Information for patients
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What is urinary stress incontinence?
Urinary Stress Incontinence (USI) is when you leak urine when increased abdominal pressures occurs, such as exercising, coughing, laughing or sneezing.
USI can occur when there are weak muscles in the pelvic floor or a weakened sphincter muscle at the neck of the bladder.
What is Urethral Bulking Injection (Bulkamid)?
Bulkamid is the injection of a smooth, water-based gel into the walls of the urethra at 3 to 4 different sites in order to improve the volume of the neck of the bladder and prevent leakages of urine. This substance remains in the body over time.
In order to inject bulkamid, a small microscope will pass through your urethra into the bladder in order to visualise where the injections should be administered. Sterile water is used to flush this scope which will later be passed by yourself when on the toilet.
What happens at the hospital?
Once your consent has been obtained to proceed with the Bulkamid treatment, you will be placed on a waiting list. Waiting list times can vary depending if you have chosen to have a general anaesthetic, spinal anaesthetic or local anaesthetic.
For general or spinal anaesthetic, you will have your procedure in the theatre setting. This will require you to attend the access lounge on the day of your procedure. This is where you are admitted, see the nurses and doctors and will wait until you are called for your procedure.
Once the procedure is completed in theatre, you will return here to recover and pass urine successfully before going home. In some cases, you may have to stay overnight but this is generally no the case with Bulkamid.
You may have to attend Access Lounge at a required time and have a wait before being called for your procedure.
If you have chosen to have the procedure done with local anaesthetic, you may also have your procedure completed in theatre or in the outpatient setting depending on availability. In the outpatient setting, you will attend at your required appointment time.
There you will have your procedure done under the care of the doctor and nurses. You will need to pass urine before leaving the clinic. This appointment can usually take 1 to 3 hours.
You will have a telephone follow up review with the Urogynaecology specialist nurse. At this appointment you can discuss your recovery, symptoms and any questions that you may have.
What are the advantages of having Bulkamid Injections?
Bulkamid is a minimally invasive procedure which can be done under local anaesthetic and usually takes around 10 to 15 minutes to complete. This can be an advantage for many women who are unable to have general anaesthetics or who need quick recovery times for different reasons.
What are the associated risks?
There is risk that patients who have Bulkamid for treatment of urinary stress incontinence will see some improvement but the benefits will likely wear off. This may require repeat injections.
There is also limited information on complications, especially long term. Women can also have a burning or stinging sensation when passing urine but this was usually for a short period of time after the injections.
As the injections aim to help relieve the symptoms of stress incontinence, there is also a risk that patients are unable to pass urine or fully empty their bladder. This may require self-catheterisation which will be taught to you before your injections if requested, or after if required.
Are there any alternative treatments?
NICE guidelines recommends that patients with urinary stress incontinence undergo conservative measures such as lifestyle changes, weight management and fluid education as well as pelvic floor muscle training for a period of 3 months before proceeding with further treatments. These options can be declined by yourself.
There are also alternative surgical options such as colposuspension and autologous fascial sling. More information on these surgical options can be requested.
Mid-urethral mesh sling operations are currently not being offered due to a national pause.
It is important to remember there is the option of having no treatment and managing your symptoms.
Before proceeding with Bulkamid, you will have a test called Urodynamics, this is completed in the outpatient setting and gives your doctor more information regarding your bladder.
Your case and urodynamic assessment will be discussed at an MDT (multidisciplinary team meeting) to ensure Bulkamid is the best treatment option for you.
Associated leaflets and References
- International Urogynaecology Association (Stress Urinary Incontinence)
- International Urogynaecology Association (Pelvic Floor Exercises)
- International Urogynaecology Association (Intermittent Self Catheterisation)
- International Urogynaecology Association (Cystoscopy)
- British Society of Urogynaecology Association – Urethral Bulking to treat Stress Urinary Incontinence; https://bsug.org.uk/budcms/includes/kcfinder/upload/files/info-leaflets/Urethral-bulking-BSUG-Mar-2018.pdf
- NICE – Surgery for stress urinary incontinence Patient Decision Aid; https://www.nice.org/guidance/ng123/resources/surgery-for-stress-urinary-incontinence-patient-decision-aid-pdf-6725286110
- International Urogynaecology Association – Urethral Bulking for Stress Urinary Incontinence; https://www.yourpelvicfloor.org/conditions/urethral-bulking/
- Bulkamid: A long lasting treatment for stress urinary incontinence; https://bulkamid.com/patients.what-is-bulkamid
01642 624 216
Tuesday to Thursday; 8am to 4pm
Friday; 8am to 1pm
01642 383 838
Monday to Friday; 8am to 4pm
Urogynaecology Specialist Nurse
07760 554 010
Monday to Friday; 8am to 4pm
Please be aware these are not emergency lines and any urgent medical attention or query should be addressed with 111 or 999.
- The British Society of Urogynaecology (BSUG) https://busg.org.uk/
- Home | RCOG https://www.rcog.org.uk/
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This leaflet has been produced in partnership with patients and carers. All patient leaflets are regularly reviewed, and any suggestions you have as to how it may be improved are extremely valuable. Please write to the Clinical Governance team, North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, TS19 8PE or:
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Leaflet reference: PIL1477
Date for Review: December 2026