Treatment for urinary incontinence
An overview of the options for leaking urine, from pelvic floor exercises and lifestyle changes first, through medicines, injections and, for some people, surgery.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Treatment starts with the least invasive options: supervised pelvic floor muscle training for stress or mixed leakage, and bladder training plus lifestyle changes for an overactive bladder.
- Pelvic floor training takes commitment over at least three months, and many people improve enough to avoid further treatment.
- Because of serious safety concerns, mesh tape surgery for stress incontinence was paused in the UK and is now only used under strict conditions, after discussing all the alternatives.
- There is genuine long-term uncertainty about the complications of all incontinence operations, so an unhurried, fully informed decision with a specialist matters.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Conservative treatment (pelvic floor and bladder training) is low-risk and helps many people avoid surgery
You have not yet had an assessment to confirm the type of incontinence, which determines the right treatment.
No physical recovery, but results take time. Pelvic floor training is judged after at least three months and bladder training after at least six weeks of...
Access to a specialist pelvic floor physiotherapist and clear exercise guidance.
No physical recovery, but results take time. Pelvic floor training is judged after at least three months and...
It may take a few weeks to feel the benefit. Your clinician reviews how well it works and whether side effects are...
Expect some discomfort and possibly temporary difficulty passing urine; occasionally a catheter is needed for a...
Avoid heavy lifting, straining and strenuous exercise while you heal. Many people return to light activity and...
What are the treatments for urinary incontinence?
Urinary incontinence means leaking urine when you do not mean to. The two main types are stress incontinence (leaking when you cough, laugh, lift or exercise) and urgency incontinence (a sudden, strong need to pass urine that is hard to hold), and many people have a mix of both. Treatment depends on the type, so an assessment to work out which you have comes first.
UK guidance (NICE) is clear that treatment should start with the least invasive options. For stress and mixed incontinence, this means a supervised programme of pelvic floor muscle training for at least three months. For urgency incontinence and overactive bladder, bladder training over at least six weeks, with lifestyle changes such as adjusting caffeine and fluids and losing weight if needed, comes first. These simple measures help many people and carry very little risk.
If symptoms continue, the next steps depend on the type: medicines for an overactive bladder, or, for stress incontinence, surgery such as colposuspension, a sling made from your own tissue, a mesh tape, or bulking injections. Because of serious safety concerns about vaginal mesh, the use of mesh tapes for stress incontinence was paused in the UK and is now tightly restricted, so these are only considered under strict conditions and after a full discussion of all the options. This guide explains the choices, not a single operation, and is not a substitute for a specialist assessment.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Stress vs urgency incontinence — first steps differ
| Feature | Stress incontinence | Urgency incontinence |
|---|---|---|
| Typical trigger | Coughing, lifting, exercise | Sudden, strong urge |
| First-line | Pelvic floor training (3+ months) | Bladder training (6+ weeks) |
| Next step | Surgery or bulking | Bladder medicines |
| Later options | Sling, colposuspension, mesh (restricted) | Botox, nerve stimulation |
Many people have a mix of both. An assessment works out the main problem so the right treatment is chosen. This is general information, not personal advice.
Preparing for your treatment
- Have an assessment with a clinician (GP, continence specialist nurse, gynaecologist or urologist) to work out the type of incontinence, as treatment depends on it.
- Keep a bladder diary of drinks, toilet trips and leaks for a few days, as this helps guide treatment.
- Expect simple checks such as a urine test to rule out infection, and sometimes bladder tests (urodynamics) before surgery.
- For pelvic floor training, ask to be referred to a specialist physiotherapist who can check you are exercising correctly.
- If surgery is being considered, ask for written information and time to weigh up all the options, including doing nothing.
- Tell the team about all medicines, other health conditions, and any plans for future pregnancy, which affect timing.
- If a mesh procedure is ever discussed, ask specifically about the UK restrictions and the alternatives.
What happens
What happens depends on the treatment. Pelvic floor muscle training is taught by a physiotherapist and done at home, typically several sets of squeezes each day for at least three months, with reviews to check progress. Bladder training involves gradually stretching the time between toilet visits, supported by lifestyle changes.
Medicines for an overactive bladder are started at a low dose and reviewed for benefit and side effects, with changes if they do not suit you.
Surgery for stress incontinence is usually a day case or short stay under a general, spinal or sometimes local anaesthetic. Colposuspension lifts the tissues around the bladder neck; an autologous sling uses a strip of your own tissue to support the urethra; bulking injections add material around the urethra to help it close; and a mesh tape (used only under strict UK conditions) supports the urethra. Your surgeon will explain exactly what is planned and what to expect afterwards.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- You have not yet had an assessment to confirm the type of incontinence, which determines the right treatment.
- Surgery is being considered before a proper trial of conservative treatment, which UK guidance recommends first.
- You are planning further pregnancies, as surgery is usually best delayed until your family is complete.
- An untreated urinary infection or other reversible cause is present and should be addressed first.
- For mesh specifically: you do not meet the strict UK conditions for its use, or you would prefer to avoid the long-term uncertainties.
Delay or rearrange if…
- You have a current urinary infection or other treatable cause of symptoms.
- You have not completed an adequate trial of supervised pelvic floor or bladder training.
- You are pregnant or planning pregnancy, which can change symptoms and affect surgical timing.
- You have not yet been given full written information and time to weigh up all the options.
- Bladder tests (such as urodynamics) needed to plan surgery have not yet been done.
Alternatives to discuss
- Supervised pelvic floor muscle training for stress or mixed incontinence (first-line).
- Bladder training and lifestyle changes (caffeine, fluids, weight) for urgency and overactive bladder.
- Bladder medicines (anticholinergics or a beta-3 agonist) for an overactive bladder.
- Containment products, such as pads, while deciding or if treatment is not chosen.
- Different surgical options for stress incontinence — colposuspension, an autologous sling or bulking agents — instead of mesh.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Conservative treatment (pelvic floor and bladder training) is low-risk and helps many people avoid surgery
- Lifestyle changes such as adjusting caffeine, fluids and weight can reduce leaks with no side effects
- Medicines can calm an overactive bladder when training alone is not enough
- Surgery can significantly reduce or stop stress-related leaking for suitable people
- Having clear information lets you choose the option that fits your life and your attitude to risk
Risks & complications
- Pelvic floor and bladder training need months of effort and do not work for everyone
- Bladder medicines often cause side effects such as a dry mouth, constipation or blurred vision
- After surgery, temporary difficulty passing urine, urinary infections, or discomfort
- Symptoms may improve only partly, or come back over time
- New or worsening urgency after stress-incontinence surgery
- Needing a catheter for a while if the bladder does not empty properly after surgery
- Wound or urinary infections needing antibiotics
- Bulking injections wearing off and needing repeating
- Serious mesh-related complications, such as the tape eroding into the vagina, bladder or urethra, or causing chronic pain — a key reason mesh use is restricted in the UK
- Difficulty emptying the bladder long term after surgery
- Injury to the bladder, urethra or nearby structures during surgery
- Chronic pain or pain during sex after some procedures
The biggest issue with surgery for stress incontinence is genuine uncertainty about long-term complications for all the operations, and the serious harm some women have suffered from vaginal mesh — which led to its use being paused and tightly restricted in the UK. Mesh tape is now only considered under strict conditions, after a full discussion of colposuspension, an autologous sling and bulking agents. You should be given written information, including the device details if any implant is used, and never feel rushed.
Published figures to discuss
Success and complication rates vary by the type of incontinence, the treatment chosen and the individual. NICE highlights that, while the recommended operations show benefit, there is limited long-term evidence and the true prevalence of long-term complications is unknown — a key reason for caution and shared decision-making. The figures below are broad anchors from guidelines and reviews, not personal predictions.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Mid-urethral sling improvement or cure | Often quoted around 80–90% in selected stress-incontinence series | Long-term mesh complications are the difficult consent issue; NICE says their true prevalence is uncertain. | NICE NG123 — Urinary incontinence and pelvic organ prolapse in women: recommendationsnice.org.ukPublished figure |
| Autologous fascial sling or colposuspension success | Commonly around 50–70% objective cure in comparative studies, depending on definition and follow-up | Autologous sling avoids synthetic mesh but has more short-term voiding difficulty than some alternatives. | NHS England — Specialised services for mesh complicationsengland.nhs.ukPublished figure |
| Bulking injection success | Lower and less durable than sling surgery; pooled objective success about 67% at 12 months and about 46% beyond 12 months in one review | Repeat injections are common; it is often chosen because it is less invasive. | NHS England — Specialised services for mesh complicationsengland.nhs.ukPublished figure |
| Botox for overactive bladder | About 70% significantly improved or cured in BAUS patient information; UTI about 15–18% and catheterisation/retention about 6–10% | Patients must be willing and able to self-catheterise if retention occurs. | NHS England — Specialised services for mesh complicationsengland.nhs.ukPublished figure |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
What happens afterwards depends on the treatment. Pelvic floor and bladder training have no physical recovery but take months of effort. Surgery involves several weeks of taking it easy while you heal, and a check that your bladder is emptying well.
- Slow, gradual improvement with pelvic floor or bladder training rather than an instant fix
- Some side effects when starting bladder medicines that may settle or need a change
- Temporary difficulty passing urine or mild discomfort after surgery
- A few weeks of taking it easy after an operation
- A period of adjusting as your bladder settles into its new pattern
Aftercare
- Stick with pelvic floor or bladder training for the full recommended period, as benefits build over months.
- Take any bladder medicine as prescribed and report troublesome side effects rather than just stopping.
- After surgery, avoid heavy lifting and straining for the time your surgeon advises.
- Drink sensibly and watch for signs of a urine infection, such as burning or needing to go very often.
- Tell your team if you cannot pass urine, or feel you are not emptying your bladder, after surgery.
- Keep follow-up appointments so your progress and bladder function are checked.
- Keep any written information about an implant, including its name and the surgeon's details, if mesh was used.
- Bladder diary completed before your appointment
- Referral to a pelvic floor physiotherapist requested if relevant
- Written information on all surgical options obtained before deciding
- Questions about mesh restrictions and alternatives prepared
- Help at home arranged if having surgery
- Pads or protection available during treatment if needed
- Clinic's contact number saved for problems
Scars and how they heal
Pelvic floor training, bladder training, medicines and bulking injections do not leave scars. Colposuspension and sling surgery involve a cut (in the lower abdomen for colposuspension, and sometimes the abdomen and vagina for a sling), leaving scars that usually heal and fade. Your surgeon will explain where any scars will be for the specific operation planned.
⚠ Get urgent help if…
- Being unable to pass urine at all after surgery — seek urgent help
- A high temperature, severe lower abdominal or pelvic pain, or feeling very unwell
- Burning when passing urine, blood in the urine, or needing to go very often (possible infection)
- Heavy or persistent vaginal bleeding or discharge after surgery
- New pelvic, vaginal or groin pain, or pain during sex, after a procedure
- Anything coming through the vaginal wall, or being able to feel mesh — report this promptly
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good result means leaking is much reduced or stops, and you can do everyday activities with more confidence. Pelvic floor and bladder training help many people and are judged after a few months; medicines can ease an overactive bladder. Surgery can be effective for stress incontinence, but there is genuine uncertainty about long-term complications for all the operations, and no treatment is guaranteed to be a permanent cure.
Results can fade over time, and some people need more than one approach. Treatment aims to improve symptoms and quality of life, not necessarily to make leaking impossible forever, and should be chosen after weighing the benefits and the long-term risks with a specialist.
How long the benefit lasts varies by treatment and person. Pelvic floor strength needs ongoing exercises to maintain. Bladder medicines work only while taken, and many people stop them over time. Surgical results can last for years but may weaken, and symptoms can return, sometimes needing further treatment. Bulking agents in particular often wear off and may need repeating. Future pregnancy and childbirth, weight changes and ageing can all affect symptoms again, which is why an unhurried, informed choice and good follow-up matter.
Related tests, treatments or support
Treatments are often used in steps or combinations rather than all at once — for example, continuing pelvic floor exercises alongside other treatment, or treating an overactive bladder and stress incontinence in turn when both are present. Incontinence is sometimes assessed at the same time as pelvic organ prolapse, as the two can occur together; your specialist will explain how the conditions and their treatments relate.
Follow-up & long-term care
You should be reviewed to see whether conservative treatment, medicines or surgery is working, and to check side effects and bladder function. After surgery, follow-up confirms the bladder is emptying well and looks for any complications. If mesh has ever been used, this should be recorded in a national registry with the device details. Report new pain, difficulty passing urine or mesh-related symptoms promptly.
- Keep doing pelvic floor exercises long-term to maintain the benefit.
- Continue helpful lifestyle changes, such as managing caffeine, fluids and weight.
- Attend reviews of any bladder medicine to check it is still needed and tolerated.
- Have any urethral bulking repeated if and when its effect wears off, if you and your specialist agree.
- Report promptly any new pelvic pain, difficulty emptying the bladder, or mesh-related symptoms if mesh was used.
Repeat, follow-on and what comes next
- Conservative treatment and medicines may not work or may wear off, leading to a step up in treatment.
- Urethral bulking agents commonly lose effect and may need repeating.
- Surgical results can fade over time, and symptoms may return and need further treatment.
- Mesh, if used, can be very difficult to remove fully if complications occur — a major reason for the UK restrictions.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Access to a specialist pelvic floor physiotherapist and clear exercise guidance.
- Review of any medicine for benefit and side effects, with changes if needed.
- After surgery, a check that the bladder is emptying well and a named contact for problems.
- Recording of any mesh implant in a national registry, with written device details given to you.
- Clear routes to specialist mesh-complication services if mesh problems arise.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- The number of pelvic floor physiotherapy sessions and whether supervised programmes are included
- Assessment and tests such as bladder diaries, urine tests and urodynamic studies
- Bladder medicines and the reviews needed to monitor them
- For surgery: the surgeon's and anaesthetist's fees, theatre and any hospital stay
- The type of procedure (colposuspension, autologous sling, bulking agents, or restricted mesh) and any device or material used
- Follow-up appointments and checks that the bladder is emptying well
- Cover for managing complications, including specialist mesh-complication care if relevant
- What is included in any pelvic floor physiotherapy package and for how long
- Assessment and tests such as urodynamics before surgery
- For surgery: surgeon's and anaesthetist's fees, theatre and any stay
- The specific procedure planned and any device or material used
- Follow-up appointments and bladder-emptying checks
- The cancellation policy
- What happens, and who pays, if the treatment does not work or a complication occurs
On the NHS? Assessment and treatment for urinary incontinence, including pelvic floor physiotherapy, continence services, medicines and surgery, are widely available on the NHS; private care is sometimes used for a shorter wait or choice of specialist.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Not being offered or given time for conservative treatment before surgery.
- Not being told about all surgical options, including those not available locally.
- Inadequate explanation of the long-term uncertainties and the specific risks of mesh.
- No written information or device details when an implant is used.
- Being rushed into a decision rather than given time to weigh benefits and risks.
Marketing red flags
- Promising a quick, permanent 'cure' for incontinence.
- Pushing surgery, especially mesh, without offering conservative treatment first.
- Downplaying the serious, well-documented complications of vaginal mesh.
- Not mentioning the UK mesh restrictions or the alternatives.
- No discussion of long-term uncertainty or the possibility of symptoms returning.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What type of incontinence do I have, and how does that change my treatment?
- Can I be referred to a specialist pelvic floor physiotherapist before considering surgery?
- What are all my surgical options, including doing nothing, and the long-term risks of each?
- If mesh is suggested, why, what are the UK restrictions, and what are the alternatives?
- What is the chance the treatment works, and what if it does not or wears off?
- How will you check my bladder is emptying properly after surgery?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
What treatment will I be offered first?
Is treatment available on the NHS?
Is mesh surgery still used in the UK?
Do pelvic floor exercises really work?
What are the alternatives to surgery for stress incontinence?
Will treatment cure my leaking for good?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NICE NG123 — Urinary incontinence and pelvic organ prolapse in women: recommendations NHS — Urinary incontinence NHS England — Specialised services for mesh complications First Do No Harm — Independent Medicines and Medical Devices Safety Review (Cumberlege) BAUS — Vaginal mesh complications NHS — Surgery and procedures for urinary incontinence Current overview of surgical options for female stress urinary incontinence Bulking agents for stress urinary incontinence — review BAUS — Botox injections for overactive bladder
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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