Urinary incontinence: best treatments to fix bladder leakage

With the openness about women’s and vaginal health issues increasing by the day, it’s no surprise that searches for ‘bladder leakage’ and ‘urinary incontinence treatments’ are on the up. It’s something that as women, we have put up with for years, often thinking that the term ‘incontinence’ doesn’t apply to us because our pee leaks are a minor – but nevertheless daily – inconvenience. But consultant gynaecologist Miss Tania Adib says that bladder leakage, however small, in the medical world is classed as incontinence – and it always deserves treatment.

“It’s my big bugbear that we’ve normalised living with it,” she says. “You see rows and rows of Tena Lady pants and that’s just not OK in my book. As if you just have to put up with it – when in many cases, you don’t have to live with leaks.”

If you’re one of the millions of women who spring a small (or not so small) leak when you cough, laugh or run, or if you dice with death on your doorstep as you battle the sudden and overwhelming urge to pee (what our grandmothers called ‘latchkey incontinence’), there are minimally invasive procedures that can help.

So-called ‘vaginal rejuvenation treatments’ (although that’s often a misnomer as they in many cases treat the vulva, not the vagina) can have a profound impact on urinary incontinence and can step in to fill the gaps in what’s available on the NHS.

They involve tech and techniques such as radiofrequency and even injectables, all aimed at supporting the bladder. Terrifying as that sounds (and yes, some GTG writers have tried them), it’s perhaps unsurprising that many mid-life women who aren’t shy of having facial tweakments are now seeking out similar solutions for their vulvas.

I’ve rounded up some of the options below. I’ll also delve into what the NHS offers for urinary incontinence and bladder leakage and what you can do at home. You don’t need to suffer in silence!

First, it’s key to know what type of urinary incontinence you have.

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What are the types of urinary incontinence or bladder leakage?

Apart from functional incontinence (when a physical or mental impairment stops you from making it to the loo in time) the main types of bladder leakage are:

• Stress incontinence: this is when there is physical stress on the bladder that causes a leak, such as sneezing or lifting something heavy.
• Urge incontinence: the sudden urge to pee. The body responds immediately to the bladder’s signal that you need to go, meaning you barely have time to make it to the toilet.
• Mixed incontinence: both stress and urge.
• Overflow incontinence: when you get frequent dribbling because the bladder doesn’t empty completely.

What causes urinary incontinence in the first place?

Stress and urge incontinence become more common with age, says Adib, while childbirth and menopause are also contributing factors.

• If you’ve had a vaginal delivery

A vaginal birth can weaken the muscles that control the bladder and can damage supportive tissues. This can mean that your pelvic floor drops (it’s called prolapse) and that the bladder drops as well. The result is that it’s even harder for the muscles in the area to keep the urethra (urine tubes) closed, with leaks as a result.

• If you’re in menopause

We don’t just lose collagen more rapidly in our faces in menopause, when oestrogen goes into sharp decline – we lose it everywhere. The collagen and elastin in your vaginal wall normally cushion and support the bladder. When they deteriorate and the vaginal walls thin out, you have more trouble holding your pee in.

• Bladder nerve damage from childbirth

Childbirth can damage bladder nerves which can cause an overactive bladder and this can set off urge incontinence.

What does the NHS offer as a treatment for urinary incontinence?

The NHS will advise reducing fluid intake and stopping drinking alcohol and caffeine – cutting the latter does make a difference, GTG’s Victoria Woodhall, who has tried many of the treatments, has noted. They will also offer physiotherapy if you suffer from bladder leaks, and there’s prescription medication for urge incontinence (but with side effects, more on that below). HRT can help, too.

“But between that and surgery, there is nothing in their repertoire,” says Adib. So, unfortunately, for the many efficient procedures that can make a long-term difference, you’ll have to go private.

How do you choose the right treatment for incontinence?

In Adib’s view, if you suffer from bladder leaks, you should see a gynaecologist. They will take a detailed history and examine you, so they can determine precisely what is needed. “I will want to know when and how you leak, whether you have vaginal dryness or not, whether you’ve had children, and so forth,” says Adib.

The reason to see a pro is that you could be wasting your money on a tweakment that’s not right for you. For example, sessions on the trendy Emsella chair, which can help fix leaks caused by a weak pelvic floor and are done fully clothed and without the need for a doctor, are widely available in clinics such as the national chain Therapie and the Rita Rakus Clinic in London. They can be very effective, but Emsella is not the right option for everyone, says Adib: it might not be your pelvic floor muscles that are the problem.

“I’ll use a speculum so I can see the quality of the tissues, including how lax the vagina is,” Adib says. “It also allows me to see if the womb or the bladder has dropped.” She will then assess the strength of the pelvic floor, by the low-tech but effective method of inserting two fingers and getting you to squeeze.

“It means I can determine whether your pelvic muscles need strengthening, whether you need a collagen boost, or whether your bladder is overactive,” says Adib. Without a proper assessment, how can a doctor know this, and how can you know you’re not wasting your money?

Given that treatments are quite the investment, getting an examination certainly makes sense, especially as there are so many options to choose from.

What urinary incontinence treatments for women are there?

You certainly have options – both in-clinic and at home.

Tech treatments for incontinence

• Vaginal radiofrequency such as Emfemme and Ultrafemme

Good for: supporting and calming the bladder

Radiofrequency (RF) is good for collagen production. “Strengthening the front wall of the vagina this way supports the bladder, pushing it back up that little bit,” says Adib. “And that can really help with stress incontinence.”

It involves a dildo-like probe being inserted and moved in and out of the vagina; we highlighted it as one of the best tweakments for 2024. It’s painless as the heat is mild at about 42C (plus the inside of the vagina has no pain receptors). The new BTL Emfemme 360, and its earlier and more widely available incarnation the Ultrafemme, treat the entire inside of the vagina in just eight minutes. You need around three treatments. Emfemme is slightly more comfortable than Ultrafemme as it controls the delivery of the heat better, but in our experience, both are good.

RF also calms the bladder nerves (“somehow the heat has this effect,” says Adib, “although we’re not 100 per cent sure why”) and, as our GTG testers report anecdotally,  increases vaginal lubrication.

Price: Emfemme and Ultrafemme treatments start from £350 per session, but can be as much as £900.

• Vaginal laser (fractional Co2) such as MonaLisa Touch

Good for: collagen regeneration for vaginal dryness and bladder support

Just like laser on your face and body, a vaginal laser causes micro-damage in order to ramp up a healing ‘collagen remodelling response’ inside the vagina and at its entrance. Before you cross your legs, Miss Adib says they are only “tiny little micro-lacerations” that act “very superficially in the skin to trigger regeneration of collagen.”

You’ll need numbing cream on the vulva (the vagina has no pain receptors – otherwise we’d never be able to give birth). “You won’t feel any pain inside the vagina, but its entrance is often where the main issue is. The vulva has loads of nerve endings, being the second most sensitive part of the body,” explains Adib, who uses the Mona Lisa Touch, a fractional carbon dioxide laser.

She’s seen it help with incontinence for the same collagen-boosting reason that RF works, but most of the evidence is for increased lubrication. If you suffer from dryness as well as stress incontinence, she would likely treat you with the laser. “The laser is awesome for dryness; way better than RF,” she says. “If the vagina is dry, this is going to affect the bladder (think of a dry sponge versus a wet sponge), so good lubrication is important.”

Laser, however, doesn’t help with urge incontinence.

Choose a very experienced gynaecologist for this treatment as you don’t want to accidentally suffer burns and lose sensation. MonaLisa Touch treatments take as little as five minutes, three are needed initially, followed by single maintenance treatments every year or so. Results can be noticeable after just one session, but 90 per cent of patients notice results after three.

Price: Adib charges £1800 for a course of three treatments and £650 for a single one.

• High-Intensity Focused Electromagnetic Technology (HIFEM): BTL Emsella Chair

Good for: pelvic floor toning

If Adib’s ‘two-finger test’ shows that your pelvic floor muscle strength leaves a lot to be desired and is at least part-responsible for leakage, the Emsella chair could come into its own. A pelvic floor-toning device that you sit on fully clothed, it delivers the equivalent of 11,000 Kegels or pelvic floor contractions in one half-hour session. Typically, you need four to six sessions, a few days apart, over which the intensity can be slowly ramped up.

The involuntary vaginal muscle contractions feel very bizarre but certainly not painful, and Emsella says 95 per cent of users report an improved quality of life. GTG’s Victoria Woodhall, an avowed fan, said her “pelvic floor has never been better” after a series of sessions. She rates it in combination with radiofrequency. “The Emsella Chair worked to stem my leaks in my late 40s, but as I got into menopause, the next course was less effective. Miss Adib examined me and suggested I try Ultrafemme vaginal RF as well, as she could see that collagen loss was my issue. The combination of both worked better.”

Price: A course of six sessions costs £690, or £792 for eight, at Therapie Clinics.

Vaginal PRP: (platelet-rich plasma injections)

Good for: stress incontinence

Adib really rates PRP for stress incontinence. A small amount of your blood is put in a centrifuge (this takes a few minutes) to separate the plasma, which is rich in regenerative platelets and growth factors. These are then injected into the vagina to “bulk and strengthen the collagen around the urethra to keep them strong,” says Adib. It’s particularly good in combination with RF treatments, she says, “Many women come back for their jabs every year. Numbing injections included!”

Price: RRP costs from £1150 with Dr Tania Adib. Typically one session will last a year.

• Vaginal hyaluronic acid fillers and skin boosters – Desirial

Good for: dryness

You’ve probably heard of Profhilo, the injectable collagen-stimulating skin booster made of hyaluronic acid. There’s something very similar called Desirial (we didn’t name it!) licensed for the opening of the vagina (the ‘vulvovaginal area’) to restore moisture, tone and tautness. “When it’s injected around the entrance of the vagina, it spreads throughout to hydrate the tissues inside as well,” says Adib. She feels it’s an excellent option if you don’t want laser or hormones (see below). “I inject some on the outside as well for extra moisture and comfort,” she says. As said, dryness affects bladder function, so increased lubrication is one way to help with leaks. It’s a very quick treatment, and a topical numbing cream is used to make it comfortable.

Desirial (a hydrator)is not to be confused with Desirial Plus, which is a thick filler designed to plump up thinning labia majora (it’s also called ‘Desirial Labial Puff Treatment’) for overall cushioning and protection of the labia minora.

Price: Desirial costs from £500 and lasts six to nine months.

What about bladder Botox or vagina Botox?

Good for: overactive bladder, urge incontinence, vaginismus

When you read about ‘vagina Botox’, in most cases this is actually about the vaginal fillers and moisturising injections mentioned above (people often confuse Botox and fillers). “Toxin injections are not something that would work for stress incontinence and they’re not something I would use,” says Adib. Toxin in the vagina is however used to treat a condition called vaginismus.

That said, Adib says urologists do use bladder toxin for an overactive bladder and urge incontinence: “it could calm the nerves down,” she says. The treatment is described as stopping the bladder wall muscle from contracting (squeezing) too much, reducing the constant urge to pee.

Price: Treatments cost from £500, can take three days to three weeks to work, and last three to six months.

At-home treatments for urinary incontinence

Pelvic floor exercises

Good for: stress incontinence due to weak pelvic muscles

Good old pelvic floor exercises will make a difference if your problem is muscle tone-related and if you’re consistent with them. “A vaginal moisturiser could help a little too”, says Adib, for the dryness aspect that can contribute to leaks. (We’ve rounded up the best vaginal lubes and moisturisers for menopause for you).

LED therapy for the vagina

Good for: stress and urge incontinence

A 2019 study showed that red LED therapy (PMBT or photobiomodulation) was effective for treating GSM (genitourinary syndrome of menopause: the menopausal symptoms of the vulva, vagina and bladder) and stress incontinence. The device used was the Joylux, available in the UK as the Issviva x Joylux Vaginal Rejuvenation Device, £299, which scooped Bronze in the 2023 Get The Gloss Wellness Awards.

It emits sonic vibrations, gentle heat (at 40 to 42 degrees) and red LED light, which together promise to boost collagen in the vagina, so improving lubrication and building protection against leaks in the case of both stress and urge incontinence. “Yes, professional LED would mildly help regenerate tissues, so it’s worth investigating,” says Adib. “But the kind of energy used for a home device is going be far lower than that in a clinic, and you would really have to use it every day, and consistently, to see results.”

The Joylux is recommended for use for ten minutes every other day, inserted into the vagina “while you lie back and relax” like, well, any vibrator.

Supplements for bladder leaks

Any nutrients that help the tissues stay supple and hydrated should be of some help, so Adib can see the point of things like omega-7 and sea buckthorn oils (try Pharma Nord Omega 7 Sea Buckthorn Oil , £22.95) taken as oral supplements. They help with dry eyes and a dry mouth too.

Bladder support supplements are available featuring pumpkin seed and soy germ extracts – these were shown in a clinical study to help with urge incontinence and get you through the night. Try Healthspan Bladder Support with Go-Less, £21.99, or Jude, £36, but Adib does not support their use as she doesn’t think them particularly effective.

Urinary incontinence medication options

• HRT for vaginal dryness

“Vaginal dryness is a sign that vaginal tissues are thinned-out and lacking collagen, resulting in a propensity for leaks,” says Adib. “So treating vaginal dryness is a starting point for tackling leaks.” This means, she says, that HRT can be a first port of call because it boosts oestrogen and therefore collagen production in the body. Sometimes your regular oestrogen daily gel is sufficient, but for some women who take HRT, it doesn’t reach the vaginal tissues. “So rather than up your daily dose of systemic oestrogen, I would give you vaginal oestrogen or vaginal DHEA  to use alongside your daily HRT,” says Adib.

Vaginal oestrogen pessaries or creams are available on the NHS and the brand Gina has recently become available at pharmacies without prescription. But it’s not effective for all women, says Adib, because “The vulva has mainly testosterone receptors, so oestrogen doesn’t always work.” As an alternative hormone, she can prescribe DHEA (Intrarosa). It’s available on the NHS, but not all GPs will prescribe it.

• Prescription medication
• for urinary incontinence

Oral medications for urge incontinence are available on the NHS, says Adib: Solifenacin and Mirabegron are examples. But they come with side effects, including constipation and a dry mouth, and “some are associated with a higher risk of dementia,” she cautions.

• What does surgery for urinary incontinence involve?

“You can do all kinds of surgery, including techniques that pull the bladder up, or narrow the vagina. In serious cases, these can make all the difference and last a considerable amount of time, if not forever,” says Adib.

• Can you fix urinary incontinence permanently?

Surgery is the most “permanent” solution, although “many surgeries only last ten years and then you have to do it again,” says Adib. The ‘techie’ solutions such as RF and PRP will have to be repeated every year.

Which doctors do you recommend for treating urinary incontinence?

Here are three top intimate female health doctors to try:

• Consultant gynaecologist Miss Tania Adib is based at The Medical Chambers Kensington and specialises in menopausal issues and bespoke treatment plans for vaginal health. She offers the gamut of vaginal health treatments, from HRT to laser, RF and injectables.
• Dr Galyna Selezneva is an aesthetic doctor with a background in both gynaecology and psychiatry, and has an excellent bedside manner to put patients at ease. She practices out of Knightsbridge’s Rita Rakus clinic and offers a free consultation to determine a treatment plan; she’s a whizz with the Emfemme 360, the Emsella chair and injectable hydrating boosters. Book in for a free consultation.
• Dr Shirin Lakhani is an aesthetic doctor and GP with a background in urology. She’s based in Kent and London and specialises in sexual rejuvenation for women and men; she performed radiofrequency vaginal remodelling on a patient live on
• This Morning.
• The offers the Ultrafemme 360, PRP and Emsella Chair and many other intimate health treatments.