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Originally published June 8, 2026
Last updated June 8, 2026
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Female incontinence is an issue patients can have trouble opening up about. Feelings of shyness or embarrassment, or the mistaken belief that nothing can be done, may prevent many from seeking treatment.
That’s why Elodi Dielubanza, MD, a urologist specializing in pelvic floor conditions with USC Urology and the USC Urogynecology and Reconstructive Pelvic Surgery Program, both part of Keck Medicine of USC, is dedicated to educating doctors and patients about the latest advances in female incontinence treatment.
“There’s now a wide variety of treatments that fit into people’s goals and lifestyle expectations,” Dielubanza says. Clinical trials on others are also ongoing, meaning more innovations are on the horizon.
Dielubanza recently shared the most recent developments in the treatment of female incontinence and the profound impact they could have on patients’ quality of life.
When discussing female incontinence, it’s important to bear in mind that there are three kinds: urge, stress and mixed symptoms. “If a patient has mixed symptoms, we generally will focus on the component that bothers them the most first,” Dielubanza says.
“The thing that we’re all most excited about is that our guideline now states that we don’t have to follow a treatment algorithm for urge-incontinence patients and that any of our available therapies are appropriate as a first-line approach,” Dielubanza says.
Up until 2024, the guideline was to require step therapy, meaning patients would have to try and fail medications, physical therapy and behavior modification before the minimally invasive procedures available for their condition could be considered.
The new guideline, however, gives doctors more latitude with treatments such as botulinum toxin injections to the bladder, which can be over 80% effective in reducing episodes of urge incontinence. The injections have also been shown to reduce the number of a patient’s daily bathroom trips as well as the frequency of urge sensation.
Another notable advancement has been in the field of neuromodulation, a form of nerve stimulation that helps control the signals between the bladder and its neural control centers.
“Percutaneous tibial nerve stimulation (PTNS) is an office-based form of nerve stimulation,
which is provided in course of 30 minutes, once a week, for 12 weeks, for initial therapy,” Dielubanza says. “After that, patients return every three to six months for a series of maintenance sessions.”
Continuous neuromodulation is also available using implanted nerve stimulators. For the past 25 years, this type of neuromodulation has required a minimally invasive surgery near the sacrum, which patients may shy away from unless they feel it is absolutely necessary. And for patients with certain health concerns, the option of sacral surgery simply isn’t feasible. Now, a new neuromodulation type targets the same bladder control center in the spine, but via the tibial nerve through a device implanted at the inner ankle.
And for patients who want a nonsurgical and less time-consuming option, a solution is on the way — a nonsurgical percutaneous neuromodulation procedure that uses external electrical impulses to control urgency. With no implantation necessary, patients will be able to manage their condition at home. This option is still in trials but could be available for clinical use in fewer than five years.
While physical therapy is still an excellent treatment option for stress incontinence, there are external devices and minimally invasive procedures that can make a big difference in a patient’s quality of life.
Transvaginal bladder supports are one promising option. The insertable devices come in pessary or tampon form and offer support to the bladder without procedures. “They’re becoming increasingly patient-friendly for self-use,” Dielubanza says.
Advances have also been made in bulking agents, filler-like injections that provide connective-tissue support for the urethra. These injections can be administered under local anesthesia or sedation.
The latest versions of these fillers offer improved longevity compared to the older agents — in many cases, from two to seven years. And it’s something that can be done again in the future, once the effects wear off.
“It’s also possible to move between injections and other options,” Dielubanza says.
Finally, the sling procedure — an outpatient treatment — places a bladder-supporting sling in the body to reduce leakage for 10 to 15 years. These slings can be made of polypropylene mesh material or a patient’s own fascia. Once the sling is in place, it reinforces the tissue around the urethra so that a patient can cough or move without urethral leakage.
“A polypropylene mesh sling can be placed in as little as 30 to 60 minutes,” Dielubanza says. “When we harvest your own tissue, it can be done in as little as 90 minutes. Both can be done on an outpatient basis, and they offer really durable symptom control.”
Dielubanza stresses that patients do not need to wait to explore these options.
“When people think about surgery, they often use the term, ‘have to,’” she says. “But that’s not the metric we’re using. We’re really trying to improve quality of life. If a patient is bothered, then surgery is a very reasonable option, even as a first approach.”
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