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Stress Incontinence in Women: Should I Have Surgery?

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

Your options

  • 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.
FAQs

What is stress incontinence?

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.

How is it treated?

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

When is surgery done for stress incontinence?

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. 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.

Why might your doctor recommend surgery for stress incontinence?

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

Compare

What is usually involved?









What are the benefits?









What are the risks and side effects?









Have surgery for stress incontinence Have surgery for stress incontinence
  • Tension-free vaginal tape (TVT) surgery takes about 30 minutes and requires local anesthesia .
  • Suspension and sling surgeries require general anesthesia and 2 or 3 days in the hospital.
  • Recovery can take 1 to 2 weeks (TVT) or up to 4 weeks (suspension and sling surgery).
  • 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.
Don't have surgery Don't have surgery
  • 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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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.

More important
Equally important
More important

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.

More important
Equally important
More important

I've tried medicines, but they don't work for me.

I think that medicines might work for me.

More important
Equally important
More important

Stress incontinence lowers my quality of life.

My quality of life is not too bad.

More important
Equally important
More important

I think surgery can help me.

I don't want to have surgery for any reason.

More important
Equally important
More important

My other important reasons:

My other important reasons:

More important
Equally important
More important

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.

Having surgery

NOT having surgery

Leaning toward
Undecided
Leaning toward

What else do you need to make your decision?

Check the facts

1.

Is surgery usually the first treatment for stress incontinence?

  • Yes Sorry, that's not right. Surgery is usually done only after other treatments have failed.
  • No You're right. Surgery is usually done only after other treatments have failed.
  • I'm not sure It may help to go back and read "Get the Facts." Surgery is usually done only after other treatments have failed.
2.

Can pelvic floor exercises help with stress incontinence?

  • Yes You're right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.
  • No Sorry, that's not right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.
  • I'm not sure It 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.
3.

Can symptoms come back after surgery?

  • Yes You're right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.
  • No Sorry, 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 sure It may help to go back and read "Get the Facts." Surgery can often cure incontinence. But sometimes symptoms come back.

Decide what's next

1.

Do you understand the options available to you?

2.

Are you clear about which benefits and side effects matter most to you?

3.

Do you have enough support and advice from others to make a choice?

Certainty

1.

How sure do you feel right now about your decision?

Not sure at all
Somewhat sure
Very sure
3.

Use the following space to list questions, concerns, and next steps.

Your Summary

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Your decision  

Next steps

Which way you're leaning

How sure you are

Your comments

Your knowledge of the facts  

Key concepts that you understood

Key concepts that may need review

Getting ready to act  

Patient choices

Credits and References

Credits
Credits Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Avery L. Seifert, MD - Urology

References
Citations
  1. 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.
  2. 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).
  3. Mariappan P, et al. (2005). Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults. Cochrane Database of Systematic Reviews (3).
  4. Onwude JL (2009). Stress incontinence, search date June 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  5. Richter HE, et al. (2010). Retropubic versus transobturator midurethral slings for stress incontinence. New England Journal of Medicine, 362(22): 2066–2076.
  6. Lapitan MCM, et al. (2009). Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews (4).
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?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
  1. Get the facts
  2. Compare your options
  3. What matters most to you?
  4. Where are you leaning now?
  5. What else do you need to make your decision?

1. Get the Facts

Your options

  • 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.
FAQs

What is stress incontinence?

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.

How is it treated?

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

When is surgery done for stress incontinence?

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. 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.

Why might your doctor recommend surgery for stress incontinence?

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.

2. Compare your options

  Have surgery for stress incontinence Don't have surgery
What is usually involved?
  • Tension-free vaginal tape (TVT) surgery takes about 30 minutes and requires local anesthesia .
  • Suspension and sling surgeries require general anesthesia and 2 or 3 days in the hospital.
  • Recovery can take 1 to 2 weeks (TVT) or up to 4 weeks (suspension and sling surgery).
  • You do Kegels to strengthen your pelvic muscles.
  • You try medicines or medical devices for help with symptoms.
What are the benefits?
  • 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.
  • Stronger muscles help control urine leaks. Kegels cure incontinence in many women who try them.
  • You avoid the cost and risks of surgery.
What are the risks and side effects?
  • 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.
  • 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

Are you interested in what others decided to do? Many people have faced this decision. These personal stories may help you decide.

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

3. 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.

             
More important
Equally important
More important

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.

             
More important
Equally important
More important

I've tried medicines, but they don't work for me.

I think that medicines might work for me.

             
More important
Equally important
More important

Stress incontinence lowers my quality of life.

My quality of life is not too bad.

             
More important
Equally important
More important

I think surgery can help me.

I don't want to have surgery for any reason.

             
More important
Equally important
More important

My other important reasons:

My other important reasons:

   
             
More important
Equally important
More important

4. 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.

Having surgery

NOT having surgery

             
Leaning toward
Undecided
Leaning toward

5. What else do you need to make your decision?

Check the facts

1. Is surgery usually the first treatment for stress incontinence?

  • Yes
  • No
  • I'm not sure
You're right. Surgery is usually done only after other treatments have failed.

2. Can pelvic floor exercises help with stress incontinence?

  • Yes
  • No
  • I'm not sure
You're right. Pelvic floor exercises (Kegels) can help you control your bladder when you cough, laugh, sneeze, or exercise.

3. Can symptoms come back after surgery?

  • Yes
  • No
  • I'm not sure
You're right. When the correct cause of incontinence is known, surgery can often cure it. But sometimes symptoms come back.

Decide what's next

1. Do you understand the options available to you?

2. Are you clear about which benefits and side effects matter most to you?

3. Do you have enough support and advice from others to make a choice?

Certainty

1. How sure do you feel right now about your decision?

         
Not sure at all
Somewhat sure
Very sure

2. Check what you need to do before you make this decision.

  • I'm ready to take action.
  • I want to discuss the options with others.
  • I want to learn more about my options.

3. Use the following space to list questions, concerns, and next steps.

 
Credits
By Healthwise Staff
Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
Specialist Medical Reviewer Avery L. Seifert, MD - Urology

References
Citations
  1. 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.
  2. 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).
  3. Mariappan P, et al. (2005). Serotonin and noradrenaline reuptake inhibitors (SNRI) for stress urinary incontinence in adults. Cochrane Database of Systematic Reviews (3).
  4. Onwude JL (2009). Stress incontinence, search date June 2008. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.
  5. Richter HE, et al. (2010). Retropubic versus transobturator midurethral slings for stress incontinence. New England Journal of Medicine, 362(22): 2066–2076.
  6. Lapitan MCM, et al. (2009). Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews (4).

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Last Revised: September 11, 2012

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