Female Urology (Incontinence, Overactive Bladder, Pelvic Floor)
Urinary leakage is common but it is not normal, and it is treatable. The first requirement of the right treatment is establishing which type of leakage it is — because the right treatment applied to the wrong type does not work.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
Private Online Consultation
A private, one-to-one video consultation by appointment, without visiting the clinic. Especially for patients who value privacy.
- Procedure time
- Initial assessment 30–45 minutes
- Anesthesia
- Not required for assessment
- Hospital stay
- Day case – 1 night depending on procedure
- Stay in Türkiye
- 4–7 days
- Return to work
- A few days (strenuous activity deferred for weeks)
- Flight clearance
- After the review appointment
About the condition
Female urology covers the diagnosis and treatment of urinary leakage, overactive bladder, pelvic organ prolapse, recurrent urinary infections and difficulty emptying the bladder.
FIRST, PLAINLY: URINARY LEAKAGE IS NOT A NATURAL CONSEQUENCE OF AGEING. That it is common does not make it normal. Many women live with it for years without telling anyone, using pads, avoiding drinking and restricting their social lives. Yet most can achieve marked improvement without surgery.
THE FIRST REQUIREMENT OF TREATMENT IS ESTABLISHING THE TYPE. In stress incontinence, leakage occurs when abdominal pressure rises — coughing, laughing, lifting — with no preceding urge. In urgency incontinence, a sudden and irresistible need comes first and you cannot reach the toilet in time. This distinction is critical: drugs that relax the bladder do nothing for the stress type, and a sling operation does nothing for the urgency type.
A WARNING: BLOOD IN THE URINE IS NOT A SIMPLE LEAKAGE COMPLAINT. Blood in the urine must be investigated separately, even when it occurs alongside leakage. Equally, burning and frequency that persist despite treatment should not be dismissed as a "sensitive bladder".
A SECOND WARNING: IF THE BLADDER IS NOT EMPTYING, MEDICATION MAKES IT WORSE. Residual urine after voiding should therefore be measured before treatment is started. When this simple measurement is skipped, a well-intentioned prescription can do harm.
Who is it suitable for?
May be suitable
- Women who leak when coughing, laughing, sneezing or lifting
- Women who cannot reach the toilet because of sudden urgency
- Women who experience both types together
- Women waking repeatedly at night to pass urine
- Women describing pressure or heaviness from pelvic organ prolapse
- Women with recurrent urinary tract infections
- Women treated previously without benefit — often the problem is not the treatment but the type having been misidentified
May not be suitable
- Women with untreated urinary infection: this is treated first, as it can mimic all of these symptoms
- Women whose bladder does not empty completely: drugs that relax the bladder are not appropriate, and this is assessed first
- Women requesting surgery without assessment: an operation is not planned before the type is established
- Women planning further pregnancies, in whom the timing of prolapse and sling surgery is discussed separately
Technology used
- Bladder diary — a record of how often, how much and with what urgency; it yields more than expensive investigations
- Urinalysis and culture — to exclude infection
- Post-void residual measurement — a mandatory step before any decision about medication
- Urodynamics — in selected women, where the type is unclear
- Cystoscopy — where there is blood in the urine or an atypical picture
- Pelvic floor assessment and teaching of the correct muscle
- Minimally invasive sling surgery and pelvic floor repair
- Intravesical botulinum toxin and sacral neuromodulation
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Initial assessment
The type of your symptoms, your obstetric history, your medication and any previous investigations are reviewed. On request, the consultation is arranged with a female member of staff present.
- Preparation
Bladder diary
Over a few days you record when and how much you pass urine and how strong the urge was. This simple record is the most valuable tool for establishing the type, and it is also used to measure the effect of treatment.
- Day 1
Examination and tests
Examination, urinalysis and culture, post-void residual measurement. Urodynamics is arranged where needed.
- Decision stage
Establishing the type and the plan
The type of leakage is clarified and the appropriate step chosen. For most women the first step is not surgery.
- Day of procedure
Intervention, if required
Sling surgery, pelvic floor repair or intravesical botulinum toxin. Most are performed as a day case or with one night in hospital.
- Before you fly
Review
Whether the bladder empties properly after voiding is checked and flying clearance given.
Method comparison
| Criterion | Stress type | Urgency type | Overflow type |
|---|---|---|---|
| When leakage occurs | Coughing, laughing, lifting | After a sudden urge | Dribbling, more or less constant |
| Is there urge beforehand? | No | Yes, and it cannot be deferred | Unclear; a sense of incomplete emptying |
| First step | Pelvic floor exercises | Bladder training and fluid management | Finding what prevents emptying |
| Does medication help? | Bladder relaxants DO NOT help | Yes, as a second step | Bladder relaxants CAN BE HARMFUL |
| Surgical option | Sling | Botulinum toxin, neuromodulation | Relieving the obstruction |
The single purpose of this table is to show that the same sentence — "I leak urine" — leads to entirely different treatments. A treatment given without assessment may therefore achieve nothing, however well intended.
Risks
- THE RIGHT TREATMENT FOR THE WRONG TYPE: the greatest risk in this field is not a surgical complication but misidentification of the type. A sling performed for urgency incontinence does not help and leaves the patient believing her problem cannot be solved
- Temporary difficulty passing urine after sling surgery
- Urinary tract infection
- Pain, swelling and temporary discomfort
- Symptoms not resolving completely after surgery — particularly in mixed incontinence when only one component is treated
- After intravesical botulinum toxin, incomplete bladder emptying and a temporary need for self-catheterisation; this possibility must be discussed beforehand and the patient must be prepared for it
- Recurrence of symptoms over time, requiring further treatment
- Recurrence after prolapse repair
Alternatives
- Pelvic floor muscle exercises — effective provided the right muscle is used. The commonest error is tightening the abdomen, buttocks or thighs
- Bladder training — gradually lengthening the interval between visits to the toilet; the fundamental step in the urgency type
- Adjusting fluids and caffeine — severely restricting fluids is WRONG; it concentrates the urine and worsens symptoms
- Weight loss and treating constipation — measurable benefit by reducing abdominal pressure
- Drugs that relax the bladder — for the urgency type; in older women the choice of drug is made carefully with cognitive effects in mind
- Vaginal oestrogen — may reduce symptoms in selected postmenopausal women
- Pessary — a non-surgical option for prolapse
- Sling surgery — for the stress type when behavioural treatment is insufficient
- Intravesical botulinum toxin and sacral neuromodulation — for urgency incontinence unresponsive to medication
Recovery
During the exercise period
The first weeks of pelvic floor exercises are difficult and the difference is not immediate. Done correctly and consistently, the effect appears over weeks. Ask to be taught once, to be sure you are using the right muscle.
During bladder training
Intervals are lengthened gradually, not at once. The bladder diary lets you see progress, which sustains motivation.
First week after a sling
Mild discomfort and swelling are usual. Avoid lifting and straining; prevent constipation. Report any difficulty passing urine.
Weeks 2–6 after a sling
Light daily activity resumes within a few days; for strenuous activity and intercourse, follow the interval your surgeon gives you.
After botulinum toxin
The effect lasts some months and then wanes, so it needs repeating. Bladder emptying is checked in the early period.
Long term
If symptoms return, the cause is reassessed. Weight control, avoiding constipation and continuing the exercises all contribute to the durability of the result.
Frequently asked questions
Is urinary leakage a normal part of getting older?
No. That it is common does not make it normal. It is treatable, and most women achieve marked improvement without surgery. There is no need to spend years using pads and restricting your social life.
I was treated before and it did not help — is my problem unsolvable?
Before concluding that, ask whether the type was correctly identified. Giving a bladder relaxant for stress incontinence, or performing a sling for urgency incontinence, does not work. In that situation the problem lies not in your condition but in the treatment having been aimed at the wrong type.
What does the assessment involve — is it embarrassing?
It consists of listening to your symptoms, going through the bladder diary, a urine test and an examination. The examination is brief and every step is explained first. On request a female member of staff is present and a female medical interpreter provided; asking for this is a right, not a favour.
Do pelvic floor exercises really work?
Yes, provided the right muscle is used. The commonest error is tightening the abdomen, buttocks or thighs, which does not count as the exercise. Once the technique is taught correctly, the effect appears over weeks. Even where surgery is being considered, this step should not be skipped.
If I drink less, will I leak less?
No — the opposite. Drinking little concentrates the urine, irritates the bladder and increases urgency. The right approach is to spread fluids through the day and reduce them in the evening. Cutting down caffeine and fizzy drinks can help.
Is sling surgery permanent?
In appropriately selected women with stress incontinence it can give lasting improvement. In mixed incontinence, however, treating only the stress component may leave the urgency symptoms behind, and it matters that this was discussed beforehand. Be cautious of anyone promising a definitive and permanent result.
There is blood in my urine but my main problem is leakage — does it matter?
Yes, separately so. Blood in the urine must be investigated in its own right even when it occurs alongside leakage. Dismissing it as a "sensitive bladder" can delay a diagnosis.
Will I have to catheterise myself after bladder botulinum toxin?
In some women the bladder relaxes too much and does not empty fully, in which case temporary self-catheterisation may be needed. The likelihood is low but real, and it must be discussed beforehand. If you are not prepared or physically able to do it, this option may not suit you.
I am planning to have children — should I have surgery now?
If you are planning a pregnancy, say so. The timing of prolapse and sling surgery depends on it, and these are generally preferred after childbearing is complete. In the meantime, behavioural treatment and pelvic floor exercises come to the fore.
What should I send beforehand?
Any urodynamic study, your urinalysis and culture, your post-void residual measurement, your obstetric history, previous operations, a list of your medication, and a bladder diary covering a few days. The diary looks trivial but contributes more to the assessment than anything else.
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This page is for general information only and is not a substitute for medical advice.
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Treatments in this category
Overactive Bladder and Urgency Incontinence
A sudden, hard-to-defer need to pass urine, going frequently, and sometimes not getting there in time. Treatment is stepwise, and most women improve markedly without needing medication or surgery.
Learn moreStress Urinary Incontinence: the Treatment Options
Leaking urine when you cough, sneeze or exercise. The type has to be established first, and treatment should begin with the least invasive step — surgery is not the first option.
Learn moreTOT (Transobturator Tape) Surgery
Surgery for stress urinary incontinence — leaking when you cough, sneeze or lift — in which a narrow tape is placed beneath the urethra to restore its support.
Learn morePectopexy (Pelvic Organ Prolapse Surgery)
A laparoscopic repair for a descending uterus or vaginal vault in which the suspension is attached to the strong ligament on the side wall of the pelvis (the iliopectineal ligament).
Learn moreBladder Botox (Intradetrusor Botulinum Toxin)
Where medication is not enough in overactive bladder, botulinum toxin is injected into the bladder muscle through a cystoscope to reduce the involuntary contractions.
Learn more