Management of stress urinary incontinence

It is recommended that the following approaches are tried for at least 3 months to manage your incontinence. 

Lifestyle changes and self-management

• Adjust food and fluid intake. 
• Manage your weight and adapt your exercise.
• Treat constipation. 

Pelvic floor muscle training 

With supervision from a pelvic health physiotherapist or continence nurse specialist.

• Individualised training and advice over at least 3 months. 
• Possible bladder retraining. 
• Possible nerve stimulation. 

Other options

• Pessaries (a device that is placed into the vagina to support the uterus).
• Other devices including biofeedback devices, pelvic floor muscle apps, or vaginal cones, weights or balls.
• Pads and incontinence underwear. 
• Medication.

There are 4 surgical options available when non-surgical options have been tried and are unsuccessful. The 4 options are: 

• urethral bulking agents (internal link)
• native tissue sling (internal link)
• colposuspension (internal link)
• mesh tape/mesh sling (internal link) (only available in very rare cases). 

Your surgeon may offer one or more of these options. You may be referred to another surgeon or district depending on what you decide. You can discuss all these surgical options with your health care team then make an informed decision in your own time about what is right for you. 

Take time to consider your options and make sure you have enough information to make an informed decision. 

Patient decision guide: Surgery for stress urinary incontinence [PDF, 10 MB]

General risks associated with any form of surgery include:

• anaesthetic risk 
• damage to nearby organs 
• wound infection 
• bleeding 
• deep vein thrombosis
• pain.

These risks increase if you:

• have any significant medical conditions, such as diabetes
• smoke
• are overweight
• have previously had surgery for a similar problem or received pelvic radiation.

General risks and complications associated with surgery for managing incontinence

Complications can happen soon after surgery or many years later. They may not trouble you very much at all, or they could affect your quality of life a great deal. They may be minor and treatable, or they may be difficult to treat. 

If you have any complications, it is important to seek help as soon as possible from your doctor or specialist. 

Some general risks and complications include the following. 

• You may have difficulty passing wee (urine) and be unable to empty your bladder fully immediately after surgery. This is usually temporary. Your surgeon can advise if you need further surgery to address this, but further surgery is not common. In some cases, a catheter (a tube which is placed to drain wee from the bladder) may be needed for a few days or weeks, and you may need to self-catheterise at home. 
• You may get a urinary tract infection. These infections can be severe, persistent and difficult to treat, although there may not be an obvious cause. 
• You may experience urgency and urge incontinence (the feeling like you need to pass wee more often than usual), or have trouble getting to the toilet in time. 
• There is a possibility the surgery may not fix your incontinence, and further surgery may be needed. 
• You may experience pain during sex, or pain or changes in sensation in the back, abdomen, pelvis, leg, vagina, groin o the area between the front and back passages (the perineum). 
• There may also be damage to the urethra, bladder or nerves.

Risks relating to pregnancy, childbirth and surgery for managing incontinence

Incontinence may return after further pregnancies regardless of whether you have had previous surgery. Talk to your surgeon about this.