Stress Incontinence in women
Date issued: August 2024
For review: August 2026
A-238/Gynae/PE/Stress Incontinence in women v7
PDF: Stress Incontinence in women v7.pdf [pdf] 116KB
What is stress Incontinence?
What causes Stress incontinence?
Most cases of stress incontinence are due to weakened pelvic floor muscles. The pelvic floor muscles are a group of muscles that wrap around the underside of the bladder and rectum. Stress incontinence is common in women who have had children, particularly if they have had several vaginal deliveries. It is also more common with increasing age particularly after the menopause and in women who are obese.
What are the treatment options for Stress incontinence?
Pelvic floor physiotherapy
First-line treatment involves strengthening the pelvic floor muscles with pelvic floor exercises. About 6 in 10 cases of stress incontinence can be cured or much improved with this treatment. Your doctor will refer you to the physiotherapist for supervised pelvic floor exercises.
Weight loss
If you are overweight and incontinent then you should first try to lose weight. It has been shown that losing a modest amount of weight can improve urinary incontinence in overweight and obese women. Even just 5-10% weight loss can help symptoms.
Smoking
Can cause cough which can aggravate symptoms of incontinence. It would help not to smoke.
Surgery may be an option if the problem continues despite pelvic floor exercises and is a significant bother.
Surgery for stress incontinence
1. TVT (Tension-free Vaginal Tape)
TVT was the most performed operation to treat stress incontinence but is currently suspended. It involves use of a synthetic mesh as a sling to support the urethra. It is often performed as a day case. (We are currently unable to offer this surgery following NHS England notification in July 2018 but it might be available in future)
2. Urethral Bulking Agent
Another commonly performed operation; this involves the injection of a soft permanent gel into the urethra near the bladder neck to increase resistance to urine flow. It is the least invasive procedure available and can be carried out under local anaesthetic but has a reduced success rate and the efficacy may reduce over time. See leaflet on Urethral Bulking for more details.
3. Colposuspension
The traditional operative procedure for stress incontinence has been a colposuspension, which is an inpatient operation where a bikini line cut is made, and the bladder is hitched up internally using stitches. It is a successful operation with 80% satisfaction, but with a slightly higher complication rate. This operation can also be performed by a keyhole surgery. See leaflet on Colposuspension for more details.
4. Autologous Fascial Sling
This operation involves using your own body tissue as a sling to support the urethra. The sling is obtained from the tummy wall and requires a bikini line cut in the abdomen. This operation works well but has some complications which might be long lasting. See leaflet on Autologous sling for more details.
Please seek the advice of your consultant before your operation if you wish to discuss any of these further and in more detail. Surgery may be possible in most cases. The type of appropriate surgery and the risks of surgery do partly depend on each individual, and not all surgery is suitable for all patients.
Further help and information
British Society of Urogynaecologyinformation leaflets
International Urogynecological Association patient information leaflets
