Urinary Incontinence in Women & Men | Dr. Theodore Cisu

The short answer: Urinary incontinence means leaking urine when you don't mean to. It is common in both women and men, and it can almost always be improved. The main types are stress leakage (with coughing, sneezing or exercise), urge leakage (a sudden need to go) and a mix of both. Treatment usually starts simple, with pelvic floor therapy and habit changes, and moves to medicines or procedures if needed.

Written by Theodore Cisu, MD, board-certified urologist. Based on the AUA/SUFU guideline on surgical treatment of female stress urinary incontinence (2023 amendment) and the AUA/GURS/SUFU guideline on incontinence after prostate treatment (2024 amendment). Last reviewed November 2026.

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What is urinary incontinence?

Incontinence is any leakage of urine you can't control. It can be a few drops when you laugh or a full loss of bladder control. Many people wait years before bringing it up because they feel embarrassed or think it's just part of getting older. It is a medical problem with real treatments, and you don't have to simply live with it.

Types of urinary incontinence

Stress incontinence

Leakage happens with pressure on the bladder: coughing, sneezing, laughing, lifting, running or jumping. It happens when the muscles and tissues that support the urethra are weak. In women it is often linked to pregnancy, childbirth, menopause or extra weight. In men it most often follows prostate surgery.

Urge incontinence

You feel a sudden, strong need to urinate and can't make it to the bathroom in time. It is part of overactive bladder. Learn more in our article on overactive bladder.

Mixed incontinence

Many people, especially women, have both stress and urge leakage. Treatment usually starts with whichever type bothers you most.

Other types

Overflow leakage happens when the bladder doesn't empty well, such as with a blocked prostate or weak bladder muscle. Some people leak because of trouble getting to the toilet due to mobility or memory problems.

Incontinence after prostate surgery or radiation

Leakage is common right after a radical prostatectomy for prostate cancer. The AUA guideline notes that it usually gets better over time, often returning close to normal within about a year, though some men need more treatment. Leakage can also happen after radiation or after surgery for an enlarged prostate. Some men also notice leakage during sexual activity, which can be treated too.

Pelvic floor muscle exercises, started right after surgery, are the first step. They may also be offered before surgery. If bothersome stress leakage isn't improving, surgery may be considered as early as 6 months. If it is still a problem at 1 year despite exercises, the guideline recommends offering surgery.

How is incontinence evaluated?

Most people need only a few simple steps:

• Your history: when you leak, how much, and how much it bothers you
• A bladder diary: a few days of tracking fluids, bathroom trips and leaks
• A physical exam: for women this includes a pelvic exam, often with a cough test when the bladder is full
• A urine test to check for infection or blood
• A bladder scan after you urinate to see how well your bladder empties

Some people need more testing, such as urodynamics (a test of how the bladder fills and empties) or cystoscopy (a look inside the bladder with a thin camera). For women considering a first surgery for clear stress leakage, the AUA says urodynamics can often be skipped. For men, the guideline calls for cystoscopy before stress incontinence surgery to check the urethra and bladder.

Treatment options

Treatment follows a step-by-step ladder. How much the leakage bothers you is a big part of deciding how far up the ladder to go.

1. Habit and lifestyle changes

• Spread fluids through the day and cut back in the evening
• Limit caffeine, alcohol and fizzy drinks if they make symptoms worse
• Go on a schedule before your bladder feels urgent
• Treat constipation and a chronic cough
• Lose weight if you are carrying extra, which can reduce stress leakage

2. Pelvic floor muscle therapy

Pelvic floor exercises strengthen the muscles that support the bladder and urethra. Working with a pelvic floor physical therapist, sometimes with biofeedback, helps you find and train the right muscles. It is low risk and helps many people with stress, urge or mixed leakage.

3. Devices for women

A pessary or vaginal insert supports the urethra and can reduce stress leakage during exercise or daily life. Your urologist can discuss whether one might help, and Dr. Cisu can coordinate a referral for a pessary fitting.

4. Medications

Medicines mainly help urge leakage by calming the bladder. They do little for stress leakage. See our overactive bladder article for these options.

5. Procedures for stress leakage in women

If simpler steps aren't enough, the AUA guideline says women considering a first surgery should be counseled about four main options:

• Midurethral sling: a narrow strip of mesh placed under the urethra to support it. Before choosing one, you should hear about its benefits and mesh-related risks and about non-mesh options.
• Autologous fascial sling: a sling made from your own tissue
• Burch colposuspension: stitches that lift the tissue next to the urethra
• Bulking agents: material injected around the urethra in a short procedure. They are less invasive and generally less effective than surgery.

6. Procedures for men after prostate treatment

• Artificial urinary sphincter: an implanted inflatable cuff around the urethra, controlled by a small pump in the scrotum. The AUA says it should be discussed for mild to severe leakage, and it is the preferred option after radiation. It requires the ability to work the pump, and repeat surgery over the years is common.
• Male sling: supports the urethra and should be discussed for mild to moderate leakage. It isn't routinely used for severe leakage.
• Adjustable balloons: may be offered to men who have not had radiation.
• Bulking agents: the guideline notes they work poorly in men and rarely cure leakage.

Your urologist can discuss whether any of these procedures fit your situation. Dr. Cisu performs sling surgery and bulking agent procedures at Augusta Health. If an artificial urinary sphincter is the better fit, he can coordinate referral to a surgeon who focuses on it.

When to see a urologist

• Leakage that bothers you or changes what you do
• Leakage that continues several months after prostate surgery
• Leakage along with blood in the urine, pain or repeated urinary infections
• A feeling that your bladder never empties

When it's an emergency

Go to the emergency room if you suddenly can't urinate at all, or if new leakage comes with back pain, leg weakness, or numbness in the groin or inner thighs.

Seeing Dr. Cisu for urinary leakage

Many incontinence visits can start by telehealth from anywhere in Virginia. Our office can request your records, prior tests and imaging so Dr. Cisu reviews them before you talk. Second opinions are welcome, including after prostate surgery done elsewhere. In-person exams are available at our clinics in Charlottesville and Fishersville, and no referral is needed. Book an appointment.

Frequently asked questions

Is leaking urine a normal part of aging?

It is common as people get older, but it isn't something you have to accept. Most people can improve with the right treatment.

Do Kegel exercises really work?

Yes, for many people. Pelvic floor exercises help most when done correctly and regularly for several months. A pelvic floor physical therapist can make sure you're using the right muscles.

How long does leakage last after prostate surgery?

It varies. Leakage usually improves over the first year, and many men return close to normal. If it is still bothersome at 6 to 12 months despite exercises, talk with your urologist about other treatments.

What is the difference between stress and urge incontinence?

Stress incontinence is leakage with pressure, like a cough or sneeze. Urge incontinence is leakage after a sudden, strong need to go. Many people have some of both.

Is a mesh sling safe?

Midurethral slings are a well-studied option for stress leakage in women. Like any surgery, they carry risks, including mesh-specific problems. The AUA recommends discussing these and non-mesh alternatives before you decide.

Can incontinence be treated without surgery?

Often, yes. Pelvic floor therapy, habit changes, devices and medicines help many people enough that they never need a procedure.

Sources

• American Urological Association. Surgical Treatment of Female Stress Urinary Incontinence: AUA/SUFU Guideline (2017; amended 2023).
• American Urological Association. Incontinence after Prostate Treatment: AUA/GURS/SUFU Guideline Amendment (2024).

This article is for general education and isn't a substitute for medical advice. If you suddenly can't urinate, or have new leakage with back pain, leg weakness or numbness, call 911 or go to the nearest emergency room.