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?

1

Get the
Facts

2

Compare
Options

3

Your
Feelings

4

Your
Decision

5

Quiz
Yourself

6

Your Summary

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 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. 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.
Medicine. An example is vaginal estrogen cream.
Mechanical 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 pelvic organs.

When is surgery done for stress incontinence?

Surgery may be done when other treatments have not worked. Surgery is done to support, lift, or strengthen the bladder or the urethra. This makes it less likely that urine will leak from the bladder when you sneeze, cough, or laugh.

Types of surgery include:

Retropubic suspension. This surgery lifts the sagging bladder neck and urethra that have dropped abnormally low in the pelvic area.
Urethral sling. The surgeon places a sling around the urethra. There are different types of urethral slings, but they all help support the urethra to aid in urine retention.
Urethral bulking. Material is injected around the urethra. This may be done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.

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

Retropubic suspension. This surgery lifts the sagging bladder neck and urethra by attaching support tissue to the pubic bone or tough ligaments. This returns the bladder and urethra to their normal position. This can be done through a few small cuts in your belly. Or it may be done through one larger cut in your lower belly.
Urethral sling. A sling is placed around the urethra. The sling helps support the urethra and helps it retain urine. It can be placed through a few small cuts in your belly or upper thigh. Or it may be done through one larger cut in your lower belly. There are different types of urethral sling surgeries. The two main types of slings are midurethral and traditional. Midurethral slings are made out of synthetic mesh material. Traditional slings are made out of a strip of human or animal tissue.
Urethral bulking. Material is injected around the urethra. This is done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.

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 an organ, such as the bladder, urethra, or ureters.
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 risks of surgery.

These treatments don't work for everyone. You may still need to have surgery.

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. 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, including pelvic floor exercises. 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:

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

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

What matters to you

Print Summary

Credits

Author	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Brian D. O'Brien MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Avery L. Seifert MD - Urology
Primary Medical Reviewer	Kara C. Taggart MD - Urology

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.

Get the facts
Compare your options
What matters most to you?
Where are you leaning now?
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 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. 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?

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.
Medicine. An example is vaginal estrogen cream.
Mechanical 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 pelvic organs.

When is surgery done for stress incontinence?

Types of surgery include:

Retropubic suspension. This surgery lifts the sagging bladder neck and urethra that have dropped abnormally low in the pelvic area.
Urethral sling. The surgeon places a sling around the urethra. There are different types of urethral slings, but they all help support the urethra to aid in urine retention.
Urethral bulking. Material is injected around the urethra. This may be done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.

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?	Retropubic suspension. This surgery lifts the sagging bladder neck and urethra by attaching support tissue to the pubic bone or tough ligaments. This returns the bladder and urethra to their normal position. This can be done through a few small cuts in your belly. Or it may be done through one larger cut in your lower belly. Urethral sling. A sling is placed around the urethra. The sling helps support the urethra and helps it retain urine. It can be placed through a few small cuts in your belly or upper thigh. Or it may be done through one larger cut in your lower belly. There are different types of urethral sling surgeries. The two main types of slings are midurethral and traditional. Midurethral slings are made out of synthetic mesh material. Traditional slings are made out of a strip of human or animal tissue. Urethral bulking. Material is injected around the urethra. This is done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.	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 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 an organ, such as the bladder, urethra, or ureters. 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.

Personal stories

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. 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, including pelvic floor exercises. 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:

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

Credits

By	Healthwise Staff
Primary Medical Reviewer	E. Gregory Thompson MD - Internal Medicine
Primary Medical Reviewer	Brian D. O'Brien MD - Internal Medicine
Primary Medical Reviewer	Adam Husney MD - Family Medicine
Primary Medical Reviewer	Avery L. Seifert MD - Urology
Primary Medical Reviewer	Kara C. Taggart MD - Urology

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.