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.

Surgery and procedures for stress incontinence

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.

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. The sling can be made of:

• tissue taken from another part of your body (autologous sling)
• tissue donated from another person (allograft sling)

Vaginal mesh surgery (tape surgery)

At the moment, it may not be possible to have vaginal mesh surgery for urinary incontinence on the NHS. But you should have a detailed discussion with a specialist to talk about your options.

Urethral bulking agents

A urethral bulking agent is a substance that's injected into the walls of the urethra in people with stress incontinence who have a vagina. This increases the size of the urethral walls and allows the urethra to stay closed with more force.

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.

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.

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.

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.

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.

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.