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What is urinary incontinence?

Urinary Incontinence is the involuntary leakage of urine. There are different types of urinary incontinence, each with different causes and treatments, which include:

  • Stress incontinence – leakage during activities that increase pressure inside the abdomen and push down on the bladder, such as coughing, sneezing, running, or heavy lifting. this type of incontinence is the focus of this information resource
  • Urge incontinence – urinary incontinence preceded by a sudden and strong need to urinate
  • Incontinence associated with chronic retention – when the bladder is unable to empty properly and frequent leakage of small amounts of urine occurs as a result
  • Functional incontinence – due to medications or health problems that make it difficult to reach the bathroom in time

Sometimes women have more than one type of incontinence. Specialised tests will help diagnose the type of incontinence you have and which treatment options are right for you. These tests may include a urodynamic study or a cystoscopy. Urinary incontinence can be embarrassing and distressing. Your treatment really depends on how much it affects you and what you feel you can cope with, as well as your general health. 

Urge Incontience - What are my treatment options?

  • Do nothing
    • Manage your symptoms with continence aids (pads)
  • Conservative treatments
    • Pelvic floor exercises
    • Bladder Retraining program 
    • Weight loss
    • Vaginal oestrogen
  • Medical treatments
    • Anticholinergic tablets/ patches (Ditropan, Oxytrol, Vesicare)
    • Beta agonist tablets (Mirabegron)
    • Alpha blockers (Tofranil)
  • Surgical treatments
    • Botox injections to the bladder
    • Tibial nerve stimulator
    • Sacral nerve stimulator

Stress Incontience - What are my treatment options?

  • Do nothing
    • Manage your symptoms with continence aids (pads)
  • Non-surgical treatments
    • Lifestyle changes
    • Pelvic floor exercises
    • Continence pessaries (Contiform device)
    • Vaginal oestrogen
  • Surgical treatments
    • Mid-urethral sling
      • Retropubic mid urethral sling
      • Transobdurator mid-urethral sling
    • Pubovaginal sling
    • Burch colposuspension (laparoscopic or open)
    • Urethral bulking agents

Each of these options is explained in more detail on the following pages. 

Do nothing:

After speaking with your doctor and considering information about SUI, you may choose not to have any treatment, particularly if your symptoms are mild or very mild.

Absorbent products do not reduce the symptoms of SUI, but you may find that leakage of urine can be sufficiently managed with pads and other absorption aids.

See the Continence Foundation of Australia for more information on incontinence and products to manage the conditions. You may be eligible for a subsidy for continence products. https://www.continence.org.au/resources.php/01tA0000001b1bqIAA/funding-schemes-for-continence-products-national-and-state-schemes

Non-surgical treatment options

Non-surgical treatments are recommended as the first line of treatment by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists. The following treatment options are safe, and a combination of these options may give you good results. However, they may not work for everyone and you may still have symptoms that affect your quality of life.

Lifestyle changes

Reducing weight, avoiding heavy lifting, avoiding constipation and chronic coughing, stopping smoking and doing lower impact exercises are all non-surgical options that should be considered. Each of these options can help increase control over your bladder and contribute to overall good health.

These changes need consistent effort, over the long term as it takes time for lifestyle changes to work. Support from a health professional, such as a dietitian or your general practitioner may be helpful, as well as support from family and friends to assist in making these lifestyle changes.

Pelvic floor exercises

Pelvic floor exercises are intended to strengthen the pelvic floor, over time, through actively tightening and lifting the muscles at regular intervals. Involvement of a health professional, such as a physiotherapist with a special interest in pelvic floor dysfunction or continence nurse, is important to give instruction and assist in improving the outcomes of these exercises.

These exercises can reduce symptoms or the need for surgery and help increase control over your bladder. They need to be done correctly and consistently over time; these exercises are not a “quick fix”. If muscles are very weak, there are other additional treatments that may help to improve pelvic floor function. A physiotherapist with a special interest in pelvic floor dysfunction may suggest biofeedback or electrical stimulation.

An internal examination and some specialised tests may also need to be performed to assess whether you are doing the exercises correctly and whether they are helping improve your pelvic floor strength.

Continence pessary

Your doctor or a physiotherapist with a special interest in pelvic floor dysfunction can fit you with a removable device called a pessary. This is inserted into your vagina to compress your urethra against your pubic bone and lift the neck of your bladder. Pessaries are made from a variety of materials including vinyl, silicone and latex. You may need to try a few types and sizes of pessaries to find what works for you. One example is the Contiform device. 

https://contiforminternational.com/contiform-shop/

Surgical treatment options

If non-surgical treatments do not work for you, and your symptoms are severe and continue to disrupt your life, you might consider surgery. Surgery is intended to improve support of the urethra and bladder so that loss of urine is minimised.

Surgery for SUI can be performed through either the vagina or abdomen, or both. Your surgeon will work with you to determine the best approach for you. All surgery has risks including not fixing your SUI, damage to nearby organs, infection and life-threatening bleeding.

The main surgical treatment options are:

    • Mid-urethral sling
      • Retropubic mid urethral sling
      • Transobdurator mid-urethral sling
    • Fascial/ Pubovaginal sling
    • Burch colposuspension (laparoscopic or open)
Retropublic Midurethral Sling (TVT)

Retropubic Midurethral Sling: In the retropubic approach, the sling is placed through a small cut made in the vagina over the mid-point of the urethra. Through this the two ends of the sling are passed from the vagina, passing either side of the urethra, to exit through two small cuts made just above the pubic bone in the hairline, about 4-6 cm apart. The surgeon will then use a camera (cystoscope) to check that the sling is correctly positioned and not sitting within the bladder. The sling is then adjusted so that it sits loosely underneath the urethra and the vaginal cut is stitched to cover the sling over. The ends of the sling are cut off and they too are covered over.

A special note about transvaginal mesh: The Therapeutic Goods Administration (TGA) has reviewed evidence on the use of transvaginal mesh slings for SUI. It has decided that the scientific evidence supports using mid-urethral slings for SUI. This is distinct to the vaginal mesh for prolapse, which was the subject of the senate enquiry in 2018, and is now no longer available for use in Australia. Mid-urethral slings are different devices to single incision mini-slings which are also no longer recommended (outside clinical trials).

Fascial/ Pubovaginal Slings: Fascial slings are made from the patient ́s own fascia. The fascia is a layer of strong connective tissue usually obtained from the abdomen or thigh. The surgeon usually takes a strip of fascia 1-3cm wide and places it under the urethra to give support and reduce leakage of urine.

Burch Colposuspension: This is an operation that involves placing sutures (stitches) in the vagina on either side of the urethra and tying these sutures to supportive ligaments to elevate the vagina. Normally, the urethral sphincter and the muscles and ligaments around the urethra contract to prevent involuntary leakage of urine. Damage to these structures from childbirth and/or aging can lead to stress incontinence. The sutures in colposuspension elevate the vagina and support the urethra, thus reducing or stopping the leakage.

Urethral bulking agents: Urethral bulking involves an injection into the wall of the urethra usually of a water-based gels or silicone substance, to help strengthen the muscle around it. Urethral bulking is not a first-line treatment for SUI.

It is most commonly used in women where other procedures have not worked and the urethra is fixed or severely scarred. It is a minor procedure and is normally done as a day-procedure or 24-hour stay. Recovery time is short and the risk of complications is low. The success rate is not as good as for surgical procedures for SUI. Incontinence does not always improve after the procedure, and you may need repeat injections. 

It can be helpful to take a support person with you when you talk to your doctor. You may wish to ask the doctor to explain some answers again.

Adapted from a publication by the Australian Commission on Safety and Quality in Health Care and IUGA

Further information

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has some useful resources, including two excellent short videos to be watched prior to considering a mid-urethral sling
https://www.ranzcog.edu.au/Mesh-Resources

UroGynaecological Society of Australasia has information on the range of treatment options for stress incontinence
https://www.ugsa.com.au/resources/urinary-stress-incontinence/

The UroGynaecological Society of Australasia also has information on the range of treatment options for urge incontinence/ overactive bladder symptoms
https://www.ugsa.com.au/resources/overactive-bladder/

Patient information brochures in English and other languages
https://www.yourpelvicfloor.org/leaflets/

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Related Topics

  • Mater Health
  • UroGynaecological Society of Australasia
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