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Learning About Surgeries for Stress Urinary Incontinence in Women

Urinary stress incontinence

What is stress urinary incontinence?

Stress urinary incontinence (stress incontinence) is the leaking of urine when you sneeze, cough, laugh, jog, or lift something heavy. These actions put pressure on your bladder and urethra. The urethra is the tube that carries urine from the bladder and out of the body. Stress incontinence is the most common type of urinary incontinence in women.

What causes it?

Stress incontinence can be caused by childbirth, weight gain, or other conditions that stretch the pelvic floor muscles. When these muscles no longer support your bladder enough, the bladder drops down and pushes against the vagina. This prevents the muscles that close off the urethra from squeezing as they should. This leads to leaking.

How does surgery fix it?

Surgery lifts the urethra and bladder into their normal position. This helps the urethra close tightly. It keeps urine from leaking.

What types of surgery are used?

There are several types of surgery. The type you have depends on your medical problem and your overall health. Talk with your doctor about which one is right for you.

Tension-free vaginal tape (TVT) surgery

The doctor puts a mesh tape under the urethra like a sling or a hammock. It supports the urethra and returns it to its normal position. The doctor puts in the tape through small cuts (incisions) in your vagina and pubic hairline. This can also be done if urine leakage comes back after you have another type of incontinence surgery.

Other sling surgeries are done in a way that is like TVT surgery. Transobturator tape (TOT) surgery is done almost as often as TVT. But it's done in a slightly different way.

Retropubic suspension

The doctor attaches the sagging bladder and urethra to the pubic bone or to strong ligaments in the pelvis. 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

The doctor creates a sling out of a piece of muscle, ligament, or tendon. Or the doctor can use man-made material. The sling lifts the urethra back into a 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.

What can you expect after surgery?

Recovery can take 4 to 6 weeks. You will need help around the house during this time. You will not be able to do any heavy lifting or strenuous activities for 4 to 6 weeks. You will probably need to take off work at least 2 to 6 weeks. It depends on which type of surgery you have. You may feel more tired than usual. This can last for up to several weeks.

After surgery you should have less or no urine leakage when you sneeze, cough, laugh, or exercise. At first you may find that it is harder than usual to empty your bladder. This usually improves within several weeks.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor or nurse call line if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

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