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Treating urinary incontinence
Treatment is stepped: from simple, safe methods to more complex ones. The first step — exercises, bladder training and lifestyle changes — helps most women. Your plan is always chosen together with your doctor, based on the type and severity of symptoms, your general health, pregnancy plans and your preferences.
Step 1: lifestyle changes
This is the foundation for every type of incontinence:
- Weight loss if you're overweight. In a large clinical trial, women who lost an average of 8% of their body weight had almost half as many leaks.
- Fluid intake. Not too little and not too much — usually 1.5–2 litres a day unless your doctor advises otherwise.
- Less caffeine — coffee, strong tea, energy drinks, cola. Especially helpful for urgency symptoms.
- Treating constipation and avoiding straining.
- Stopping smoking and treating a chronic cough.
More in Prevention.
Step 2: pelvic floor muscle training
This is the main treatment for stress and mixed incontinence. International guidelines recommend supervised training for at least 3 months, with at least 8 contractions 3 times a day. According to systematic reviews, women who do these exercises are several times more likely to report cure or significant improvement than those who don't.
If you can't feel the right muscles, a doctor or physiotherapist may use biofeedback (a sensor shows whether you're squeezing correctly) or electrical stimulation alongside the exercises. The technique and a 12-week plan are in Pelvic floor muscle training.
Step 2: bladder training
This is the main treatment for urgency incontinence and overactive bladder. The idea is to gradually "retrain" the bladder to hold more:
- Use your diary to see how often you go now — for example, every hour.
- Set a schedule and go by the clock, not by the urge.
- When an urge comes early, stop, do a few quick pelvic floor squeezes, breathe deeply and wait for the urge to pass.
- Each week, extend the interval by 15–30 minutes.
- Aim to pass urine about every 3–4 hours during the day.
The recommended duration is at least 6 weeks. The first results are usually noticeable after a few weeks.
Step 3: medicines
If exercises and bladder training haven't helped enough with urgency incontinence, a doctor may prescribe medicines that relax the bladder muscle. There are several groups, each with its own side effects (such as dry mouth or constipation) and limitations, especially in older women. The effect is assessed a few weeks after starting.
Post-menopausal women with vaginal dryness and thinning may be offered local (vaginal) oestrogen — it reduces urgency and discomfort.
Tablets are generally not the main treatment for stress incontinence.
Supportive options
- Pessary — a soft silicone ring or insert in the vagina that supports the urethra. Suitable if surgery isn't wanted or as a temporary solution (for example, during sport).
- Continence products — incontinence pads and underwear. They help you feel secure during treatment but don't replace it.
Step 4: procedures and surgery
If several months of conservative treatment haven't helped and symptoms seriously affect your life, a specialist will discuss other options.
For stress incontinence
- operations that support the urethra (sling procedures, colposuspension);
- bulking agents injected into the urethral wall — less invasive, but the effect may not last as long.
For urgency incontinence
- botulinum toxin injections into the bladder wall;
- tibial or sacral nerve stimulation.
Any procedure is decided only after assessment by a specialist and a detailed discussion of benefits, risks and alternatives. If you're planning a pregnancy, tell your doctor — it affects the choice.
How to tell if treatment is working
- Compare your bladder diary before and after — the most objective way.
- Retake the ICIQ-SF test after 3 months: a lower score shows improvement.
- Notice what you've returned to: sport, travel, sleeping through the night.
If there's no improvement after the agreed time, treatment causes side effects or symptoms get worse, tell your doctor — the plan can be changed.
Sources
- NICE guideline NG123. 2019. nice.org.uk
- Dumoulin C, Cacciari LP, Hay-Smith EJC. Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database Syst Rev. 2018;10:CD005654.
- Subak LL, et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med. 2009;360(5):481–490.
- EAU Guidelines on Non-neurogenic Female LUTS. uroweb.org
- AUA/SUFU guidelines on stress urinary incontinence (2023) and overactive bladder (2024). auanet.org