Urinary incontinence in women

Expert reviewer Professor Raj Persad, Consultant Urological Surgeon
Next review due July 2022

Urinary incontinence is when you pass urine without meaning to. It’s common in women, particularly as you get older. It’s hard to say exactly how many women have urinary incontinence, because lots of women feel too embarrassed to talk about it. If you have urinary incontinence, it can be embarrassing and upsetting and can affect every area of your life.

Some women stop going out or being physically active because of it. Incontinence can affect your sex life and relationships and sometimes lead to depression. Many women don’t ask for help and put up with it, but there’s lots of help available and it can often be treated.

An elderly woman is planting seeds

Types of urinary incontinence

There are two main types of incontinence.

  • Urge incontinence. This is when you feel a sudden need to pass urine without warning which is difficult to put off – you have to go to the toilet then and there.
  • Stress incontinence. This is when urine leaks when you sneeze, cough or exert yourself.

You can also have ‘mixed incontinence’ which means you have both stress incontinence and urge incontinence.

An overactive bladder is when you get a strong urge to pass urine often, including at night. It sometimes, but not always, leads to urge incontinence.

Symptoms of urinary incontinence

The main symptom of urinary incontinence is leaking urine. But this can vary quite a bit, from leaking a few drops to partly or totally emptying your bladder.

If you have urge incontinence, you’ll feel a sudden urge to go to the toilet which you can’t put off. You may not be able to make it to the toilet in time. Some women also need to go to the toilet at night and sometimes leak at night too.

If you have stress incontinence the main symptom is leaking urine when you do things like cough, sneeze, lift something heavy or exercise.

You may have other symptoms such as:

  • needing to pass urine often
  • a feeling of pressure in your vagina
  • dribbling urine after you’ve been to the toilet
  • it hurts or stings when you pass urine

Causes of urinary incontinence

The cause of urinary incontinence depends on the type of incontinence you have.

Urge incontinence occurs when the muscle of your bladder wall (the detrusor muscle) contracts when you don’t want it to. This causes you to feel the need to pass urine urgently. This can develop as you get older or be caused by neurological conditions such as a stroke or multiple sclerosis.

Some things which make having stress incontinence more likely include the following.

  • Being pregnant and giving birth. This stretches and weakens your pelvic floor muscles, which can lead to incontinence. Having a vaginal birth, having a cut to your perineum (the area between your vagina and anus) during childbirth or having more than one pregnancy are all linked to stress incontinence.
  • Being overweight.
  • Being constipated.
  • Getting older — the older you are the more likely you are to have any type of incontinence.
  • Other members of your close family having stress incontinence.
  • Having a prolapse — this is when one or more of the organs in your pelvis slip down from the normal position and bulge into your vagina.

Other causes of incontinence include:

  • a urine infection
  • drinking too much caffeine
  • Parkinson’s disease
  • a long-term cough
  • strenuous activity such as weight lifting

Diagnosis of urinary incontinence

If you’re leaking urine and it’s upsetting you or affecting your day-to-day life, you should see your GP. You can also see a specialist pelvic health physiotherapist, or your GP may refer you to one. 

Your GP will ask about your symptoms and medical history. This helps them find out which type of incontinence you have and rule out any underlying causes. Your GP will also ask about any medicines you may be taking.

Your GP should examine you too. They’ll feel your abdomen and probably do an internal examination. This means putting a finger into your vagina and asking you to squeeze your pelvic floor muscles. This can help to show how well they’re working.

Your GP may ask you to keep a ‘bladder diary’ for a few days. This means writing down when you go to the toilet, how much urine your pass and whether or not you have any incontinence. It’s best to fill in your diary on both work and non-working days to give a complete picture.


Depending on your symptoms, your GP may test your urine to see if you have an infection.

They may also refer you to a specialist for further tests, such as:

  • an ultrasound scan of your bladder after you’ve passed urine – this can help to show whether or not your bladder is emptying properly
  • urodynamic tests — these can show when you’re leaking urine

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There are several things you can do to help manage your symptoms. Your doctor may suggest some of the following:

  • drinking less caffeine
  • losing weight if you’re overweight
  • changing the amount of fluid you drink each day
  • treating any constipation - this may mean eating more fruit and vegetables and drinking plenty of fluids
  • doing less strenuous exercise
  • doing pelvic floor exercises – these may help if you have stress incontinence
  • bladder training – this may help if you have urge incontinence

To find out more about pelvic floor exercises and bladder training, see our section: Treatment of incontinence below.

You may also find it helpful to use incontinence products. For example:

  • wearing pads in your underwear to soak up any leaks
  • using a handheld urinal
  • using devices that you insert into your urethra or vagina to prevent leaks – these can’t be used all the time, but may help temporarily in some situations (for example, during exercise).
  • learning to self-catheterise – this involves inserting a thin, flexible tube into your urethra to drain urine when needed. If this is an option for you, an incontinence specialist will teach you how to do this.

Image showing the organs of the female pelvis

Treatment of urinary incontinence

Treatment for incontinence usually starts with the least invasive treatments first. This means trying lifestyle changes, such as those listed in the self-help section above, as well as other treatments before thinking about surgery. The treatment you need depends on the type of incontinence you have.

Treatment for stress incontinence

There are three main treatments for stress incontinence.

  • Pelvic floor muscle training (Kegel exercises). Your pelvic floor muscles help to control your bladder and bowel. Strengthening and toning these using exercises can sometimes help stress incontinence. A specialist pelvic health physiotherapist can show you how to do these exercises. You'll need to do them three times a day for three months to see whether or not they help. If you have problems tightening your pelvic floor muscles, using biofeedback or electrical stimulation may help. Biofeedback is when sensors placed on your skin or into your vagina send signals to a monitor when you squeeze your pelvic floor muscles. This can help to show you how well you’re doing the exercises. Electrical stimulation uses an electrical current to stimulate your pelvic floor muscles from a small electrical probe placed in your vagina.
  • Medicines. There are some medicines which may help to treat urinary incontinence, but these often cause side-effects and aren’t usually given as a first treatment. If you don’t want to have surgery, your doctor may suggest taking a medicine. They’ll speak to you about the best medicine for your specific circumstances and review this after four weeks to see if it’s working for you.
  • Surgery. There are several operations to treat stress incontinence, depending on what’s causing it. Your doctor is only likely to suggest surgery for incontinence if you’ve tried non-surgical treatments first and these haven’t helped. The different types of surgery for stress incontinence are described in more detail below.

Surgery for stress incontinence

If the less invasive treatments don’t help you, your GP will refer you to a specialist to discuss surgery. The main types of surgery for stress incontinence include the following.

  • Colposuspension. In this procedure your surgeon will lift the neck of your bladder by stitching the top of your vagina to the back of your pubic bone. Most people will have open surgery for this procedure.
  • Sling procedure. In this procedure, your surgeon will place a piece of your own tissue under your urethra, and use it as a sling to support it.
  • Injections of bulking agents into the wall of the urethra. This narrows your urethra, helping you to hold urine in your bladder. The effects of this procedure may wear off over time and you may need to have further injections.
  • Artificial sphincters. If you’ve already had surgery for stress incontinence and this hasn’t worked, you may be offered an artificial urinary sphincter.

Each procedure comes with risks and benefits. It’s important to discuss these and any complications you might experience with your doctor before you agree to go ahead with the procedure.

Until recently, another treatment choice for some women was to have an operation using an artificial mesh, also known as a tape, to support your urethra. There are concerns about the safety of the procedure, so for now this type of operation has been suspended and is unlikely to be offered except in exceptional circumstances.

If you’ve had the procedure and haven’t experienced any complications, try not to worry – it’s likely that everything is fine. For some people, the benefits of having the procedure will actually outweigh the risk. However, if you have the procedure, it’s really important to discuss and be fully aware of the risks involved so you can make an informed decision on whether you want to go ahead with the procedure or not. Speak to your surgeon for more advice.

Treatment for urge incontinence

There are several different types of treatment for urge incontinence.

  • Bladder training. This is usually the first treatment to try and you’ll be asked to do it for six weeks to see if it works. The training includes pelvic muscle exercises, lengthening the time between planned visits to the toilet and distractions to help you control the urge to pass urine.
  • Anti-muscarinic medicines. These help to stop the detrusor muscle in your bladder from tightening when it shouldn’t, and they help your bladder to hold more urine. They can take about a month to work and can cause a dry mouth and constipation, but these can be signs that the medicine is working.

If these treatments don’t work, there are other options.

  • Botulinum toxin A. This is injected into the wall of your bladder and helps to stop the detrusor muscle in your bladder from tightening when it shouldn’t.
  • Nerve stimulation. This involves sending electrical signals to the nerves that control your bladder.
  • Surgery. Your surgeon may suggest making your bladder bigger (augmentation) or redirecting urine away from your bladder into a bag (urinary diversion). Both are major operations and only used if other treatments haven’t worked.

Each treatment comes with risks and benefits. Talk to your doctor about your treatment options and make sure you have all the information you need to decide what is best for you.

Prevention of urinary incontinence

Being overweight, being constipated, lifting heavy weights and drinking a lot of caffeine all make incontinence more likely. So, if you’re worried about incontinence, try to maintain a healthy weight, eat and drink healthily and to reduce the amount of strenuous exercise you do.

You may be able to prevent incontinence during pregnancy and in the first few months after by doing pelvic floor exercises while you’re pregnant. Ask your midwife for more information.

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Related information

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    • Personal communication, Dr Raj Persad, Consultant Urological Surgeon, March 2019
  • Reviewed by Michelle Harrison, Specialist Health Editor, Bupa Health Content Team, July 2019
    Expert reviewer Professor Raj Persad, Consultant Urological Surgeon
    Next review due July 2022