Bulkamid: A Minimally Invasive Option for Stress Urinary Incontinence

Urethral bulking isn’t new. What has changed is the technology behind it. Coughing, sneezing, lifting, and other “normal” activities put additional pressure on the bladder that can lead to urinary leakage. For women with stress urinary incontinence, urethral bulking with Bulkamid could be a great minimally invasive solution, especially for those who would rather avoid surgery.

Stress urinary incontinence (SUI) is urine leakage that happens when pressure on the bladder increases – coughing, sneezing, laughing, exercising, lifting, or climbing stairs are common contributors.

SUI is the most common form of urinary incontinence, affecting over one-third of American women.¹ Pregnancy and childbirth, aging, changes in pelvic support, obesity, chronic coughing, constipation, and changes in the tissues around the urethra can all contribute to SUI. The severity can range from occasional drops of urine during high-pressure events (coughing, stair climbing, etc.) to continuous or near-constant loss of urine with low exertion. It’s the exertion and resulting tension inside the abdomen that puts additional pressure on the urethra. If the urethra cannot close firmly enough to withstand that pressure, urine can leak.

Treatment depends on the type and severity of incontinence and may include pelvic floor muscle training, lifestyle changes, vaginal devices, medications for certain types of urinary symptoms, urethral bulking, or surgery.

“Pelvic floor exercises are an underutilized treatment for stress urinary incontinence. Working with a pelvic floor physical therapist can help you learn how to activate these muscles correctly and use them to better support the urethra.” — Dr. Taghechian, Aayla Sexual Wellness and Aesthetics

Bulkamid is specifically used to treat stress urinary incontinence by supporting the urethra, helping it close more effectively when pressure is placed on the bladder.

How Does Bulkamid Work?

Bulkamid is a urethral bulking agent made of 97.5% water and 2.5% cross-linked polyacrylamide. It is a homogeneous hydrogel, a soft, gel-like material rather than particles suspended in a liquid.

“Urethral bulking isn’t a new concept – they’ve been used for decades. But older bulking materials had limitations. Newer materials such as Bulkamid have made this approach a more viable option for treating stress urinary incontinence.”

During treatment, a clinician uses a small injection device to place several small deposits of Bulkamid into the tissue around the urethra. These deposits increase the thickness of the urethral wall and improve urethral coaptation (how well the urethra comes together when it closes).

The goal is not to block the urethra. Rather, the added volume provides additional support so the urethra can better resist the pressure that causes stress-related leakage.

Bulkamid stays in place rather than being absorbed by the body, and long-term studies have found that improvement can persist for several years. In one seven-year follow-up study, 67.1% of women who received Bulkamid as their initial treatment reported marked improvement and even described themselves as “cured.”² Some patients did require another incontinence treatment during the follow-up period, so results vary from person to person.

Urethral bulking is also recognized as an option for women who have stress urinary incontinence and want to avoid or delay more invasive surgical treatment.

What Can You Expect During and After Bulkamid Treatment?

Bulkamid injections are typically performed as an outpatient procedure. The clinician views the urethra with a small scope while placing the gel in several locations around the urethral wall. It is a short procedure, usually only taking about 10 minutes, although the total appointment may be longer depending on the type of anesthesia or sedation used.

Because Bulkamid is minimally invasive, recovery tends to be much shorter than from a surgical procedure such as a sling. Your clinician will provide specific instructions about activity, medications, and when you can return to normal activities.

Some women notice improvement immediately after treatment. Over the following two to four weeks, as the local tissue settles, patients experience the full benefits. But the degree of improvement varies. Bulkamid is intended to reduce stress-related urine leakage, and it does not treat every type of urinary incontinence. For example, urgency, frequent urination, or leakage associated primarily with an overactive bladder may require a different treatment approach. Women who have both stress and urgency-related leakage may need treatment directed at both components.

Temporary difficulty emptying the bladder and urinary tract infection (UTI) are among the potential complications of urethral bulking. Sometimes, antibiotics will be used prophylactically to reduce UTI risk. Other urinary symptoms, including new or increased urgency, can also occur. In clinical studies, these complications were generally temporary, but patients should discuss their individual risks and expectations with their healthcare provider.³

For some women, one treatment provides sufficient improvement. Others may eventually benefit from another Bulkamid injection or a different incontinence treatment. The possibility of retreatment is an important part of deciding whether urethral bulking is right for you.

If SUI is interfering with everyday activities, Dr. Taghechian can help you understand your treatment options and determine whether Bulkamid is appropriate for you. Contact the team at Aayla Sexual Wellness and Aesthetics and let us help you find freedom from pads and bathroom mapping.

References:

1. Cleveland Clinic. (2025, August 6). Stress incontinence. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22262-stress-incontinence. 
2. Brosche, T., Kuhn, A., Lobodasch, K., & Sokol, E. R. (2021). Seven-year efficacy and safety outcomes of Bulkamid for the treatment of stress urinary incontinence. Neurourology and urodynamics, 40(1), 502–508. https://doi.org/10.1002/nau.24589.  
3. Contura. (2020). Bulkamid® Urethral Bulking System. https://www.accessdata.fda.gov/cdrh_docs/pdf17/P170023D.pdf.