Stress Incontinence in Women: Should I Have Surgery?

Stress incontinence is the accidental release of urine that occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It's the most common type of incontinence in women.

Stress incontinence can be caused by childbirth, weight gain, or other problems that stretch the pelvic floor muscles. When these muscles can't support your bladder, the bladder drops down and pushes against the vagina. You're not able to tighten the muscles that close off the urethra. Urine may leak because of the extra pressure on your bladder.

Incontinence can have more than one cause, so your doctor will treat the main cause first. Surgery for stress incontinence is usually done only after other treatments have failed.

Other treatments you might try include:

• Kegel exercises. These are also called pelvic floor exercises. They strengthen the pelvic muscles that control urination. You can do these exercises at any time without anyone knowing you're doing them. Women who do Kegel exercises are more likely to improve, and even cure, their incontinence. These women had fewer leakage problems a day and said their quality of life was better.^{footnote 2}
• Medicines. These can be used to reduce how often you leak and can improve your quality of life. But medicines rarely cure stress incontinence.^{footnote 3}
• Medical devices. These are products used to prevent urine from leaking, such as a pessary. A pessary is a device that fits into the vagina to support the bladder. Another option is a nonprescription product which you insert like a tampon, such as Poise Impressa. It lifts and supports the urethra to help prevent urine from leaking.
• Electrical stimulation, which sends a mild electric current to nerves in the lower back or the pelvic muscles that are involved in urination. Electrical stimulation of the pelvic floor muscles may reduce how often you leak.^{footnote 4}

Surgery may be done when stress incontinence is severe and other treatments have not worked. Surgery lifts and supports the connection between the bladder and the urethra.

Surgery works better than any other treatment for stress urinary incontinence in women.^{footnote 1} But sometimes symptoms come back.

Types of surgery include:

• Tension-free vaginal tape (TVT). In this surgery, a mesh tape is placed under the urethra like a sling to support it and return it to its natural position. Surgery takes about 30 minutes and is usually done under local anesthesia. Another procedure called transobturator tape (TOT) surgery is like TVT. Both TVT and TOT cure stress incontinence in about 8 out of 10 women. That means that about 2 out of 10 women still have problems with incontinence after this kind of surgery.^{footnote 5}
• Retropubic suspension. This surgery lifts the sagging bladder neck and urethra by attaching support tissue to the pubic bone or tough ligaments. It requires general anesthesia and 2 or 3 days in the hospital. Depending on how it is done, surgery cures stress incontinence in about 8 or 9 out of 10 women in the first year. Five years after surgery, about 7 out of 10 women are still "dry."^{footnote 6}
• Sling surgery. This surgery involves making deep cuts in the belly to get to the bladder and urethra. The surgeon uses a piece of muscle, ligament, or tendon tissue or synthetic material to make a sling. The sling lifts the urethra back into a normal position. It requires general anesthesia and 2 or 3 days in the hospital. Sling surgery is usually done after other surgeries have failed. It works well to get rid of stress incontinence.^{footnote 1}

Talk with your doctor about things you can do to increase the chance of having a successful surgery. You may have better results if you lose weight or do Kegels before surgery. If you smoke, quit.

Your doctor may suggest surgery if:

• You have tried other treatments, and they have not helped.
• You and your doctor know the cause of your stress incontinence. Surgery is more likely to fail if the true cause isn't known.