Stress urinary incontinence happens when the muscle that closes off the bladder (the sphincter) doesn’t work as well as it should. This can happen when the sphincter nerves, muscle or both get damaged, which often is caused by vaginal childbirth. This type of bladder leakage also can happen because of intrabdominal pressures and other changes that happen as women age.
But there are highly effective, minimally invasive treatments that can cure this common, but not “normal,” condition.
What should you do if you have bladder leakage?
First, see your primary care doctor or gynecologist to rule out possible infections, like urinary tract infections. If nothing is wrong, but you still experience symptoms, it’s time to see a urogynecologist.
Urogynecologists are specially trained in pelvic floor conditions like stress incontinence. Medication usually won’t work to treat this type of bladder leakage, but there are many treatment options that we can recommend. Cutting down on fluid consumption, doing Kegel exercises to strengthen the pelvic floor muscles and urinating on a schedule can help keep symptoms at bay if you have just a little bladder leakage.
But if the leakage is enough to affect your quality of life, I’ll be honest—none of these will be as effective over time as a simple outpatient procedure. Urogynecologists perform a higher volume of incontinence procedures compared to general gynecologists, which improves your chances of a good outcome.
Midurethral sling surgery for stress urinary incontinence
The gold standard of stress urinary incontinence treatment is a midurethral sling procedure. It’s the most studied, most effective treatment for stress bladder leakage, and it’s highly effective with low risk. Women’s happiness rate for the surgery is 80 to 90 percent.
Please note: This is not the same mesh sling you may have seen in lawsuit commercials on TV or online. That’s for an entirely different issue called vaginal prolapse.
Sling surgery for stress urinary incontinence takes just 20 minutes, and we do it in the office. You’ll get local anesthesia and light sedation, which means we don’t have to put you all the way to sleep. Then we make a half-inch incision inside the vagina to access the urethra—the tube through which pee exits your bladder. From there, we use a tiny mesh sling that supports the urethra to prevent bladder leakage from sneezing, coughing and other day-to-day functions.
Most women can expect rapid recovery, including leaks stopping almost immediately. Half of our patients can urinate normally right after surgery. The other half go home with a 3-inch catheter for just a few days. Of those who take a catheter home, 90 to 95 percent of them can pee normally within three days. If they can’t go normally after three days, the mesh may be a little too tight, and we can loosen it to get them flowing normally again.
I’ve learned in my long career never to tell people how much discomfort they’ll have after surgery, because everyone is different. But most women have minimal to no issues. Still, we recommend they avoid placing anything in the vagina for the first 2 weeks. That means avoiding sex and the use of tampons, for example. We also recommend avoiding extreme exercise, such as heavy weightlifting and endurance running. In the first few days after surgery, women can start back to light exercise, such as walking or moderate running.
If you’ve had complications with synthetic mesh surgeries in the past, this may not be the right procedure for you. Your doctor can help you find an alternative to cure your urinary stress incontinence.
Urinary leakage is a common problem, but it can be fixed. If you’re tired of crossing your legs to sneeze or losing urine when you exercise, come see us. We’ll find a solution to fit your condition and lifestyle.
