Roughly one in three women experiences bladder leakage at some point, and most wait years before mentioning it — usually because they were told it was a normal part of having children or getting older. It is common. That is not the same as being something you have to live with.
This matters more than anything else on this page, because the two types respond to almost opposite treatments. Treating the wrong one is the most common reason women decide “nothing works”.
Stress incontinence — you leak when pressure rises: coughing, sneezing, laughing, lifting, running, jumping. There is no warning and usually no urge. The amount is often small. The problem is support and closure, not the bladder itself.
Urge incontinence — you get a sudden, strong need to go and cannot reliably hold it. Often triggered by a key in the door, running water, or cold. You may go very frequently and wake at night. The problem is the bladder muscle contracting when it should be quiet.
Mixed — both, in some proportion. This is common, and the assessment is partly about working out which one is dominant, because that decides what to treat first.
If you are not sure which you have, that is a normal answer and not a problem. A bladder diary over three days usually settles it.
Not sure this is your symptom? →Supervised pelvic floor muscle training is the first-line treatment for stress incontinence in essentially every international guideline, and it is the option most often skipped — because it is unglamorous and takes months rather than weeks.
The word doing the work there is supervised. A large proportion of women doing Kegels from memory or from an app are contracting the wrong muscles, or bearing down, which makes things worse. Being taught the contraction and having it checked is the difference between the treatment working and the treatment being blamed.
Expect to give it around three months of consistent daily practice before judging it. That is genuinely slow, and we would rather say so than have you stop at week three and conclude it failed.
Bladder training is the equivalent first step for urge incontinence: scheduled voiding with gradually lengthened intervals, plus identifying triggers. Reducing caffeine helps some women noticeably and others not at all.
Do not restrict fluids. It is the most common self-treatment and it backfires — concentrated urine irritates the bladder and makes urgency worse.
Where first-line treatment has been given a fair attempt and has not been enough, there are in-clinic options that do not involve surgery. Which is appropriate depends on your type, your examination findings and whether you have prolapse alongside — not on which is newest.
Pelvic floor stimulation — a device-assisted way of producing contractions for women who cannot yet isolate the muscle voluntarily. It is a way into training, not a replacement for it; the training still has to happen.
Vaginal laser and energy-based devices — sometimes offered for mild stress incontinence, particularly around menopause when tissue changes are part of the picture. The evidence here is more limited than the marketing suggests, and we will tell you so in the room. It is not an alternative to surgery for moderate or severe leakage.
Pessary or continence device — a support fitted vaginally, useful if leakage is mainly during specific activity such as running, or if you want to delay surgery.
Who these do not suit: anyone with pure urge incontinence — support devices and tissue treatments address closure, not an overactive bladder muscle. Also anyone with significant prolapse that has not been assessed, because the prolapse usually needs addressing first or alongside.
Any treatment is quoted after the assessment, not before. Nobody can price this honestly without examining you, and a quote given before an examination is a sales figure.
If there is a bulge as well →For moderate to severe stress incontinence that has not responded to properly supervised training, surgery is the option with the strongest long-term track record. A mid-urethral sling is the most commonly performed procedure internationally; colposuspension and autologous fascial sling are alternatives, and which is appropriate is a real discussion rather than a default.
Mesh has been the subject of serious safety concerns and regulatory action in several countries. You are entitled to a full conversation about material, alternatives, and what is and is not known about long-term outcomes. If a clinic does not raise this with you unprompted, that is informative.
Surgery is not the answer for urge incontinence. This is worth stating plainly: operating on a bladder that is contracting when it should not will not stop it contracting, and can leave you worse. Urge incontinence is treated with bladder training, medication, and other bladder-directed options.
We would also rather not operate on someone who has not genuinely tried supervised training, who is planning further pregnancies, or who has an untreated urinary tract infection or significant constipation — each changes the picture.
A history of when and how you leak, a bladder diary if you have kept one, and an examination — including assessing your pelvic floor contraction and checking for prolapse, since the two travel together frequently enough that finding one means looking for the other.
A urine test to exclude infection, because a UTI can produce exactly these symptoms and is treated completely differently. Sometimes a post-void residual measurement. More detailed bladder-function testing is only done where it would change the plan.
You leave with the type, the severity, the options, and what each would involve. Nothing is decided in the room if you would rather go away and think, and we would rather you did.
Consultation ฿1,500–3,000 depending on the complexity of your case, plus a ฿300 clinic service fee. Treatment is quoted separately after the assessment.
You will see a female specialist if you would prefer one. Consultations are conducted in English or Thai.
Which doctor would see you →No residency, referral or Thai insurance is needed. The assessment is a single appointment, so it fits inside a trip — and knowing your type and your options is worth having even if you decide to be treated at home.
A pessary fitting or starting supervised training can be done on the same trip. Surgery is not something to arrange around a return flight without an assessment first, and we will say so rather than book you in.
If you are travelling specifically for this, send us the symptom and your possible dates before you book flights. You will be told whether the trip is worth making.
Coming to Bangkok for treatment →Describe when you leak — coughing and exercise, or sudden urgency, or both. That alone narrows it, and the assessment settles it.
This page is general information, not a diagnosis or a treatment recommendation. Suitability for any treatment is decided individually after assessment, and results vary between individuals. Consultations are conducted in English or Thai. THE FIT CLINIC — 8th Floor, EM Tower, EMSPHERE, BTS Phrom Phong, Bangkok. Open daily 10:00–19:00.