Tackling Incontinence Through Life-Changing Procedures

Africa. In South Africa, one in three women suffers from urinary incontinence, and yet access to timely treatment remains limited, particularly in the public healthcare system, where backlogs for intervention can extend to a year.

Addressing Incontinence

These delays carry consequences far beyond just physical discomfort. Delayed treatment often results in worsening symptoms, which can lead to infections, morbidity, and even mortality in vulnerable patients, but the emotional and social toll is often just as significant.

There is a strong sense of embarrassment and loss of dignity, with many women feeling ashamed or anxious about odor or visible leakage. Some avoid exercise, travel, and social interaction, and may struggle to maintain employment – especially in roles without easy access to restrooms. There are also hidden economic costs, including spending on pads, extra laundry, and lost productivity.

What exactly is it?

Defined as the involuntary leakage of urine, urinary incontinence presents in several forms, including stress incontinence, urge incontinence, and overflow incontinence. Despite how common it is, urinary incontinence is frequently underreported and undertreated, even though there are effective ways to manage and treat the condition.

Many women suffer in silence, either too embarrassed to seek help or unable to access effective treatments, but timely intervention can be truly life-changing for women who have been living with untreated urinary incontinence, especially those discouraged by long waiting lists.

Treating incontinence

In response, Mediclinic marked World Continence Week (15 to 21 June) with a targeted corporate social investment (CSI) initiative aimed at reducing the treatment backlog. The initiative saw eight public sector patients, referred from Groote Schuur Hospital, undergoing intravesical Botox procedures to treat urge incontinence from 15 June 2026. This is in addition to the over 1,600 pro-bono surgeries Mediclinic has performed since 2018.

I spearheaded the initiative, and the decision was driven by both clinical need and a desire to make a tangible difference. With increasing service pressures, cancelled theatre lists, and limited resources, the waiting list continues to grow. This is a way to contribute, even in a small way, to restoring quality of life for women who have been waiting too long for care.

Procedures for incontinence

Intravessical Botox is a minimally invasive procedure that involves injecting botulinum toxin into the bladder wall. It works by relaxing the overactive bladder muscles responsible for urgency and involuntary contractions. The procedure is typically performed under sedation in a day-theatre setting and can be completed within an hour.

Early treatment can significantly improve or even resolve symptoms, allowing women to regain bladder control and return to normal daily activities. It can also reverse many of the emotional and social effects, restoring confidence and independence.

There are also non-medical methods that can be very effective in some cases, especially when they are started early. Many women can see significant improvement with conservative measures, encouraging first-line treatments such as pelvic floor muscle training, bladder training, and lifestyle adjustments, including weight management and reducing caffeine and alcohol intake.

Awareness and education are also absolutely critical. In my experience, one of the biggest barriers is not just access to care, but the fact that many women don’t realize that what they are experiencing is a medical condition that can be treated.

Bottom line

My message to women is simple. You are not alone, and you do not have to live with this. There are effective treatments available, and taking that first step to seek help can be life-changing. The sooner you come forward, the sooner we can help you regain your confidence, comfort, and quality of life.

Who is the author?

Dr Colin Montgomery is a specialist Obstetrician and Gynaecologist with a sub-speciality in Urogynaecology who consults primarily at Mediclinic Stellenbosch. His clinical focus is women’s health and pelvic floor disorders, including urinary and faecal incontinence, overactive bladder, pelvic organ prolapse, and related bladder and bowel dysfunction.

He offers comprehensive, individualised care that may include urodynamic assessment, pelvic floor rehabilitation, and minimally invasive surgical options (including advanced laparoscopic and robot-assisted techniques) where appropriate, alongside general gynaecological services such as routine screening, menstrual concerns, family planning, and early pregnancy care (up to 23 weeks).