Urinary incontinence is highly treatable, yet many Canadians suffer in silence or wait months—even years—for a public consultation.
This guide cuts through the confusion to explain the diagnosis, the conservative steps to try first, and the urinary incontinence surgery costs and options available if you decide to take control of your care.
1. Understanding the diagnosis: what is urinary incontinence?
Urinary incontinence is the involuntary loss of urine. It can be a few drops when you cough or laugh, or a strong, sudden urge that leads to a full bladder leak before you reach the bathroom.
It's important to remember that it is,
- Common, especially in older adults and people who have given birth or had prostate surgery
- Medical, not a personal failure, it is often related to muscles, nerves, or structural changes
- Treatable with a range of non-surgical and surgical options
Before fixing the leak, we have to know why the tap is dripping. There are five buckets of urinary incontinence.
1.1. Stress incontinence
You leak when you cough, sneeze, laugh, or lift something heavy. This is a plumbing issue—the valve (sphincter) or the support under the bladder is weak.
1.2. Urge incontinence (overactive bladder)
You get a sudden, uncontrollable urge to go, and you often can't make it in time. This is a wiring issue—the bladder squeezes when it shouldn't.
Note: Surgery is primarily used to fix Stress Incontinence (the plumbing issue).
1.3. Overflow incontinence
Your bladder doesn’t empty fully and it slowly overflows or dribbles. Imagine a sink where the drain is partially blocked or a pipe is kinked: fluid backs up because it can’t leave. Causes include obstruction (for example, prostate enlargement) or a weak pump that can’t push things through.
1.4. Mixed Incontinence
More than one problem in the system. You have features of both plumbing and wiring problems — for example, a loose valve plus an overactive pump. Mixed incontinence needs a combined approach: identify which issue is the main driver and treat accordingly.
1.5. Functional incontinence
The plumbing itself may be fine, but you can’t reach or use the bathroom in time because of mobility, cognitive, or environmental barriers. It’s like having a perfectly working sink but a blocked hallway or a locked door preventing access. Solutions focus on access and support (mobility aids, timed toileting, caregiver help), not on fixing pipes.
2. How is urinary incontinence diagnosed?
Your healthcare provider will start by understanding your symptoms and medical history, then may order tests to clarify what’s happening.
Typical steps include:
- Medical History and Symptom Discussion
- When you leak
- How often you urinate
- Any triggers, medications, or prior surgeries
- Bladder or Voiding Diary
- You track how much you drink, how often you urinate, and when leaks occur over several days.
- Physical Examination
- Pelvic exam for women
- Genital and prostate exam for men
- Assessment of pelvic floor muscle strength
- Urinalysis
- To rule out infection, blood, or other abnormalities.
- Post-Void Residual Measurement
- Ultrasound or catheter-based test to see how much urine remains after you void.
- Urodynamic Testing
- Specialized tests that measure bladder pressure, capacity, and how the sphincter muscles function. Often used if surgery is being considered.
- Cystoscopy
- A small camera is passed into the bladder to look for structural issues, if indicated.
Together, these steps help clarify what type of incontinence you have and which treatments are most likely to help.
3. Try conservative measures first
Most surgeons will recommend trying non-surgical options first for 3-6 months, as many patients improve without surgery.
3.1. Pelvic Floor Physiotherapy
This isn't just "doing Kegels." A specialized physiotherapist can teach you how to strengthen the muscles that act as the tap for your bladder.
- A trained pelvic health physiotherapist can:
- Assess strength and coordination
- Provide tailored exercise plans
- Use biofeedback (sensors and visual feedback)
- Offer electrical stimulation to help muscles contract
3.2. Lifestyle Changes
Reducing caffeine and alcohol (which irritate the bladder) and managing fluid intake can make a surprising difference.
Some studies show caffeine restriction reduces urinary frequency and incontinence episodes by 35-61%, particularly in women consuming >200-300mg per day.
3.3. Devices (For Women)
A pessary is a removable silicone ring inserted into the vagina to support the urethra. It’s simple, non-surgical, and effective for many.
If you’ve tried these and you're still planning your day around leaks, it may be time to look at surgical intervention.
4. Surgical options
If you've given conservative measures several months, and leakage is still interfering with your life, then it may be time to consider surgery.
Modern incontinence surgery is far less invasive than it used to be. Most procedures are designed to provide support to the urethra so it stays closed when you cough or move.
If you already know you would like to speak with a private surgeon, please consult our directory for vetted Canadian surgeons who specialize in urinary incontinence procedures.
4.1. For Women
Women experience urinary incontinence more often than men, largely due to pregnancy, childbirth, hormonal changes, and differences in anatomy.
Below are the main surgical options your specialist may discuss with you. Not every procedure is right for every patient; the “best” option depends on your type of incontinence, overall health, and personal preferences.
i. Midurethral sling (TVT / TOT and similar procedures)
Good for: Stress incontinence
A midurethral sling is one of the most common operations for stress urinary incontinence in women.
- How It Works
- A narrow strip of synthetic mesh or your own tissue is placed under the urethra like a hammock to provide support and prevent leakage during coughing, sneezing, or activity.
- Procedure Overview
- Minimally invasive
- Usually done under general or regional anesthesia
- Small incisions in the vagina and lower abdomen or groin
- Often same-day surgery
- Recovery
- Typically a few days of discomfort
- Avoid heavy lifting and strenuous activity for several weeks
- Most people return to normal daily activities within a couple of weeks
ii. Burch colposuspension (bladder neck suspension)
Good for: Stress incontinence, sometimes done alongside other pelvic surgeries
- How It Works
- Sutures are used to lift and support the tissues near the urethra and bladder neck, attaching them to ligaments or the pelvic bone.
- Procedure Overview
- Can be done via open or laparoscopic (keyhole) surgery
- Often performed if you are already having abdominal surgery for another condition (e.g., prolapse)
- Recovery
- Longer recovery than a sling (several weeks)
- Hospital stay may be required
iii. Pubovaginal sling (autologous fascial sling)
Good for: Stress incontinence, particularly in more complex cases or when synthetic mesh is not desired
- How It Works
- A strip of your own tissue (often from the abdominal fascia) is used to create a sling under the urethra.
- Procedure Overview
- Involves an additional incision to harvest the tissue
- No synthetic mesh used
- Recovery
- May be longer and more uncomfortable initially because of the extra incision
- Similar activity restrictions as other sling procedures
iv. Urethral bulking agents (injections)
Good for: Mild stress incontinence, or patients who are not candidates for more invasive surgery
- How It Works
- A bulking material is injected around the urethra to help it close more tightly and reduce leakage.
- Procedure Overview
- Typically an outpatient procedure
- Done under local anesthesia or light sedation
- Often quick, with minimal downtime
- Recovery
- Most people resume normal activities within a day or two
- Effects can wear off, so repeat injections may be needed
v. Botox Injections (OnabotulinumtoxinA)
Good for: Overactive bladder/urge incontinence that has not responded to medications
- How It Works
- Botox is injected into the bladder muscle via a cystoscope to reduce overactivity and urgency.
- Procedure Overview
- Outpatient procedure
- Done under local anesthesia, light sedation, or short general anesthesia
- Multiple small injections inside the bladder wall
- Recovery
- Mild burning or blood in urine for a short time is possible
- Effect typically lasts several months (commonly 6–9 months)
- Repeat treatments are needed to maintain benefit
4.2. For Men
In men, urinary incontinence often follows prostate surgery (such as prostatectomy for cancer), or may be related to prostate enlargement or neurological conditions.
Here are the key surgical options commonly considered.
i. Male sling
Good for: Mild to moderate stress incontinence, often after prostate surgery
- How It Works
- A synthetic sling is placed under the urethra to reposition and support it, increasing resistance to leakage during activity.
- Procedure Overview
- Performed under general or regional anesthesia
- Incision between the scrotum and anus, sometimes with additional small incisions
- Typically outpatient or short hospital stay
- Recovery
- Discomfort in the groin/perineal area for a couple of weeks
- Avoid heavy lifting and vigorous activity per your surgeon’s guidance
ii. Artificial urinary sphincter (AUS)
Good for: Moderate to severe stress incontinence, especially after prostatectomy
The artificial urinary sphincter is considered the standard surgical option for severe male stress incontinence.
- How It Works
- A small, fluid-filled cuff is placed around the urethra. A pump is placed in the scrotum, and a reservoir is placed in the abdomen. The system allows you to control urine flow by squeezing the pump to temporarily deflate the cuff.
- Procedure Overview
- Performed under anesthesia
- Involves a few small incisions to place the components
- The device is usually activated several weeks after surgery once tissues heal
- Recovery
- Soreness and swelling in the groin and scrotum initially
- Learning how to operate the device is part of follow-up care
iii. Urethral bulking agents (Injections)
Good for: Selected men with mild leakage or those unable or unwilling to undergo more invasive surgery
- How It Works
- Bulking material is injected around the urethra to improve closure.
- Procedure Overview
- Outpatient
- Usually under local anesthesia or light sedation
- Recovery
- Short downtime
- Effects are often temporary, and repeat injections may be needed
v. Botox injections (OnabotulinumtoxinA)
Good for: Men with overactive bladder/urge incontinence not controlled by medication
- How It Works
- Botox temporarily relaxes the bladder muscle to reduce uncontrolled contractions.
- Procedure and Recovery
- Short cystoscopic procedure
- Repeat injections required periodically.
5. Urinary Incontinence surgery cost
This is the question on everyone’s mind. In Canada, you generally have two paths, and each has a different "cost."
5.1. The public path
- Financial Cost: $0 (Fully covered by provincial health plans).
- The Hidden Cost: Time. The wait to see a specialist can take 6–12 months, followed by another 6–18 months on a surgical waitlist.
5.2. What's covered under insurance in Canada, what's not?
Navigating coverage can be confusing. In Canada, the general rule for public healthcare (provincial plans like OHIP, MSP, or AHCIP) is that they cover the service (the surgeon’s time and the hospital facilities), but they don’t always cover the supplies or medications used during that service.
Here is how the specific procedures typically break down when performed in a public hospital setting:
i. Fully covered procedures
For these major structural surgeries, the provincial health plan typically covers 100% of the cost. This includes the surgeon’s fee, the hospital stay, anesthesia, and the implant or mesh itself.
- Mid-urethral sling (TVT/TOT)
- Burch colposuspension
- Autologous fascial sling
ii. Partially covered procedures (doctor’s fee only)
For injection-based treatments, the province usually pays the doctor for the act of performing the procedure, but they generally do not pay for the substance being injected. You are essentially "buying the product" and the doctor is installing it for free.
- Urethral bulking injections (e.g., Bulkamid): The procedure to inject the agent is covered, but the cost of the bulking hydrogel is often the patient's responsibility.
- Bladder Botox injections: The cystoscopy and injection procedure are covered, but the cost of the Botox medication itself is usually charged to the patient.
Note: If you have private health insurance (e.g., through an employer), it will often cover the cost of the Botox or Bulkamid gel under your prescription drug or medical device plan.
5.3. The private path
If you choose a private clinic, you are paying for immediate access, choice of surgeon, and potentially advanced technology.
Note: These are estimates. Prices include surgeon fees, facility costs, anesthesia, and follow-up care.
Note: These are estimates. Prices include surgeon fees, facility costs, anesthesia, and follow-up care.
6. Conclusion: reclaiming your agency
You do not have to accept incontinence as a normal part of aging. Whether you choose to wait for the public system or invest in private care, the most important step is knowing that solutions exist.
If the public wait times are affecting your quality of life, you have the right to explore other options.
Ready to find a solution?
Check the Surgency Directory to find accredited Canadian surgeons who can help you get back to living your life—confident and worry-free.
