Common, treatable, and not something to live with. Supervised pelvic floor physiotherapy is free and dramatically under-used.
Assessed and treated by a GMC-registered GP
Prescriptions, sick notes and referral letters included
A written treatment plan after every appointment
Your NHS records in the room, with your consent
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Urinary incontinence means leaking urine when you do not intend to. It affects a large proportion of women at some point, and a meaningful number of men — particularly after prostate surgery.
It is common, it is treatable, and it is not something to put up with. The average person waits several years before mentioning it, usually having concluded that it is an inevitable consequence of childbirth or age. Neither is true.
The single most useful thing on this page is that supervised pelvic floor muscle training — taught by a physiotherapist, done for at least three months — is first-line treatment and works. Not "do your pelvic floor exercises" as a passing remark, but a proper supervised programme. It is available free on the NHS, in many areas by self-referral, and it is dramatically under-used.
This page covers stress incontinence and the general picture. If your problem is a sudden urgent need you cannot defer, see overactive bladder, which is a different mechanism and a different treatment.
Both together, which is very common — and the usual approach is to treat whichever bothers you most first.
A dragging sensation or a bulge felt in the vagina suggests prolapse. Leaking during sex, which people very rarely raise and which is worth mentioning. Recurrent urine infections.
The history establishes the type, and the type determines the treatment. Leaking on coughing without warning is stress. A sudden urge then leaking is urgency. Both is mixed. Dribbling with poor emptying is overflow and is assessed differently.
Three days recording fluid intake, times, volumes passed and every leak with what you were doing at the time. It is the single most useful assessment tool, it is free, and it is skipped constantly. It also gives a baseline against which to measure whether treatment is working.
Urodynamic testing is not recommended before starting conservative treatment. It is for when surgery is being considered, or where the diagnosis is genuinely unclear.
Urinary infection, pelvic organ prolapse, prostate enlargement, constipation, diabetes, medication effects, neurological disease, and — rarely — a fistula, which should be considered where leaking is continuous rather than intermittent.
Incontinence assesses well remotely up to a point, because the type is established from the history and a bladder diary. What cannot be done on a screen is the examination for prolapse and the assessment of pelvic floor strength.
Started online, escalated to in-person assessment if it does not improve. For most people the first three months are conservative treatment that needs no examination at all.
Going straight to examination is not the faster route. UK guidance is explicit that conservative treatment comes first, and urodynamic testing is not recommended before it has been tried.
Examination for prolapse, assessment of pelvic floor contraction, a bladder scan, or a prostate examination. We will tell you clearly when that is the next step rather than working around it — and for most people that point comes after conservative treatment, not before it.
Two things go in person from the start: visible blood in the urine, and a palpable pelvic mass.
Seek urgent assessment for:
Seek prompt assessment for:
Book a routine consultation if: leaking is affecting what you do, you have been doing pelvic floor exercises without benefit, you have never been referred for supervised physiotherapy, or you want to understand the options before considering surgery.
This is the treatment. It is not an adjunct, and "do your pelvic floor exercises" is not instruction.
Do not stop exercising. A great many women give up running or the gym rather than mention leaking. Pelvic floor training plus the knack usually resolves it, and giving up activity has its own costs.
Do not restrict fluids to reduce leaking. It concentrates urine, irritates the bladder and makes urgency worse.
Do not rely on pads as a solution. They manage the symptom; they treat nothing.
Search for your local NHS pelvic health physiotherapy service before paying anyone for anything. That is the honest advice, and it is what we would tell you in the appointment.
This page follows NICE NG123 on urinary incontinence and pelvic organ prolapse in women, and NICE CG97 for lower urinary tract symptoms in men.
Following the Independent Medicines and Medical Devices Safety Review, use of transvaginal mesh for stress urinary incontinence has been subject to significant restriction in England. Anyone considering surgery should have a full and current discussion of what is available, what the alternatives are, and what the evidence shows — and should expect that conversation to happen in a specialist multidisciplinary setting.
Reviewed against NICE NG123 and CG97 current at the date shown above.
It is common after childbirth, but it is not something you have to accept. Pelvic floor training resolves or substantially improves it for most women.
The average wait before mentioning it is several years, which is the real problem.
Quite possibly not — a substantial proportion of people are not. The commonest error is bearing down instead of lifting, which makes things worse.
This is exactly why NICE recommends supervised training, and why a physiotherapist checking your technique is worth more than any amount of doing it alone.
At least three months of consistent daily training. Improvement is gradual and easy to miss without a diary.
Most people stop far too early.
Deliberately squeezing your pelvic floor immediately before you cough, sneeze, laugh or lift.
It works straight away, costs nothing, and is very rarely taught.
No. Concentrated urine irritates the bladder and makes things worse.
Drink normally, cut caffeine, and stop a few hours before bed if nights are the issue.
No, and please do not. Leaking with high-impact exercise is common and treatable.
Pelvic floor training plus the knack resolves it for most people — giving up the activity is the wrong trade.
Vaginal oestrogen can help urinary symptoms after the menopause. It acts locally, is different from systemic HRT, and carries none of the same risks.
It is significantly under-prescribed.
Surgery is effective for stress incontinence that has not responded to proper conservative treatment.
Transvaginal mesh use has been substantially restricted in England following a national safety review, and alternatives exist. Any decision should follow a full discussion in a specialist setting.
Yes. Male stress incontinence is most often related to prostate surgery, and pelvic floor rehabilitation is effective and frequently not arranged.
Dribbling with a poor stream is a different problem — usually prostate enlargement, which is assessed separately.
August 30, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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