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Stress Incontinence in Women: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Stress Incontinence in Women: Should I Have Surgery?
Get the facts
- Have surgery for stress incontinence.
- Don't have surgery. Try exercises, medicines, and medical devices instead.
Key points to remember
- Surgery is usually done only after other treatments for stress incontinence have failed.
- You may be able to treat stress incontinence by doing pelvic floor exercises (Kegels). They may help you control your bladder when you cough, laugh, sneeze, or exercise.
- Medicines may help you control urine leaks, but they don't work for everyone. You can also try a pessary, a catheter, or an adhesive patch to deal with symptoms.
- Incontinence can have more than one cause. Surgery can fix stress urinary incontinence. But if you have mixed urinary incontinence, you may still have urgency symptoms after surgery.
- Surgery works better than any other treatment for stress urinary incontinence in women.1 But sometimes surgery for stress incontinence causes new symptoms of urgency or urge incontinence. And sometimes symptoms come back.
- Surgery has risks, including trouble urinating after surgery, injury to the bladder or other pelvic organs, problems caused by the mesh tape used in surgery, infection, and problems linked to anesthesia.
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.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.3
- Medical devices (such as a pessary or an adhesive patch) and absorbent pads. These are often used to treat urinary incontinence. They have no serious side effects. They can be used at home, and they don't limit other options. They work well in treating mild to moderate incontinence.
- 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.4
Surgery works better than any other treatment for stress urinary incontinence in women.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.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."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.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.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- When the cause of incontinence is known, surgery can often cure it.
- After surgery you should have less urine leakage—or none at all—when you do things that put pressure on your bladder.
- Surgery doesn't always work.
- Symptoms may come back after surgery.
- Risks depend on the type of surgery. Risks include:
- Trouble urinating after surgery, new symptoms of urgency or urge incontinence, injury to the bladder or other pelvic organs, and problems caused by the mesh tape used in surgery (from TVT).
- Internal bleeding, injury to an organ, abscess, urinary tract infection, and pulmonary embolism (from suspension surgery).
- Stitches that pull out, rejection of the sling material, and problems with the sling material wearing away tissues in the urethra or vagina (from sling surgery).
- All surgery has risks, such as bleeding, infection, and problems linked to anesthesia. Your age and your health can also affect your risk.
- You do Kegels to strengthen your pelvic muscles.
- You try medicines or medical devices for help with symptoms.
- Stronger muscles help control urine leaks. Kegels cure incontinence in many women who try them.
- You avoid the cost and risks of surgery.
- These treatments don't work for everyone. You may still need to have surgery.
- Medicines for stress incontinence have side effects such as nausea, dizziness, trouble sleeping, and a cough or sore throat.
Personal stories about choosing treatments to manage stress incontinence
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I started having stress incontinence after my son was born. After I had my second child, it got worse. I feel like I am way too young to be wearing pads or diapers, and I worry that other people will notice the smell. My doctor showed me how to do some exercises to strengthen the muscles that help hold urine in. I know other women who have been helped by them. I am glad to have options other than surgery.
Tina, age 39
I thought I had tried everything for my stress incontinence. I can manage it most of the time, but when I jog, I get quite a bit of dribbling. I went to my doctor to find out whether there was anything I hadn't tried or whether surgery was my only other option. We talked about a lot of options, like pelvic floor exercises and wearing a tampon when I jog to put a little pressure on my urethra and stop the leaking. I am going to give those methods a try.
Maria, age 45
Ever since I was in my 20s, I have leaked a little bit of urine when I cough or sneeze or exercise. After I had my kids, it seemed to get worse. I really wanted a solution that would take care of the problem all the time. Even though there are some risks, my doctor and I agreed that surgery was a reasonable choice for me.
Faith, age 39
At my last visit, my doctor and I talked about many aspects of getting older: the leaking urine, the weaker bones, the change in my hormones, and all that. I was surprised to learn about surgery to help with my urine leakage problem. It is good to know that so many women have had success from surgery.
Carrie, age 55
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery
Reasons not to have surgery
I've tried Kegel exercises, but they haven't worked for me.
I think that Kegels might work for me.
I don't want to wear absorbent pads or try a pessary to avoid leakage.
I don't mind wearing pads or trying a pessary.
I've tried medicines, but they don't work for me.
I think that medicines might work for me.
Stress incontinence lowers my quality of life.
My quality of life is not too bad.
I think surgery can help me.
I don't want to have surgery for any reason.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
NOT having surgery
What else do you need to make your decision?
Check the facts
Is surgery usually the first treatment for stress incontinence?
Can pelvic floor exercises help with stress incontinence?
- YesYou're right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.
- NoSorry, that's not right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.
- I'm not sureIt may help to go back and read "Get the Facts." Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.
Can symptoms come back after surgery?
- YesYou're right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.
- NoSorry, that's not right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.
- I'm not sureIt may help to go back and read "Get the Facts." Surgery can often cure incontinence. But sometimes symptoms come back.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||E. Gregory Thompson, MD - Internal Medicine|
|Specialist Medical Reviewer||Avery L. Seifert, MD - Urology|
- American Urological Association (2009). Guideline for the surgical management of female stress urinary incontinence: Update (2009). Available online: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines.cfm.
- Dumoulin C, Hay-Smith J (2010). Pelvic floor muscle training versus no treatment, or inactive control treatments, for urinary incontinence in women. Cochrane Database of Systematic Reviews (1).
- Mariappan P, et al. (2005). Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults. Cochrane Database of Systematic Reviews (3).
- Onwude JL (2009). Stress incontinence, search date June 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
- Richter HE, et al. (2010). Retropubic versus transobturator midurethral slings for stress incontinence. New England Journal of Medicine, 362(22): 2066–2076.
- Lapitan MCM, et al. (2009). Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews (4).