Most Women Who Seek Help Find Relief
The good news is that most women (80 to 90%) who seek help find that their symptoms improve. There is a wide array of treatment options, ranging from lifestyle and behavioral changes to surgical options. With treatment, you can recover parts of your life that you may have let go. Depending upon the extent of your symptoms and treatment goals, there may be one or more options for your bladder control problem:
Effective Non-surgical Options
· Lifestyle & Behavior
o Diet and fitness
o Pelvic floor muscle exercise
o Bladder retraining
· Physical therapy for the pelvic floor
· Vaginal Devices (Pessary)
Doctors may suggest surgery to improve bladder control if other treatments for incontinence have failed.
Surgery helps stress urinary incontinence. The best surgical procedures improve or cure the incontinence associated with coughing, laughing, sneezing, and exercise in about 85% of women.
Experts recommend you consider surgery for urinary incontinence only if:
- Incontinence symptoms are bothersome.
- Your doctor confirmed the diagnosis of stress incontinence
- Non-surgical treatments for incontinence failed to provide relief of symptoms.
- The benefits of surgery are expected to be greater than the possible risks.
Talk with your doctor about the benefits, risks, after-care requirements, and long-term considerations of surgery. You may also want to seek a second opinion from a pelvic floor disorder expert such as an urogynecologist. Find a urogynecologist in your area here.
Types of Stress Urinary Incontinence Surgery
The most commonly performed incontinence surgeries with the highest success rates are:
- Mid-urethral Mesh Slings (also called Vaginal Tape, TVT, TOT, Transobturator Slings, Mini-Slings)
- Pubovaginal/Fascial Bladder Neck Slings
- Burch Colposuspension Procedures
- Urethral Bulking Agent Injections.
Mid-Urethral Mesh Slings
Mid-urethral sling (MUS) procedures are the most commonly performed SUI operation. They are safe, effective, and improve quality of life for many women. These procedures involve placing a small piece of mesh underneath the middle part of the urethra (mid-urethra) to provide support. The graft material in this type of sling is most often made of polypropylene mesh. These procedures have been done for over 20 years with excellent results.
Mid-urethral slings are the best-studied incontinence surgery in history. The Food and Drug Administration (FDA) supports the safety and effectiveness of this surgery. The permanent mesh used in this surgery does not cause the high rates of complications that have been in the news related to mesh used for other types of vaginal surgery.
Read interviews with real women who have gone through surgery for stress urinary incontinence. Learn about their stress incontinence surgery recovery time, how long it took to get back to everyday activities, and the effectiveness of receiving the sling as a stress urinary incontinence treatment.
Echo, 51, Indianapolis
Rebecca, 50, New Jersey
Download a patient fact sheet to learn more about the mid-urethral sling for stress urinary incontinence.
Pubovaginal/Fascial Bladder Neck Slings
Physicians have been performing this operation for stress urinary incontinence since 1947. In this operation, the surgeon uses strong tissue called fascia underneath the urethra with the ends sutured to the tissue covering the abdominal muscles. There is a small incision in the vagina and another just above the pubic bone with this procedure.
The tissue can come from the patient herself or from donated tissue. This procedure does not utilize mesh.
In Burch colposuspensions,, the surgeon places stitches into the vaginal wall alongside the urethra and then secures to ligaments nearby in the pelvis. The stitches lift the vaginal wall that the urethra rests upon and provides support.
This procedure does not utilize mesh. It is sometimes performed through small incisions (laparoscopicaly) and sometimes through a larger incision on the abdomen.
Urethral Bulking Agent
In this procedure, a long acting or permanent substance is injected into the muscular wall of the urethra using a cystoscope. This injection causes the tube of the urethral to narrow which results in less urine leakage. Although this is a less effective procedure than other surgeries for stress urinary incontinence (SUI), this procedure:
- Is much less invasive.
- Does not require incisions.
- Has a low complication rate and can be performed in an office or on an outpatient basis.
This is not considered a permanent treatment and likely will require multiple injections over time.
Doctors frequently recommend this procedure for women in poor health, for whom more invasive surgery or anesthesia is not safe; in women with intrinsic sphincteric deficiency; for those women who continue to leak after other incontinence surgery; or for women who desire future pregnancies.