Identify the type first, because the treatments differ
| Type | What it looks like | Main cause |
|---|---|---|
| Leaks under pressure (stress) | Coughing, sneezing, laughing, lifting, jumping | Weakened pelvic floor and tissue around the urethra, after childbirth or at menopause |
| Cannot hold it (urge) | Sudden strong need to go, often not making it in time, waking at night | Overactive bladder |
| Mixed | Both patterns | Common at menopause |
Level 1: pelvic floor training done correctly
This is the first step for stress incontinence of every grade. It works in 60–70% of women when done correctly and consistently for 3 months. The problem is that half of women train the wrong muscle. I can check in the examination room whether you are squeezing correctly and how strong it is, and refer you to a specialist physiotherapist when training devices are needed.
Level 2: lifestyle changes
- Lose weight if you are overweight. Every 5 kilograms lost makes a clear difference
- Avoid caffeine and fizzy drinks
- Treat a chronic cough and constipation
- Urinate on a schedule. Do not hold on for long and do not go too often
Level 3: laser or RF
For mild to moderate stress incontinence where training alone is not enough. Laser strengthens the tissue around the urethra. 2–3 sessions, no surgery, no downtime. Results last a little over a year, then it is repeated. It does not help urge incontinence, which is treated with medication and bladder training.
Level 4: devices and surgery
A vaginal support device can be used during exercise. A mid-urethral sling operation is highly effective and permanent for moderate to severe cases. It is performed by a gynaecologist or urologist. I assess you and refer you on when this level is reached.
What does the assessment involve?
A history to identify the type, a pelvic exam to check muscle strength and look for prolapse, a urine test to rule out infection, and in some cases a 3-day bladder diary. Everything is done in a private room with a female doctor and takes 20–30 minutes.
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