Stress incontinence: Should I have surgery?

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.

This Decision Point is for women. If you are a man, see the topic Urinary Incontinence in Men.

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. In a study, about 70 out of 100 women with stress incontinence found Kegels helpful, and 30 did not.¹
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.
Stress incontinence can have more than one cause. When the correct cause is known, surgery can often cure it. But sometimes symptoms come back.
Surgery has risks, such as infection, bleeding, 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?

Since stress incontinence can have more than one cause, your doctor will treat the main cause first. Surgery 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. In a study, about 70 out of 100 women with stress incontinence found Kegels helpful, and 30 did not.¹ Adding biofeedback to Kegels helps them work even better to reduce stress incontinence.
Medicines. These may be used to control urine leaks, but they can't cure incontinence. Antidepressants can reduce the severity of stress incontinence and how often you leak.²
Medical devices (such as a catheter, 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. This is often used to treat stress incontinence, but it is still being studied.

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.

After surgery, you should have less urine leakage—or none at all—when you do things that put pressure on the bladder, such as sneeze, cough, or laugh.

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. It works well in women who are obese.³ Another procedure called transobturator tape (TOT) surgery is like TVT.
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 works well in the short term. But symptoms may come back over time.⁴
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 Options

	Have surgery for stress incontinence	Don't have surgery
What is usually involved?	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: Bladder puncture, urine retention, and urges to urinate (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 sleepiness, dry mouth, blurred vision, and anxiety.

Personal stories

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

For more information, see the topic Urinary Incontinence in Women.

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 there are medications available that may help with my urine leakage problem. It is good to know that I can try something other than absorbent pads or surgery."

— Carrie, age 55

3. Your Feelings

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. Your Decision

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. Quiz Yourself

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.

Nothing. 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.

References

Citations

Lentz GM (2007). Physiology of micturition, diagnosis of voiding dysfunction, and incontinence: Surgical and nonsurgical treatment. In VL Katz et al., eds., Comprehensive Gynecology, 5th ed., pp. 537–568. Philadelphia: Mosby Elsevier.
Onwude J (2007). Stress incontinence, search date December 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.
Mukherjee K, Constantine G (2001). Urinary stress incontinence in obese women: Tension-free vaginal tape is the answer. British Journal of Urology International, 88(9): 881–883.
Chapple CR (2007). Retropubic suspension surgery for incontinence in women. In AJ Wein et al., eds., Campbell-Walsh Urology, 9th ed., vol. 3, pp. 2168–2186. Philadelphia: Saunders Elsevier.