9th March, 202213 min read

Best surgery for urinary incontinence in women

Medical reviewer:
Dr Adiele Hoffman
Dr Adiele Hoffman
Dr Ann Nainan
Dr Ann Nainan
Author:
Dr Roger Henderson
Dr Roger Henderson
Last reviewed: 09/03/2022
Medically reviewed

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Peeing when you don’t want to (urinary incontinence) can make life stressful. If you pee when you cough, exercise or laugh, or find yourself urgently needing to go to the toilet and not getting there in time, it can be difficult to talk about and cope with, and you may find it embarrassing.

Thankfully, however, there are various things that can help. In some cases, if you and your doctor have already tried non-surgical treatments (such as pelvic floor training or medication), or your doctor identifies that your condition needs a different type of help, you may need surgery or a medical procedure.

So read on to learn about surgical treatments and procedures for some of the common types of urinary incontinence, including stress, urge and overflow incontinence.

When will a doctor recommend surgery for urinary incontinence?

Urinary incontinence is a common problem that doctors see all the time, and they understand you’ll want to do all you can to help improve it. Discussing your symptoms and how they’re affecting your life is the best way to find the right treatment for you – so don’t let any feelings of embarrassment hold you back.

But when might your discussion turn to surgery? Your doctor might recommend it if you’ve tried to manage your condition in other ways – such as with lifestyle changes and pelvic floor or bladder exercises (read about urinary incontinence treatment without surgery – but these haven’t helped.

Before surgery is considered, it’s important you have an accurate diagnosis about the type of urinary incontinence you have (read about how urinary incontinence is diagnosed). You should also discuss whether you plan to have children – if you do, your doctor may suggest delaying surgery.

If you’re worried about your symptoms, you can use our Smart Symptom Checker to help you work out what conversation to have with your doctor next.

women urinary problem

What kind of surgery is effective for female urinary incontinence?

If you have stress incontinence, the 3 surgical options are usually colposuspension, sling surgery and vaginal mesh surgery. All 3 are known to effectively treat some women. But they don’t help everyone, and it’s not possible to say for certain whether a particular surgery will be better (or worse) for you.

Some women also get problems called ‘complications’ after these types of surgery. These can include problems emptying your bladder fully, needing to pee urgently, or damage to your bladder or bowel. Generally, studies show that about 1 to 10 in 100 women get these problems (so 90 to 99 in 100 do not).

In most cases, it isn’t possible to say if 1 type of surgery is more likely to cause complications. For example, research suggests that pelvic organ prolapse may be more common after colposuspension than mesh surgery, with up to 25 women in 100 getting this at some point after colposuspension (so 75 or more do not). But other complications can happen after mesh surgery – and in fact it’s not recommended on the NHS at the moment because of these (see below for details).

If you have urge incontinence, surgery is less likely to be effective, and procedures such as nerve stimulation or botox injections are more commonly recommended (see below for details). Surgery is usually only considered in rare cases, if other treatments haven’t worked.

Whatever type of surgery or procedure is recommended for you, you should always discuss the risks and benefits with your doctor. Remember, it’s important that you make a choice that’s right for your personal circumstances – and this may mean not having surgery at all. Your doctor will be able to help you make a decision.

Surgery and procedures for urinary stress incontinence

Colposuspension

With stress incontinence, your muscles may not be working well to hold your bladder in the right place, which leads to leaks. Colposuspension lifts the neck of your bladder into the right position and keeps it in place with stitches.
Key things to know about colposuspension:

  • it can be done through a large cut in your lower tummy (abdomen), or as keyhole (laparoscopic) surgery through 1 or more small cuts
  • you’ll usually be able to go back to normal activities after about 4 weeks – though strenuous activities and sex should be avoided for at least 6 weeks
  • some people take longer to recover, but keyhole surgery can have a quicker recovery time
  • your surgeon or doctor can give you more advice about your recovery
  • it can be an effective long-term treatment for stress incontinence

How other women rate this surgery

Studies suggest that on average, about 70 women out of 100 feel their symptoms have improved 1 to 5 years after having colposuspension. After 5 years, about 55 women out of 100 feel this way.

woman in hospital

Sling surgery

Sling surgery involves what’s known as a ‘fascial sling’ being inserted around the neck of your bladder or the tube that carries pee out of your body (urethra). This supports your bladder or urethra, so you don't leak pee.

Key things to know about sling surgery:

  • a cut is made in your lower abdomen and vagina
  • the sling is usually made from tissue taken from another part of your body, such as your abdomen. In rarer cases, it can be made from tissue donated by another person or from an animal
  • recovery time is about 6 weeks, and you should build up slowly when you start to go back to your usual activities
  • it’s usually very safe, and most people notice an improvement in their symptoms

How other women rate this surgery

Research shows an average of about 75 women out of 100 feel their symptoms have improved 1 to 5 years after sling surgery. And about 55 women out of 100 feel this way after more than 5 years.

Vaginal mesh surgery (tape surgery)

Vaginal mesh, or tape, surgery is when a strip of synthetic mesh is permanently inserted behind your urethra to support it and prevent leaks.

Key things to know about vaginal mesh surgery:

  • it isn’t currently available on the NHS unless there’s no alternative and your surgery can’t be delayed, because there are concerns about the complications it can cause
  • if you do need to have mesh surgery, it will only happen after a detailed discussion with a specialist
  • it isn’t known how likely you are to get complications after mesh surgery, but a complication of concern is when the skin over the mesh doesn’t heal properly and it moves through into your vagina. This is known as ‘vaginal mesh exposure’, which can cause problems in your vagina with pain, bleeding or discharge. In rare cases, it can also cause damage to your bladder or urethra
  • if you’ve had vaginal mesh surgery and you think you’re having side effects or complications, speak to your doctor or surgeon

How other women rate this surgery

Studies suggest many women who have mesh surgery do notice improvements. For the first 1 to 5 years afterwards, about 75 out of 100 feel their symptoms have improved. After 5 years, about 60 out of 100 feel this way.

Less commonly used treatments for stress incontinence

Urethral bulking

Urethral bulking is a procedure where a man-made ‘bulking material’ is injected underneath the lining of your urethra and into the muscle at the neck of your bladder to prevent leaks.

Key things to know about urethral bulking:

  • it can be an option if surgical treatment isn’t right for you
  • no cuts are made, it’s usually done under local anaesthetic and you won’t need to stay in hospital
  • you won’t have to limit your activities when you get home and you’ll usually recover in a day or 2, though you may need to go to the toilet more urgently or often, and notice some blood or burning when you pee, for a short time afterwards
  • any complications are likely to be less serious than with surgical treatment
  • it’s thought to be less likely to be effective than surgical treatment, and may improve your symptoms rather than make them go away completely
  • you may need another treatment 4 to 6 weeks later if you’re still getting leaks
  • the effects wear off over time, so you may need more injections at a later date

How other women rate this procedure

Research suggests about half of women who have urethral bulking feel it cures their stress incontinence, though some need more than 1 treatment.

Artificial urinary sphincter surgery

The urinary sphincter is a ring of muscle that stops pee flowing to your urethra from your bladder. If your urinary sphincter is weak, this can cause incontinence – so some people need to have a man-made sphincter device fitted.

Key things to know about artificial urinary sphincter surgery:

  • it’s more often used to treat incontinence in men, but can occasionally be used for women – for example, if other surgery hasn’t helped
  • a cut is made in your lower abdomen to fit the device
  • after you’ve recovered from the surgery, in about 6 weeks, you have to go back to have the device activated and be shown how it use it
  • the device can eventually stop working, so you may need more surgery to replace it at a later date

How other women rate this surgery

About 70% of women find it cures their stress incontinence, while most women notice a big improvement, even if they still get some leaks.

Procedures and surgery for urinary urge incontinence

Botox injections

Urge incontinence is usually due to the muscles that control your bladder – called detrusor muscles – being overactive and squeezing (contracting) too much. Botulinum toxin A (Botox) can be used to relax these muscles.

Key things to know about Botox injections:

  • though they’re not specifically licensed in the UK for urge incontinence, they’re recommended in national guidelines if things like bladder training and medication haven’t worked, and your doctor will discuss the benefits and risks with you
  • they’re injected into the sides of your bladder
  • most people notice an improvement in symptoms after just a few days
  • you may have trouble peeing afterwards and need to use a catheter to take pee out of your body, and may have an increased risk of getting urinary tract infections (UTIs)
  • there’s not much evidence about any long-term risks
  • the effects can last around 6 months, and you can have further injections if needed

How other women rate this surgery

About 70% of people report that their symptoms are either significantly improved or cured, with the effects lasting 6 to 12 months.

Sacral nerve stimulation

Your sacral nerves at the bottom of your back carry signals from your brain to your bladder. Sacral nerve stimulation can improve these signals, which can help with urge incontinence caused by overactive bladder muscles.

Key things to know about sacral nerve stimulation:

  • a tiny device is implanted just under your skin – usually in 1 of your buttocks – which sends an electrical current to your sacral nerve. A thin lead is also put in your lower back
  • you should avoid stretching, bending or strenuous exercise for 6 weeks after the implant is fitted
  • when the sacral nerves are stimulated, you may find it painful or uncomfortable
  • it can improve symptoms or in some cases cure urge incontinence completely
  • the stimulator battery lasts about 3 to 7 years, so you’ll need further surgery to replace it at a later date

How other women rate this surgery

About 70% of people report a significant improvement in their symptoms.

Less commonly used treatments for urge incontinence

Posterior tibial nerve stimulation

Your posterior tibial nerve goes down your leg and into your ankle. It’s thought that stimulating it may have an effect on nerves that go to your bladder and pelvic floor, to help with urge incontinence.
Key things to know about posterior tibial nerve stimulation:

  • it’s only recommended if other treatments haven’t helped or aren’t suitable, as there’s not enough evidence to prove it’s effective
  • a thin needle is inserted in your ankle to send an electric current to your tibial nerve
  • treatment takes about half an hour, and you may need multiple sessions

Augmentation cystoplasty

Augmentation cystoplasty is surgery that increases the size of your bladder, to reduce pressure from the overactive bladder muscles that can cause urge incontinence.
Key things to know about augmentation cystoplasty:

  • it’s only recommended in rare cases of urge incontinence
  • it involves keyhole surgery to add tissue from a section of your bowel to your bladder
  • it usually takes at least 6 months to fully recover
  • afterwards, there’s a chance you may not be able to fully empty your bladder when you pee, so you may need to use a catheter

Urinary diversion

Urinary diversion is surgery to stop pee passing through your bladder, to avoid the problems of an overactive bladder that can cause urge incontinence.
Key things to know about urinary diversion:

  • it’s only done rarely, if other treatments haven’t worked or aren’t suitable
  • the tubes that run from your kidneys to your bladder (ureters) are directed outside of your body
  • pee will pass out of your body through an opening in your abdominal wall called a stoma, and be collected in a bag
  • recovery can take 4 to 8 weeks, but you’ll usually be able to return to your normal activities afterwards

Procedures for urinary overflow incontinence

Overflow incontinence happens when you can’t fully empty your bladder when you pee, which can lead to frequent leaks. To manage this, you may be given a device called a catheter – a thin flexible tube to remove pee from your bladder, which you usually insert through your urethra. It can be used in the following ways.

Clean intermittent catheterisation

Clean intermittent catheterisation (CIC) is a way of regularly fully emptying your bladder, to reduce overflow.

Key things to know about CIC:

  • you can do it yourself at home – you’ll be shown how to insert a catheter
  • the catheter allows pee to drain out of your bladder and into the toilet
  • it can be uncomfortable at first, but usually eases as your body gets used to it
  • it can be used once a day or at regular intervals, depending on your symptoms – just long enough to drain your pee
  • it can put you at a higher risk getting UTIs

Indwelling catheterisation

If using CIC isn’t effectively managing overflow incontinence, you may need a permanent, ‘indwelling’ catheter fitted instead.

Key things to know about indwelling catheterisation:

  • the catheter is kept in place in your bladder by a water-filled balloon
  • a bag is attached to the end to collect your pee
  • the bag can be fitted with a valve so you can drain it into the toilet
  • you’ll usually need to have your catheter changed every 3 months
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