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URINARY INCONTINENCE

1. What causes urinary incontinence in men?

There are many possible causes. Common ones include neurological conditions (brain, spinal cord or nerve problems), prostate disease, bladder dysfunction, pelvic floor weakness, urinary infections, side-effects after surgery (especially prostate surgery), some medicines and anatomical problems.

Whatever the cause, incontinence needs a proper assessment. In some types, leakage happens because the bladder does not empty well, which can risk kidney problems if ignored. Men with incontinence should be assessed by a urologist. After prostate surgery, leakage may be temporary or persistent; management ranges from pelvic floor muscle training and medicines to procedures such as male sling or an artificial urinary sphincter when needed. (NICE)

1. What causes urinary incontinence in women?

Again, there are many causes. These include neurological conditions, changes after pregnancy and childbirth, pelvic floor weakness, urinary infections, side-effects after pelvic surgery, and anatomical problems such as pelvic organ prolapse.

All incontinence deserves assessment. As in men, leak due to poor emptying can be a red flag for kidney risk. In women, leakage is more common after childbirth and around menopause. Stress incontinence (leak with coughing, laughing, exercise) responds best to pelvic floor rehabilitation and, if needed, procedures rather than tablets alone. (NICE)

1. When is a sling operation (TOT/sling) used for stress incontinence, and how successful is it?

Stress incontinence often reflects weakened support of the urethra from childbirth-related injury, pelvic floor laxity or menopause-related tissue changes. Because this is largely mechanical, tablets rarely fix it. Mid-urethral slings and other surgical options can be effective in appropriately selected women after supervised pelvic floor muscle training.

In the UK, any surgery involving mesh is undertaken within regulated pathways, with consent and outcome tracking through national registries; alternatives include autologous fascial sling, colposuspension and urethral bulking. For men with post-prostatectomy stress incontinence, options include a male sling for mild–moderate leakage and an artificial urinary sphincter for moderate–severe cases in specialist centres. (NICE)

How incontinence is assessed and treated (both sexes)

Initial steps
• History, examination, bladder diary and urine test
• Ultrasound or flow studies when indicated; check for incomplete emptying if symptoms suggest it
• Start with conservative care: bladder training, pelvic floor muscle training with a continence-specialist physiotherapist, lifestyle measures (weight loss, treat constipation, reduce caffeine/alcohol), and manage contributing conditions or medicines. (NICE)

Overactive bladder/urgency leakage
• First line: bladder training and pelvic floor therapy
• Medicines: antimuscarinics or a beta-3 agonist such as mirabegron when conservative measures are not enough
• If symptoms persist: consider onabotulinumtoxinA bladder injections, tibial nerve stimulation or sacral neuromodulation in appropriate cases, following counselling about benefits and risks (including intermittent self-catheterisation after Botox if needed). (NICE)

Stress incontinence
• Women: supervised pelvic floor training first; if still symptomatic, options include mid-urethral sling in regulated pathways, autologous fascial sling, colposuspension or urethral bulking, chosen according to goals and anatomy
• Men (typically after prostate surgery): pelvic floor rehabilitation; if persistent, male sling for mild–moderate leakage or artificial urinary sphincter for moderate–severe leakage in specialist centres. (NICE)

Key procedures at a glance

Female mid-urethral sling (mesh)
Day-case or overnight. Aims to support the urethra and stop leaks on effort. In the UK it is performed with strict consent and registry reporting; alternatives are available for those who prefer to avoid mesh. (NICE)

Male sling
Supports and repositions the urethra for post-prostatectomy stress incontinence. Best for mild–moderate leakage. National patient leaflets report satisfaction around 70% in selected men. (baus.org.uk)

Artificial urinary sphincter (men)
Gold-standard option for moderate–severe stress incontinence after prostate surgery. Implanted device with a cuff and a small pump in the scrotum. High satisfaction in experienced centres; requires lifelong follow-up. (baus.org.uk)

Botulinum toxin A for overactive bladder
Endoscopic bladder injections for urgency/urge incontinence not controlled by conservative measures and tablets. Day-case; discuss benefits, repeat treatments and the small risk of needing intermittent self-catheterisation. (Oxford University Hospitals)

Safety and follow-up

• Female mesh procedures are performed in line with national safeguards and registry reporting.
• Choice of treatment should follow shared decision-making, considering symptom type, bladder emptying, pelvic floor status, desire to avoid mesh, and sexual/quality-of-life goals.
• Outcome tracking and timely review help manage recurrence or complications early. (NICE)

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