Continence

NHS 2023
Definition of Urinary incontinence

Urinary incontinence is the unintentional passing of urine.

It's a common problem thought to affect millions of people.

Types of urinary incontinence
• There are several types of urinary incontinence, including:
• stress incontinence – when urine leaks out at times when your bladder is under
pressure; for example, when you cough or laugh
• urge incontinence – when urine leaks as you feel a sudden, intense urge to pee,
or soon afterwards
• overflow incontinence (chronic urinary retention) – when you're unable to
fully empty your bladder, which causes frequent leaking
• total incontinence – when your bladder cannot store any urine at all, which
causes you to pass urine constantly or have frequent leaking
• It's also possible to have a mixture of both stress and urge urinary incontinence
Stress incontinence
• Stress incontinence is when you leak urine when your bladder
is put under sudden extra pressure – for example, when you
cough. It's not related to feeling stressed.
• Other activities that may cause urine to leak include: 
• sneezing 
• laughing 
• heavy lifting 
• exercise
• The amount of urine passed is usually small, but stress
incontinence can sometimes cause you to pass larger amounts,
particularly if your bladder is very full.
Urge incontinence
• Urge incontinence, is when you feel a sudden and very intense need
to pass urine and you're unable to delay going to the toilet. There are
often only a few seconds between the need to urinate and the release
of urine.
• Your need to pass urine may be triggered by a sudden change of
position, or even by the sound of running water. You may also pass
urine during sex, particularly when you reach orgasm.
• This type of incontinence often occurs as part of a group of symptoms
called overactive bladder syndrome, which is when the bladder
muscle is more active than usual.
• As well as sometimes causing urge incontinence, overactive bladder
syndrome can mean you need to pass urine very frequently, including
several times during the night.
Mixed incontinence
• Mixed incontinence is when you have symptoms of both stress and
urge incontinence. For example, you may leak urine if you cough or
sneeze, and also experience very intense urges to pass urine.
Overflow incontinence
• Overflow incontinence, also called chronic urinary
retention, is when the bladder cannot completely empty
when you pass urine. This causes the bladder to swell above
its usual size.
• If you have overflow incontinence, you may pass small
trickles of urine very often. It may also feel as though your
bladder is never fully empty and you cannot empty it even
when you try.
Total incontinence
• Urinary incontinence that's severe and continuous is sometimes known
as total incontinence.
• Total incontinence may cause you to constantly pass large amounts of
urine, even at night. Or you may pass large amounts of urine only
occasionally and leak smaller amounts in between.
Lower urinary tract symptoms (LUTS)

• The lower urinary tract includes the bladder and the tube that urine passes
through as it leaves the body (urethra).
• Lower urinary tract symptoms (LUTS) are common as people get older.
• They can include:
• problems with storing urine, such as an urgent or frequent need to pass urine or
feeling like you need to go again straight after you've just been
• problems with passing urine, such as a slow stream of urine, straining to pass urine,
or stopping and starting as you pass urine
• problems after you've passed urine, such as feeling that you've not completely
emptied your bladder or passing a few drops of urine after you think you've finished
• Experiencing LUTS can make urinary incontinence more likely.
Causes of stress incontinence

• Stress incontinence is when the pressure inside your bladder

as it fills with urine becomes greater than the strength of
your urethra to stay closed.
• Any sudden extra pressure on your bladder, such as
laughing or sneezing, can cause urine to leak out of your
urethra if you have stress incontinence.
• Your urethra may not be able to stay closed if the muscles in
your pelvis (pelvic floor muscles) are weak or damaged, or
if your urethral sphincter – the ring of muscle that keeps the
urethra closed – is damaged.
 Problems with these muscles may be
caused by:
• damage during childbirth – particularly if your baby was born vaginally,
rather than by caesarean section.
• increased pressure on your tummy – for example, because you are
pregnant or obese
• damage to the bladder or nearby area during surgery – such as the removal
of the womb hysterectomy, or removal of the prostate gland
• neurological conditions that affect the brain and spinal cord, such as
Parkinson's disease or Multiple Sclerosis
• certain connective tissue disorders such as Ehlers-Danlos Syndrome 
• certain medicines
Causes of urge incontinence

• The urgent and frequent need to pass urine can be

caused by a problem with the detrusor muscles in
the walls of your bladder.
• The detrusor muscles relax to allow the bladder to
fill with urine, then contract when you go to the
toilet to let the urine out.
• Sometimes the detrusor muscles contract too often,
creating an urgent need to go to the toilet. This is
known as having an overactive bladder.
The reason your detrusor muscles contract too often may not be
clear, but possible causes include:

• drinking too much alcohol or caffeine

• not drinking enough fluids – this can cause strong, concentrated urine
to collect in your bladder, which can irritate the bladder and cause
symptoms of overactivity
• constipation
• conditions affecting the lower urinary tract (urethra and bladder) –
such as urinary tract infections or tumours in the bladder
• neurological conditions
• certain medicines
Causes of overflow incontinence

• Overflow incontinence, also called chronic urinary retention, is often caused

by a blockage or obstruction affecting your bladder.
• Your bladder may fill up as usual, but because of an obstruction, you will not
be able to empty it completely, even when you try.
• At the same time, pressure from the urine that's left in your bladder builds up
behind the obstruction, causing frequent leaks.
• Your bladder can be obstructed by:
• an enlarged prostate gland (if you have a penis)
• bladder stones
• constipation
Overflow incontinence continued
• Overflow incontinence may also be caused by your detrusor muscles
not fully contracting, which means your bladder does not completely
empty when you urinate. As a result, the bladder becomes stretched.
• Your detrusor muscles may not fully contract if:
• there's damage to your nerves – for example, as a result of surgery to
part of your bowel or a spinal cord injury
• you're taking certain medicines
Causes of total incontinence

• Total incontinence is when your bladder cannot store

any urine at all. It can mean you either pass large
amounts of urine constantly, or you pass urine
occasionally with frequent leaking in between.
• Total incontinence can be caused by:
• a problem with your bladder from birth
• injury to your spinal cord – this can disrupt the
nerve signals between your brain and your
bladder
• a bladder fistula – a small, tunnel like hole that
can form between the bladder and a nearby
area, such as the vagina
Medicines that may cause incontinence

• Some medicines can disrupt the normal process of storing and passing
urine or increase the amount of urine you produce. These include:
• angiotensin converting enzyme (ACE) inhibitors
• diuretics
• some antidepressants
• hormone replacement therapy (HRT)
• sedatives
Stopping these medicines, if advised to do so by a doctor, may help
resolve incontinence.
Risk factors
In addition to common causes, some things can increase your risk of developing urinary
incontinence without directly being the cause of the problem. These are known as risk factors.
Some of the main risk factors for urinary incontinence include:
family history – there may be a genetic link to urinary incontinence, so you may be more at risk
if other people in your family have the problem

increasing age – urinary incontinence becomes more common in middle age and is very
common in people who are 80 or older

having lower urinary tract symptoms (LUTS) – a range of symptoms that affect the bladder and
urethra
 Diagnosis
If you experienced urinary incontinence, see a GP so they can diagnose the type
of urinary incontinence you have.
• Try not to be embarrassed when speaking to the GP about your condition. Urinary
incontinence is a common problem and it's likely the GP has seen many people
with the same problem.
• A GP will ask you questions about your symptoms and medical history, including:
• whether the urinary incontinence happens when you cough or laugh
• whether you need the toilet frequently during the day or night
• whether you have any difficulty passing urine when you go to the toilet
• whether you're currently taking any medicine
• how much fluid, alcohol or caffeine you drink
Bladder diary

The GP may suggest that you keep a diary of your bladder habits for
at least 3 days so you can give them as much information as possible
about your condition.
• This should include:
• how much fluid you drink
• the types of fluid you drink
• how often you need to pass urine
• the amount of urine you pass
• how many episodes of incontinence you have
• how many times you experience an urgent need to go to the toilet
Tests and examinations
• A GP may examine you to assess the health of your urinary system. If you have a vagina, the GP will
do a pelvic examination, which usually involves undressing from the waist down. You may be asked to
cough to see if any urine leaks.
• The GP may also examine your vagina. In many cases of stress incontinence, part of the bladder may
bulge into the vagina, which is called a cystocele.
• The GP may place their finger inside your vagina and ask you to squeeze your pelvic floor muscles.
• These are the muscles that surround your bladder and urethra (the tube that urine passes through to
leave your body). Damage to your pelvic floor muscles can lead to urinary incontinence.
• If you have a penis, the GP may check the health of your prostate gland, which is located between the
penis and bladder and surrounds the urethra.
• You may need a digital rectal examination. This will involve the GP inserting their finger into your
bottom so they can feel your prostate gland.
• If you have an enlarged prostate gland, it can cause symptoms of urinary incontinence, such as a
frequent need to urinate.
 Urinalysis
• If the GP thinks your symptoms may be
caused by a urinary tract infection (UTI),
a sample of your urine may be tested for
bacteria.
• A small chemically treated stick is dipped
into your urine sample. It will change
colour if bacteria are present. The dipstick
test can also check for blood and protein
in your urine.
Residual urine test

• If the GP thinks you have overflow incontinence, they may suggest a

test called a residual urine test to see how much urine is left in your
bladder after you pee.
• This usually involves an ultrasound scan of your bladder, although
occasionally the amount of urine left in your bladder may be measured
after your bladder is drained using a catheter.
• A catheter is a thin, flexible tube that's inserted into your urethra and
passed through to your bladder.
Further tests
• Further tests may be necessary if the cause of your urinary
incontinence is not clear. The GP will usually start treating you first
and may suggest further tests if treatment is not effective.
Cystoscopy

• A cystoscopy involves using a thin tube

with a camera attached to it (endoscope) to
look inside your bladder and urinary tract.
A cystoscopy can identify abnormalities
that may be causing incontinence.
Urodynamic tests

• These are a group of tests used to check the function of your bladder

and urethra. You may be asked to keep a bladder diary for a few days
then have several tests at a hospital or clinic.
• Tests can include:
• measuring the pressure in your bladder by inserting a catheter into your
urethra
• measuring the pressure in your tummy abdomen by inserting a catheter into
your bottom
• asking you to urinate into a special machine that measures the amount and
flow of urine
Non-surgical treatment
Your treatment will depend on the type of urinary incontinence you have
and the severity of your symptoms.
• If urinary incontinence is caused by an underlying condition, you may
receive treatment for this alongside incontinence treatment.
• Conservative treatments, which do not involve medicines or surgery, are tried
first. These include:
• lifestyle changes
• pelvic floor muscle training (Kegel exercises)
• bladder training
• After this, medicine or surgery may be considered.
Lifestyle changes
A GP may suggest you make simple changes to your lifestyle
to improve your symptoms, regardless of the type of urinary
incontinence you have. For example, the GP may recommend:
• reducing your intake of caffeine, which is found in tea,
coffee and cola, as caffeine can increase the amount of urine
your body makes
• altering how much fluid you drink each day, as drinking too
much or too little can make incontinence worse
• losing weight if you are overweight or obese – use the 
healthy weight calculator to find out if you're a healthy
weight for your height
NHS continence services
• NHS continence services are centres staffed by specialist nurses,
sometimes called continence advisers, and specialist physiotherapists.
They should be able to diagnose your condition and start treating you.
• You can usually book an appointment without a referral from a GP.
Pelvic floor muscle training
• Your pelvic floor muscles surround the bladder and urethra (the tube that carries urine from your
bladder out of your body) and control the flow of urine as you pee.
• Weak or damaged pelvic floor muscles can cause urinary incontinence, so exercising these muscles is
often recommended.
• A GP may refer you to a specialist to start a programme of pelvic floor muscle training.
• The specialist will assess whether you're able to squeeze (contract) your pelvic floor muscles and by
how much.
• If you can contract your pelvic floor muscles, you'll be given an exercise programme based on your
assessment.
• Your programme should include a minimum of 8 muscle contractions at least 3 times a day and last
for at least 3 months. If the exercises are helping after this time, you can keep on doing them.
• Research has shown that pelvic floor muscle training can benefit everyone with urinary incontinence.
• Find out more about pelvic floor exercises.
Biofeedback

Biofeedback is a way to monitor how well you do pelvic floor exercises by giving
you feedback as you do them.There are several different methods of biofeedback:
• a small probe could be inserted into the vagina, or the anus (if you have a penis),
which senses when the muscles are squeezed and sends the information to a
computer screen
• electrodes could be attached to the skin of your tummy (abdomen) or around the
anus – these sense when the muscles are squeezed and send the information to a
computer screen
• There is not much good evidence to suggest biofeedback offers a significant
benefit to people using pelvic floor muscle training for urinary incontinence, but
the feedback may help motivate some people to do their exercises.
Electrical stimulation

• If you're unable to contract your pelvic floor muscles, using electrical

stimulation may be recommended.
• A small probe will be inserted into the vagina, or into the anus (if you
have a penis). An electrical current runs through the probe, which
helps strengthen your pelvic floor muscles while you exercise them.
• You may find electrical stimulation difficult or unpleasant, but it may
be beneficial if you're unable to complete pelvic floor muscle
contractions without it.
Vaginal cones

• Vaginal cones may be used to assist with pelvic

floor muscle training. These small weights are
inserted into the vagina.
• You hold the weights in place using your pelvic
floor muscles. When you can, you progress to the
next vaginal cone, which weighs more.
• Some women find vaginal cones uncomfortable or
unpleasant to use, but they may help with stress or
mixed urinary incontinence.
Bladder training
• you've been diagnosed with urge incontinence, one of the first
treatments you may be offered is bladder training.
• Bladder training may also be combined with pelvic floor muscle
training if you have mixed urinary incontinence.
• It involves learning techniques to increase the length of time between
feeling the need to urinate and passing urine. The course will usually
last for at least 6 weeks.
Incontinence products

• While incontinence products are not a treatment for urinary incontinence, you
might find them useful for managing your condition while you're waiting to be
assessed or waiting for treatment to start helping.
• Incontinence products include:
• absorbent products, such as pants or pads
• handheld urinals
• a catheter (a thin tube that is inserted into your bladder to drain urine)
• devices that are placed into the vagina or urethra to prevent urine leakage – for
example, while you exercise
• Find out more about incontinence products, and information about 
getting free incontinence products on the NHS.
Medicine for stress incontinence
• If stress incontinence does not significantly improve with lifestyle changes or exercises, surgery will usually be
recommended as the next step.
• However, if you're unsuitable for surgery or want to avoid an operation, you may benefit from an antidepressant
medicine called duloxetine. This can help increase the muscle tone of the urethra, to help keep it closed.
• You'll need to take duloxetine tablets twice a day and will be assessed after 2 to 4 weeks to see if the medicine is
beneficial or causing any side effects.
• Possible side effects of duloxetine can include:
• nausea
• dry mouth
• extreme tiredness (fatigue)
• constipation
• Do not suddenly stop taking duloxetine, as this can also cause unpleasant side effects. A GP will reduce your dose
gradually.
• Duloxetine is not suitable for everyone, however, so a GP will discuss any other medical conditions you have to
determine if you can take it.
Medicines for urge incontinence

• Antimuscarinics
• If bladder training is not effective for your urge incontinence, a GP may prescribe a medicine called
an antimuscarinic.
• Antimuscarinics may also be prescribed if you have overactive bladder syndrome, which is the
frequent urge to urinate that can happen with or without urinary incontinence.
• The most common types of antimuscarinic medicines used to treat urge incontinence include:
• oxybutynin
• tolterodine
• darifenacin
• These are usually taken as a tablet that you swallow, 2 or 3 times a day, although oxybutynin also
comes as a patch that you place on your skin twice a week.
• You will usually start taking a low dose to minimise any possible side effects. The dose can be
increased until the medicine is effective.
Possible side effects of antimuscarincs
• dry mouth
• constipation
• blurred vision
• extreme tiredness (fatigue)
• In rare cases, antimuscarinics can lead to a build-up of pressure within the
eye (glaucoma), called angle closure glaucoma.
• You'll be assessed after 4 weeks to see if the medicine is helping, and every 6
to 12 months thereafter if the medicine continues to be effective.
• A GP will discuss any other medical conditions you have to determine which
antimuscarinic is suitable for you.
Mirabegron

• If antimuscarinics are unsuitable for you, they have not helped urge incontinence, or have
unpleasant side effects, you may be offered an alternative medicine called mirabegron.
• Mirabegron causes the bladder muscle to relax, which helps the bladder fill up with and store
urine. It usually comes as a tablet or capsule that you swallow once a day.
• Side effects of mirabegron can include:
• urinary tract infections (UTIs)
• a fast or irregular heartbeat
• suddenly noticeable heartbeats (palpitations)
• a rash
• itchy skin
• The GP will discuss any other medical conditions you have to determine whether mirabegron
is suitable for you.
Medicine for nocturia

• A low-dose version of a medicine called desmopressin may be used to treat nocturia, which is
the frequent need to get up during the night to urinate, by helping to reduce the amount of
urine produced by the kidneys.
• Another type of medicine taken late in the afternoon, called a loop diuretic, may also prevent
you getting up in the night to pass urine.
• Diuretic medicine increases the production and flow of urine from your body. By removing
excess fluid from your body in the afternoon, it may improve symptoms at night.
• Loop diuretics are not licensed to treat nocturia. This means the medicine may not have
undergone clinical trials to see if it's effective and safe in the treatment of nocturia.
• However, a GP or specialist may suggest an unlicensed medicine if they think it's likely to be
effective and the benefits of treatment outweigh any associated risk.
• If a GP is considering prescribing a loop diuretic, they should tell you it's unlicensed and
discuss the possible risks and benefits with you.
Surgery and procedures
If non-surgical treatments for urinary incontinence are unsuccessful or
unsuitable, surgery or other procedures may be recommended.
• Before making a decision, discuss the risks and benefits with a specialist, as
well as any possible alternative treatments.
• Your doctor must keep a detailed record of the type of surgery they do,
including any complications you get after you have had surgery. You should be
given a copy of this record.
• If you plan to have a pregnancy, this will affect your options. The physical strain
of pregnancy and childbirth can sometimes cause surgical treatments to fail.
• You may wish to wait until after you have had children before you choose
surgery.
Colposuspension
• Colposuspension involves making a cut in your lower tummy (abdomen), lifting the neck of
your bladder, and stitching it in this lifted position.
• If you have a vagina, a colposuspension can help prevent involuntary leaks from stress
incontinence.
• There are 2 types of colposuspension:
• open colposuspension – where surgery is done through a large cut
• laparoscopic (keyhole) colposuspension – where surgery is done through 1 or more small
cuts using small surgical instruments
• Both types of colposuspension offer effective long-term treatment for stress incontinence,
although laparoscopic colposuspension needs to be done by an experienced laparoscopic
surgeon.
• Problems that can happen after colposuspension include difficulty emptying the bladder
completely when peeing, urinary tract infections (UTIs) that keep coming back, and
discomfort during sex.
Sling surgery
• Sling surgery involves making a cut in your lower tummy (abdomen) and vagina so
a sling can be placed around the neck of the bladder to support it and prevent urine
leaking. If you have a penis, this surgery involves making a cut between the scrotum
and anus to put a sling around part of the urethral bulb (the enlarged end of the
urethra).
• The sling can be made of:
• tissue taken from another part of your body (autologous sling)
• tissue donated from another person (allograft sling)
• tissue taken from an animal (xenograft sling), such as cow or pig tissue
• In many cases, an autologous sling is used. It is made from part of the layer of tissue that
covers the abdominal muscles (rectus fascia).These slings are generally preferred because
more is known about their long-term safety and effectiveness.
• The most commonly reported problem associated with the use of slings is difficulty
emptying the bladder completely when peeing.
• A small number of people who have the procedure also find they develop urge
incontinence afterwards.
Vaginal mesh surgery
• Vaginal mesh surgery is where a strip of synthetic mesh is inserted behind the tube that carries urine out of
your body (urethra) to support it.
• Vaginal mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in the body
permanently.
• You'll be asleep during the operation. It's often done as day surgery, so you do not need to stay in hospital.
Some people need to stay in hospital overnight.
• A few people have had serious complications after mesh surgery. Some, but not all, of these complications can
also happen after other types of surgery.
• Problems include:
• long-lasting pain
• permanent nerve damage
• incontinence
• constipation
• sexual problems
• mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel
Vaginal Mesh Surgery
• Vaginal mesh surgery is where a strip of synthetic mesh is inserted behind the tube that carries urine out of your body
(urethra) to support it.
• Vaginal mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in the body
permanently.
• You'll be asleep during the operation. It's often done as day surgery, so you do not need to stay in hospital. Some
people need to stay in hospital overnight.
• A few people have had serious complications after mesh surgery. Some, but not all, of these complications can also
happen after other types of surgery.
• Problems include:
• long-lasting pain
• permanent nerve damage
• incontinence
• constipation
• sexual problems
• mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel
Artificial urinary sphincter

• The urinary sphincter is a ring of muscle that prevents urine flowing

from the bladder into your urethra.
• In some cases, it may be suggested that you have an artificial urinary
sphincter fitted to relieve your incontinence.
• This treatment is used more often for people who have a penis rather
than a vagina.
An artificial sphincter has 3 parts:
• a circular cuff that's placed around the urethra – this can be filled with fluid
when necessary to compress the urethra and prevent urine passing through it
• a small pump placed in the scrotum (when used in people who have a penis)
that contains a mechanism for controlling the flow of fluid to and from the cuff
• a small fluid-filled reservoir in the tummy – the fluid passes between this
reservoir and the cuff as the device is activated and deactivated
• The procedure to fit an artificial urinary sphincter often causes short-term
bleeding and a burning sensation when you pee.
• It's not uncommon for the device to eventually stop working, in which case
further surgery may be needed to remove it
Surgery and procedures for urge incontinence

• Botulinum toxin A injections

• Botulinum toxin A (Botox) can be injected into the sides of your bladder to treat urge
incontinence and overactive bladder syndrome.
• This medicine can sometimes help relieve these problems by relaxing your bladder.
• This effect can last for several months and the injections can be repeated if they help.
• Although the symptoms of incontinence may improve after the injections, you may find it
difficult to completely empty your bladder.
• If this happens, you'll need to be taught how to insert a thin, flexible tube called a catheter
into your urethra to drain the urine from your bladder.
• Botulinum toxin A is not currently licensed to treat urge incontinence or overactive bladder
syndrome, so you should be made aware of any risks before deciding to have this treatment.
• The long-term effects of this treatment are not yet known.
Sacral nerve stimulation
• The sacral nerves are located at the base of your back. They carry signals from your
brain to some of the muscles used when you go to the toilet, such as the detrusor
muscle that surrounds the bladder.
• If urge incontinence is the result of your detrusor muscles contracting too often, sacral
nerve stimulation, also known as sacral neuromodulation, may be recommended.
• A device is inserted near 1 of your sacral nerves, usually in 1 of your buttocks. An
electrical current is sent from the device into the sacral nerve.
• This should improve the way signals are sent between your brain and your detrusor
muscles and reduce your urges to pee.
• Sacral nerve stimulation can be painful and uncomfortable, but some people report a
substantial improvement in their symptoms or the end of their incontinence completely.
•T
Posterior tibial nerve stimulation

• Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start
from the same place as nerves that run to your bladder and pelvic floor.
• It's thought that stimulating the tibial nerve will affect these other nerves and help control the
urge to pee.
• A very thin needle is inserted through the skin of your ankle and a mild electric current is sent
through it, causing a tingling feeling and your foot to move.
• You may need 12 sessions of stimulation, each lasting around 30 minutes, 1 week apart.
• Some studies have shown that this treatment can offer relief from urge incontinence and
overactive bladder syndrome for some people, although there's not enough evidence yet to
recommend tibial nerve stimulation as a routine treatment.
• Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not
improved with medicine and you do not want to have botulinum toxin A injections or sacral
nerve stimulation.
Augmentation cystoplasty

• In rare cases, an operation known as augmentation cystoplasty may be

recommended to treat urge incontinence.
• This involves making your bladder bigger by adding a piece of tissue from
your intestine into the bladder wall.
• After augmented cystoplasty you may not be able to pass urine normally and
may need to use a catheter. 
• Because of this, augmentation cystoplasty is only considered if you're willing
to use a catheter.
• The difficulties passing urine can also mean that people who have
augmentation cystoplasty can get urinary tract infections (UTIs) that keep
coming back.
Urinary diversion

• Urinary diversion is a procedure where the tubes that lead from your
kidneys to your bladder (ureters) are redirected to the outside of your
body.
• The urine is then collected in a bag, without it flowing into your
bladder.
• Urinary diversion should only be done if other treatments have been
unsuccessful or are not suitable.
• It can cause several complications, such as a bladder infection, and
sometimes further surgery is needed to correct any problems that
happen.
Catheterisation for overflow incontinence

• There are 2 types of catheterisation for overflow incontinence, clean

intermittent catheterisation and indwelling catheterisation.
Clean intermittent catheterisation (CIC)

• Clean intermittent catheterisation (CIC) is used to empty the bladder at regular

intervals and so reduce overflow incontinence, also known as chronic urinary
retention.
• A continence adviser will teach you how to pass a catheter through your urethra
and into your bladder. Urine will then flow through the catheter and into the toilet.
• Using a catheter can feel a bit painful or uncomfortable at first, but discomfort
should ease over time.
• How often CIC will need to be done will depend on your circumstances.
• For example, you may only need CIC once a day, or you may need to use it
several times a day.
• Regular use of a catheter increases the risk of urinary tract infections (UTIs).
Indwelling catheterisation

• If using a catheter occasionally is not enough to treat overflow

incontinence, you can have an indwelling catheter fitted instead.
• This is a catheter that's inserted in the same way as CIC, but left in
place. A bag is attached to the end of the catheter to collect urine.
• Find out more about urinary catheterisation
Incontinence products
• Incontinence pads and other products and devices can make life easier
for you if you're waiting for a diagnosis or for a treatment to work.
• A wide range of products and devices are available for urinary incontinence.
• They include:
• pads and pants
• bed and chair protection
• catheters and penile sheaths
• skincare and hygiene products
• specially adapted clothing and swimwear
Pads and pull-up pants

• The most popular incontinence products are absorbent pads that are worn inside underwear to
soak up urine.
• Pads and pull-up pants use the same technology as babies' nappies and have a "hydrophobic"
layer which draws urine away from the surface of the product, so your skin stays dry.
• If you have mild to moderate incontinence you can buy thin, discreet pads or pull-up pants for
men and women from many supermarkets and pharmacies.
• For people with severe leaks, continence clinics and district nurses can supply incontinence pads
on the NHS, but these tend to be big and bulky.
• "I would not recommend that people with urinary incontinence use pads without advice from a
doctor or continence adviser," says Karen Logan, consultant continence nurse at Gwent
Healthcare NHS Trust.
• "But as a temporary measure, they can really improve your quality of life and save you from
being housebound or spending all your time in the toilet."
Avoid sanitary pads for incontinence

• "Many women use sanitary pads instead of incontinence pads because

they're cheaper, but they do not have the same technology. They stay
damp and they can make your skin sore," says Logan.
• "I recommend paying the extra for incontinence pads as they're much
more effective and comfortable."
Using tampons for stress incontinence

• Placing a tampon in your vagina puts pressure on the neck of your

bladder to stop leaks on exertion. However, do not regularly use super-
size tampons to prevent sudden leaks if you have stress incontinence.
• The National Institute for Health and Care Excellence (NICE) does not
recommend using tampons for the routine management of urinary
incontinence in women.
• However, tampons can be used occasionally, when necessary, to
prevent leaks. For example, during exercise.
Appliances and bedding

• Other useful incontinence products for more severe leaks

include urinals (devices that collect urine), or sheaths and
drainage systems (if you have a penis).
• A variety of incontinence bedding is also available, such as
washable bed pads that sit on top of the mattress and soak
up any overnight leaks. The pads stay dry to the touch and
they can be useful for trips away from home.
Can I get incontinence products on the
NHS?
• You may be able to get incontinence products on the NHS depending
on your local integrated care board (ICB). To qualify for NHS
products you may need to be assessed by a healthcare professional.
10 ways to stop leaks
• Do daily pelvic floor exercises
• Stop smoking
• Do the right exercises
• Avoid lifting
• Lose excess weight
• Treat constipation promptly
• Cut down on caffeine
• Cut down on alcohol
• Drink plenty of water
• Eat the right foods