic floor muscles are too weak to prevent urination, causing urine to leak when your bladder is under pressure, for example when you cough or laugh 
• urge incontinence, when urine leaks at the same time or just after you feel an intense urge to pass urine

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

How common is urinary incontinence?

It is not clear exactly how many people have urinary incontinence, possibly because urinary incontinence can be defined in different ways. Some people may also not report their condition because of embarrassment.

Figures from a study that included the UK found that 13% of women and 5% of men had some degree of urinary incontinence. In general, urinary incontinence affects twice as many women as men and becomes more common with increasing age.

There are several known risk factors for urinary incontinence, such as childbirth in women. See Urinary incontinence - causes for more information about this and other causes. 

Outlook

Urinary incontinence can be an uncomfortable and upsetting problem. Many people think that it is an inevitable part of ageing, but there are several forms of effective treatment, including:

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

Studies from around the world suggest that conservative treatments, such as those above, can improve stress or mixed urinary incontinence in women by two-thirds.

If these treatments are not effective, several medications may be tried, and a growing number of different surgical techniques offer long-term results. See Urinary incontinence - treatment for more information about the different treatment options.

Incontinence, Urinary - Symptoms - NHS Choices

The main symptom of urinary incontinence is a loss of bladder control that causes you to pass urine when you do not mean to. However, when and how this happens varies depending on the type of urinary incontinence you have.

Common types of urinary incontinence

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

Stress incontinence

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

• sneezing 
• laughing 
• heavy lifting 
• exercise

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

Urge incontinence

Urge incontinence, or urgency incontinence, is when you leak urine and feel a sudden and very intense need to pass urine. You are unable to delay going to the toilet. There is often only a few seconds between the need to urinate and the release of urine.

Your need to pass urine may be triggered by a sudden change of position, or even by the sound of running water. You may also pass urine during sex, particularly when you reach orgasm.

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

Less common types of urinary incontinence

Mixed incontinence

Mixed incontinence is when you have symptoms of both stress and urge incontinence. For example, you may leak urine if you cough or sneeze, and also experience very intense urges to pass urine.

Overactive bladder syndrome (OAB)

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

Overflow incontinence

Overflow incontinence, also called chronic urinary retention, occurs when the bladder cannot completely empty when you pass urine. This causes the bladder to swell above its usual size.  

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

If you have overflow incontinence, you may pass small trickles of urine very often. It may also feel as though your bladder is never fully empty and you cannot empty it even when you try.

Total incontinence

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

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

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

Incontinence, Urinary - Causes - NHS Choices

Urinary incontinence occurs when the normal process of storing and passing urine is disrupted. This can happen for a number of reasons, and certain factors may also increase your chance of developing urinary incontinence.

How you normally pass urine

The process for creating, storing and passing urine involves the following steps:

• Your kidneys, two bean-shaped organs located just underneath your ribcage, filter your blood and turn the waste products into urine. 
• The urine passes down two tubes, called ureters, which run from your kidneys to your bladder. 
• Your bladder stores the urine until it is full, stretching like a balloon as it fills up.
• Your pelvic floor muscles, which support the bladder and urethra (tube that carries urine from the bladder to outside the body), help hold the urethra closed and prevent any urine from being passed until you decide to do so.
• When your bladder is full, a nerve signal is sent from your bladder to your brain, which lets you know that you need to pass urine. 
• When you get to a toilet, another nerve signal is sent from your brain to your urethra, which relaxes at the same time as your bladder contracts. This allows urine to be emptied out of your bladder through your urethra

The various causes and risk factors of urinary incontinence are explained below.

Causes of stress incontinence

Stress incontinence happens when the pressure in your bladder as it fills with urine becomes greater than the strength of your urethra to stay closed. Your urethra may not be able to stay closed if:

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

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

• nerve damage during childbirth 
• increased pressure on your tummy, for example because you are pregnant or very overweight (morbidly obese)
• a problem with the supporting tissues, such as a problem with your collagen, a type of protein found throughout the body, which could make the tissues weaker 
• a lack of the hormone oestrogen in women (less oestrogen is produced after the menopause, when a woman’s periods stops) 
• certain medications (see box, left) 

Causes of urge incontinence

Urge incontinence can be accompanied by overactive bladder syndrome (OAB), a condition that causes an urgent need to pass urine, often frequently and during the night.

The urgent and frequent need to pass urine can be caused by the muscles in the walls of the bladder, known as the detrusor muscles. The detrusor muscles relax to allow the bladder to fill with urine, then contract when you go to the toilet to let the urine out.

Sometimes the detrusor muscles contract too often, creating an urgent need to go to the toilet. This is called detrusor overactivity. The reason your detrusor muscles contract too often may not be clear, but possible causes include:

• conditions affecting the lower urinary tract (urethra and bladder), such as urinary tract infections (UTIs) or tumours in the bladder  
• neurological conditions, which affect the brain and spinal cord, such as Parkinson’s disease or multiple sclerosis 
• conditions that affect the whole body, such as diabetes, a condition caused by too much glucose in the blood
• conditions or behaviour that affect the way your digestive system functions, such as drinking too much alcohol or caffeine (found in tea, coffee and cola) or constipation  
• certain medications (see box, left)

Some other factors related to OAB include:

• increasing age 
• depression
• erectile dysfunction in men, which is an inability to get or maintain an erection

Some of these possible causes will lead to short-term urinary incontinence, and others may cause long-term urinary incontinence. If the cause can be treated, this may cure your incontinence. For example, a UTI can be treated with medication or constipation can be managed by changing your diet.

Causes of overflow incontinence

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

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

Your bladder can become obstructed by:

• an enlarged prostate gland in men - the prostate gland is located between the penis and the bladder and can get larger as men get older
• bladder stones - small, stone-like lumps that can form in your bladder
• constipation - a build-up of faeces can obstruct your bladder if you are unable to completely empty your bowels

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

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

Causes of total incontinence

Total incontinence occurs when your bladder cannot store any urine at all. It can result in you either passing large amounts of urine constantly, or passing urine occasionally with frequent leaking.

Total incontinence can be caused by:

• a problem with your bladder from birth 
• injury to your spinal cord, which can disrupt the nerve signals between your brain and your bladder (see the Health A-Z topic about Paralysis for more information about spinal cord injuries) 
• a bladder fistula, which is a small, tunnel-like structure that can develop between the bladder and a nearby area, such as a woman's vagina

Risk factors

Risk factors are not the same as causes. Risk factors are things that increase your chance of developing a condition. However, a risk factor will not definitely cause the condition.

You can reduce some risk factors, such as obesity, through changing your lifestyle.

Risk factors in women

Risk factors for urinary incontinence in women include:

• pregnancy - if you developed stress incontinence during pregnancy or in the six weeks after the birth, you are more likely to have stress incontinence five years after the birth  
• vaginal birth - giving birth vaginally, rather than with a caesarean, may be associated with stress incontinence
• heavier birth weight - having a child or children who were heavier than normal at birth is associated with developing urinary incontinence 
• number of children - giving birth to a high number of children may be associated with urinary incontinence 
• obesity - having a body mass index (BMI) of 30 or more may also be associated with urinary incontinence (use the healthy weight calculator to work out your BMI) 
• family history - there may be a genetic link to urinary incontinence, particularly stress incontinence 
• increasing age - urinary incontinence becomes more common as you reach middle age and is most common in women over 70 years of age  
• lower urinary tract symptoms (LUTS) - symptoms that affect the bladder and urethra (see Urinary incontinence - symptoms for more information)

The menopause, when a woman’s periods stop, is not a risk factor for urinary incontinence. Most evidence suggests that a hysterectomy, an operation to remove the womb, is also not a risk factor for urinary incontinence.

Risk factors in men

Risk factors for urinary incontinence in men include:

• increasing age - urinary incontinence becomes more common as you get older 
• family history - there may be a genetic link to urinary incontinence, particularly stress incontinence 
• neurological disorders - conditions affecting your brain and spinal cord, such as multiple sclerosis, may increase your risk of urinary incontinence 
• prostatectomy - an operation to remove your prostate gland, for example if you have prostate cancer, may increase your risk of urinary incontinence
• functional and cognitive impairment - if your ability to look after yourself or to think or concentrate is affected, for example because of a condition such as dementia, you may be at increased risk of urinary incontinence
• lower urinary tract symptoms (LUTS) - symptoms that affect the bladder and urethra (see Urinary incontinence - symptoms for more information)  

Smoking and diet are also possible risk factors for urinary incontinence in both men and women.

Incontinence, Urinary - Diagnosis - NHS Choices

If you experience urinary incontinence, see your GP. Do not be embarrassed to speak to your GP about your condition.

To provide treatment, your GP will need to determine which type of urinary incontinence you have and what may be causing it. They will ask you several questions about your symptoms and medical history, such as:

• whether the urinary incontinence occurs when you cough or laugh
• whether you need the toilet frequently during the day or night
• whether you have any difficulty passing urine when you go to the toilet 
• whether you are currently taking any medications
• how much fluid, alcohol or caffeine you drink 

Bladder diary

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

• how much fluid you drink
• the type of fluid you drink
• how often you need to pass urine
• the amount of urine you pass
• how many episodes of incontinence you experience 
• how many times you experience an urgent need to go to the toilet

Tests and examinations 

You may also need to have some tests and examinations so that your GP can confirm or rule out external factors that may be causing your incontinence. Some of these are explained below.

Physical examination

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

If you are female, your GP will carry out a pelvic examination. This may include asking you to cough while you are undressed from the waist down 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 neck of the bladder may bulge into the vagina.

Your GP may also 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, which is the tube that carries urine from the bladder to outside the body. Damage to your pelvic floor muscles can lead to urinary incontinence.

If you are 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 is enlarged, it can cause symptoms of urinary incontinence, such as a frequent need to urinate.

Your may GP carry out a digital rectal examination (DRE) to check the health of your prostate gland. This involves inserting their finger into your anus. See the Health A-Z topic about DRE for more information about this procedure.

Dipstick test

If your GP thinks that your incontinence may be caused by an infection, a sample of your urine may be tested for bacteria. A small, chemically treated stick will be dipped into your urine sample. It will change colour if bacteria are present. The dipstick test can also check the blood and protein levels in your urine.

Residual urine test

If your GP thinks you may have overflow incontinence, also called chronic urinary retention, they may suggest a residual urine test. Overflow incontinence is when your bladder cannot completely empty when you try to pass urine.

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

Further tests

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

Bladder ultrasound scan

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

Urodynamic tests

Urodynamic tests are a group of tests to check the function of your bladder and urethra. This may include keeping a bladder diary for a few days (see above) and then attending an appointment at a hospital or clinic for some tests. These could include:

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

Incontinence, Urinary - Treatment - NHS Choices

The treatment you receive for urinary incontinence will depend on the type of incontinence you have and the severity of your symptoms. If your incontinence is caused by an underlying condition, such as an enlarged prostate gland in men, you will receive treatment for this first.

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

• lifestyle changes
• pelvic floor muscle training
• bladder training

After this, medication or surgery may be considered.

Lifestyle changes

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

For example, your 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
• drinking 1-1.5 litres (six to eight glasses) of fluid a day - drinking too much or too little can cause symptoms that affect the lower urinary tract (bladder and urethra) 
• losing weight if you are overweight or obese - use the healthy weight calculator to find out if you are 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 to outside the body).

Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is often one of the first treatments recommended, whether you have stress, urge or mixed incontinence.

Referral

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

• a continence adviser - a specialist nurse at an NHS continence service (see box, left)
• a urogynaecologist - a nurse who specialises in problems with the urinary system in women
• a physiotherapist - a healthcare professional trained in using physical methods to promote healing
• a specially trained practice nurse at your GP surgery

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

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

The Bladder & Bowel Foundation has pelvic floor exercise factsheets for both men and women, which explain how to complete these exercises, although your specialist should teach you how to do them.

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

In men, some studies have shown that pelvic floor muscle training can reduce urinary incontinence after surgery to remove the prostate gland. However, it is not clear if this also applies to urinary incontinence caused by other conditions.

Electrical stimulation

If you are unable to contract your pelvic floor muscles, using a device that measures and stimulates the electrical signals in the muscles may be recommended. This is called electrical stimulation.

A small probe will be inserted into the vagina in women or the anus in men. An electrical current runs through the probe, which strengthens your pelvic floor muscles.

Some women may find electrical stimulation difficult or unpleasant to use, but it may be beneficial if you are unable to complete pelvic floor muscle contractions without it. Your specialist may discuss electrical stimulation with you if they think it could be of benefit.

Biofeedback

Biofeedback is a way to monitor how well you are doing the pelvic floor exercises by giving you feedback as you do them. There are several different methods of biofeedback:

• A small probe could be inserted into the vagina in women or the anus in men. This senses when the muscles are squeezed and feeds the information to a computer screen.
• Electrodes (sticky electrical patches) could be attached to the skin of your abdomen or around the anus. These sense when the muscles are squeezed and feed the information to a computer screen.

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

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

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

Vaginal cones

Vaginal cones may be used by women to assist with pelvic floor muscle training. Vaginal cones are small weights that are inserted into the vagina. You hold the weights in place using your pelvic floor muscles. When you can, you progress to the next vaginal cone with a higher weight.

Some women find vaginal cones uncomfortable or unpleasant to use, but they may help with stress or mixed urinary incontinence. If you want to try using vaginal cones, speak to your specialist.

Bladder training

If you have been diagnosed with urge incontinence, one of the first treatments you may be offered is bladder training. Bladder training may also be combined with pelvic floor muscle training if you have stress or mixed urinary incontinence.

As for pelvic floor muscle training, your GP may refer you to a specialist for this treatment, such as a continence adviser.

Bladder training involves learning techniques to increase the length of time between feeling the need to urinate and passing urine. The course will usually last for at least six weeks.

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

Medication for stress incontinence

Duloxetine is a possible medication for stress incontinence. The National Institute for Health and Clinical Excellence (NICE) does not recommend duloxetine as an initial treatment for women with mainly stress incontinence. However, your GP may suggest duloxetine if:

• Conservative treatments have not worked. 
• Medication is preferred to surgery or surgery is not possible.

Duloxetine affects serotonin and noradrenaline. These are chemicals that carry messages to and from the brain. It is thought that noradrenaline affects the muscle tone of the urethra. Medication for stress incontinence also aims to increase the muscle tone of the urethra, which should help keep it closed.

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

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

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

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

Side effects

There are many possible side effects of duloxetine. For the full list, see the patient information leaflet that comes with your medicine or the duloxetine medicines information. Possible side effects include:

• feeling sick or being sick
• indigestion or tummy pain
• constipation
• diarrhoea
• hot flushes 
• headaches
• feeling agitated or shaky
• insomnia or feeling very sleepy

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

Medication for urge incontinence and OAB

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

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

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

Your GP will usually start you at a low dose to reduce any possible side effects. The dose can then be increased until the medicine is effective. You will be assessed after six weeks to see how you are getting on with the medication, and again after three to six months to see if you still need it.

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

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

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

Side effects

There are many possible side effects of antimuscarinics. See the patient information leaflet that comes with your medicine or medicines information for a full list. Possible side effects include:

• dry mouth
• constipation
• indigestion and heartburn
• flatulence (wind)
• blurred vision
• drowsiness
• dry eyes

Hormonal medication

The only type of hormonal medication that has had a positive effect for incontinence in women is an oestrogen cream applied to the vagina. This is used in women after the menopause who have vaginal atrophy, a condition that causes vaginal dryness, itching or discomfort.

The urgent and frequent need to pass urine, as occurs in OAB, may also be a symptom of vaginal atrophy. Treating vaginal atrophy with oestrogen cream may, therefore, relieve these symptoms. If you have vaginal atrophy, your GP will discuss this treatment with you, but oestrogen cream will not be used to treat urinary incontinence.

Medication for nocturia

Nocturia is the frequent need to get up during the night to urinate. A medication called desmopressin has proved effective at reducing the number of times people need to get up during the night and at improving people’s quality of sleep.

Another type of medication taken late in the afternoon, called a loop diuretic, may also prevent you from getting up in the night to pass urine. Diuretic medicine increases the production and flow of urine from your body. By removing excess fluid from your body in the afternoon, it may improve symptoms at night.

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

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

However, your GP or specialist may suggest an unlicensed medication if they think the medication is likely to be effective and the benefits of treatment outweigh any associated risk. If your GP is considering prescribing desmopressin or a loop diuretic, they should tell you that it is unlicensed and will discuss the possible risks and benefits with you.

Botulinum toxin A for urge incontinence and OAB

Another possible medication for urge incontinence and OAB is botulinum toxin A. This is injected into the sides of your bladder. After the injections, you may not be able to pass urine normally, so you will need to insert a catheter (thin, flexible tube) to drain the urine from your bladder.

Botulinum toxin A is not currently licensed to treat urge incontinence or OAB, so you should be made aware of any risks before deciding to have the treatment. The long-term effects of this treatment are not yet known, but it may be of benefit when other treatments have not worked.

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

Surgery

If other treatments are unsuccessful for your urinary incontinence, surgery may be recommended. Before making your decision, discuss the risks and benefits of surgery with your specialist, as well as any possible alternative treatments. If you plan to have children, this will be an important factor that will affect your decision.

A surgeon who has had specialist training in incontinence surgery should carry out the operation. A number of different surgical procedures can be used.

For women with stress urinary incontinence, NICE recommends a retropubic tape procedure if conservative treatments have not worked. The recommended alternatives to this are open colposuspension and autologous fascial slings. All these procedures are described below.

Tape procedures for stress incontinence

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

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

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

Sling procedures for stress incontinence

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

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

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

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

Colposuspension for stress incontinence

Colposuspension is a surgical procedure sometimes used to treat stress incontinence. In this operation, an incision is made in your lower abdomen and your bladder neck is lifted upwards. Stitches through the walls of the bladder neck hold it in place.

A colposuspension can be either:

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

Both types of colposuspension offer effective, long-term treatment for stress incontinence, although laparoscopic colposuspension needs to be carried out by an experienced laparoscopic surgeon.

Urethral bulking agents for stress incontinence

A urethral bulking agent is a substance that is injected into the walls of your urethra. This increases the size of the urethral walls and allows the urethra to stay closed with more force. A number of different bulking agents are available and there is no evidence that one is more beneficial than another.   

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

Artificial urinary sphincter for stress incontinence in men

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

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

This treatment is rarely used in women.

Posterior tibial nerve stimulation for OAB

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

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

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

Posterior tibial nerve stimulation can also cause side effects, such as foot or toe pain, minor bleeding and headaches. Some people may also find the stimulation too uncomfortable to continue with. There is currently little quality data to support this technique. 

Sacral nerve stimulation for urge incontinence

The sacral nerves are located at the bottom of your back. They carry signals from your brain to some of the muscles that are used when you go to the toilet, such as the detrusor muscle that surrounds the bladder.

If your urge incontinence is the result of your detrusor muscles contracting too often (detrusor overactivity), sacral nerve stimulation, also known as sacral neuromodulation, may be recommended.

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

Sacral nerve stimulation can be painful and uncomfortable, but two-thirds of women report a substantial improvement in their symptoms or the end of their incontinence completely.

Augmentation cystoplasty for urge incontinence

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

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

Urinary tract infections (UTIs) are common among people who use a catheter. See the Health A-Z topic about Urinary catheterisation for more information. 

About half of women treated with augmentation cystoplasty said their symptoms improved.

Urinary diversion for urge incontinence

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 collected directly without it flowing into your bladder. Urinary diversion should only be carried out if other treatments have been unsuccessful or are not suitable.

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

Clean intermittent catherisation for 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. 

Clean intermittent catherisation (CIC) is a technique that can be used to empty the bladder at regular intervals and so reduce overflow incontinence. A continence adviser will teach you how to place a catheter through your urethra and into the bladder. Your urine will flow out of your bladder, through the catheter and into the toilet.

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

How often CIC will need to be carried out will depend on your individual circumstances. For example, you may only need CIC once a day, or you may need to use the technique several times a day.

Regular use of a catheter increases the risk of developing a urinary tract infection (UTI). See the Health A-Z topic about UTI for more information.

Indwelling catheterisation for overflow incontinence

If using a catheter every now and then is not enough to treat your overflow incontinence, you can have an indwelling catheter fitted instead. This is a catheter inserted in the same way as for CIC, but left in place. A bag is attached to the end of the catheter to collect the urine.

Surgery for LUTS in men

Lower urinary tract symptoms (LUTS), such as problems passing urine, may be treated with surgery if it is thought that your symptoms are caused by an enlarged prostate gland. This is a small gland located between the penis and bladder that surrounds the urethra. See the Health A-Z topic about Prostate enlargement for more information about this condition.

One possible type of surgery is a transurethral resection of the prostate (TURP). This involves cutting away a section of the prostate gland. See the Health A-Z topic about TURP for more information.

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

Incontinence, Urinary - Complications - NHS Choices

Several complications can occur as a result of urinary incontinence. These are explained below.

Day-to-day activities

Urinary incontinence can stop you doing normal, everyday activities. For example, you may not feel comfortable socialising, taking part in sports or group activities, or travelling long distances. This can mean your quality of life is affected.

Psychological effects

Urinary incontinence can affect you mentally. It can cause feelings of guilt, shame and low self-confidence. It can also cause depression, which is a serious mental health condition. See the Health A-Z topic about Depression for more information. 

Working life

Urinary incontinence can have a negative impact on your work life. The feeling of needing to constantly urinate may affect your ability to concentrate, and you may need to get up from your desk to go to the toilet frequently. You may also feel very tired if your urinary incontinence continually disrupts your sleep.

Personal life

Urinary incontinence can often have a negative impact on your personal life. People close to you may find it difficult to understand your condition, and you may find it embarrassing as well as frustrating. You may avoid having sex due to the risk of urine leakage, which can affect your close personal relationships.

Incontinence, Urinary - Prevention - NHS Choices

It is not always possible to prevent urinary incontinence. However, you can reduce your risk of developing it.

Weight

Being obese increases your risk of urinary incontinence. Maintain a healthy weight by eating a balanced diet. Use the healthy weight calculator to see if you are a healthy weight for your height.

Drinking

Depending on your particular bladder problem, your GP can advise you about the amount of fluids that you should drink. This is usually around 1.2 litres (six to eight glasses) a day.

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

The recommended daily limits for alcohol consumption are:

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

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

If you have to urinate frequently during the night (nocturia), try drinking less in the hours before you go to bed. However, make sure you still drink enough fluids during the day.

Exercise

Keeping active is a very important part of leading a healthy lifestyle and can help prevent several serious health conditions, including urinary incontinence. Do a minimum of 30 minutes of exercise at least five times a week. See the Live Well topic on getting active for more information.

Being pregnant and giving birth can weaken the muscles that control the flow of urine from your bladder. If you are pregnant, strengthening your pelvic floor muscles can help prevent urinary incontinence. See the Pregnancy care planner for more information about staying active during pregnancy.

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

Incontinence, Urinary - Treatment options - NHS Choices