SPECIALIST CONTINENCE & PELVIC FLOOR CARE
Leakage can interrupt exercise, work, intimacy or a simple trip out. Understanding when it happens helps me choose treatment that gives you more control and fits the life you want to lead.
Emergency care now: sudden inability to pass urine with a painful, full bladder; or new bladder/bowel control changes with leg weakness or numbness around the genitals or anus, particularly with back pain.
Same-day advice: fever, shivering or side/back pain with urinary symptoms, feeling very unwell, or a painful, stuck prolapse. Visible blood needs prompt assessment, even once. New continuous leakage, especially after childbirth or pelvic surgery, needs early specialist review.
RECOGNISE THE PATTERN
These examples help describe your symptoms. Your assessment confirms the cause; more than one pattern can occur together.
“I leak when I cough or run.”
A rise in pressure overcomes the closure or support of the urethra—the tube carrying urine out. “Stress” here means physical pressure.
Treatment aimImprove closure and support.
See stress-leakage treatments“The urge comes and I cannot wait.”
A sudden, difficult-to-delay urge is followed by leakage. You may also pass urine often or wake at night.
Treatment aimImprove bladder storage and control.
See urgency treatments“Both kinds happen to me.”
You leak with effort and with urgency. We identify which matters most to you and make a plan for both.
Treatment aimAddress each part and review the response.
See how I plan combined careDribbling, a weak stream or constant wetness? These need their own assessment. Incomplete emptying can cause leakage; continuous leakage may have another cause. Difficulty reaching the toilet because of mobility or access also matters. You do not need to diagnose yourself before booking.
YOUR INDIVIDUAL PLAN
My continence and reconstructive expertise is especially useful when leakage overlaps with prolapse, poor emptying or previous surgery. I assess whether a continence procedure, pelvic support reconstruction or revision is appropriate, and whether treatments are best combined or staged separately.
Rehabilitation, medicines, a procedure or tailored reconstruction—with clear goals and a review of your progress.
Illustrative examples; your findings may lead to different choices.
I check the leakage pattern, urethral support and emptying. If stress leakage is confirmed, we compare bulking and continence operations around your goals, recovery needs and preferences about mesh.
I review the previous procedure and reassess support and emptying. We may treat urgency separately, address a support problem or consider revision if the findings justify it.
With mixed leakage, a stress-leakage operation targets cough or exercise leaks. Urgency may still need separate treatment. We agree what each part of the plan should improve.
PROCEDURES & SURGERY
We can discuss the full range at your first visit. A procedure may help when suitable non-surgical care has not helped enough or does not suit you.
FOR COUGH OR EXERCISE LEAKS
Suitability depends on your assessment. Continence operations can also cause difficult emptying, new urgency, infection or pain. We discuss the benefits and risks of your chosen procedure.
Compare continence procedures and recoveryFOR SUDDEN-URGE LEAKS
YOUR SPECIALIST CONSULTATION
We discuss triggers, urgency, emptying, bowel symptoms, childbirth and previous operations. Tell me what you want to return to, and about any future pregnancy plans. A three-day bladder diary can reveal patterns.
A pelvic examination can assess support, tissues and muscle function; a cough test may show stress leakage. Urine testing and a scan of urine left after emptying help identify contributing problems.
I use perineal ultrasound when it adds useful pelvic floor information. Urodynamics measures bladder filling and emptying and can help when symptoms are unclear, emptying is difficult or previous surgery affects planning.
Not everyone needs urodynamics before treatment or straightforward stress-leakage surgery. We discuss why any extra test is useful. Examination is with your consent; you can request a chaperone and pause or stop at any time.
EVERYDAY TREATMENT & SUPPORT
Supervised training is usually offered for at least three months for stress or mixed leakage. Treatment may develop strength, timing or relaxation and coordination, depending on examination.
For urgency or mixed leakage, supported practice over at least six weeks can help you respond to an urge and gradually space toilet visits.
Urgency-control strategiesA fitted vaginal support device can help selected patients with stress leakage, including during exercise. Comfort, fit and a care plan matter.
Pessary supportWe tailor fluid and caffeine advice, address cough or constipation, and consider menopause-related tissue symptoms. Avoid severe fluid restriction. Pads and skin care can help while treatment takes effect.
At review, we look at leaks, urgency, pad use and the activities you can manage. If progress is limited, we reconsider the diagnosis and discuss a different or additional treatment.
PREPARE FOR YOUR VISIT
If possible, record three usual days and nights. Bring your medicine list, previous results and operation details, plus what helped or caused problems. An incomplete diary is still useful; you can book without one.
Back to contentsCOMMON QUESTIONS
No. The consultation helps you understand the diagnosis and compare suitable choices. You can ask about surgery early without committing to an operation.
Sometimes symptoms improve together, but this is not predictable. A stress-leakage procedure and urgency treatment have different aims. With mixed leakage, we prioritise what bothers you most and plan follow-up for both.
Bring the operation report if available. I reassess the leakage pattern, support and emptying before recommending further treatment. Revision or another procedure may help selected patients; the original operation is not automatically repeated.
We aim to help you stay active. Adjust activities that trigger bothersome leaks while we build a plan. Physiotherapy, a support device or a procedure may help you return to your preferred exercise.
Some bladder injections or continence operations can make emptying difficult. Before treatment, we discuss your risk, how emptying will be checked and what temporary catheter support would involve.
It is common, but help is available. Your symptoms, preferences and health guide what is worthwhile. Even when complete dryness is not achievable, reducing leaks and improving daily life can be useful goals.
YOUR NEXT STEP
We can discuss what is driving the leaks, which options fit your priorities, and how we will judge improvement.
Reviewed by Dr Jan Adlam · 22 October 2026.