If you leak urine when you cough, sneeze, laugh, exercise or lift something, you may have stress urinary incontinence (SUI). Maybe you wear a pad “just in case,” avoid certain exercises or find yourself worrying about leaks when you’re away from home.
If bladder leakage is beginning to change how you live your life, it may be time to learn about your treatment options.
One option is bladder sling surgery, also called a midurethral sling. It is a common treatment for stress urinary incontinence that provides additional support to the urethra to help prevent urine from leaking during physical activity.
But how does a sling work? When is surgery worth considering? And how does it compare with less invasive treatments such as Bulkamid®?
Here’s what you should know.
What Is a Bladder Sling?
A bladder sling is designed to support the urethra, the tube that carries urine out of your bladder.
Normally, the muscles and tissues around the urethra help keep it closed. When those structures don’t provide enough support, pressure from coughing, sneezing, laughing or exercising can cause urine to leak.
During a midurethral sling procedure, your urologist places a narrow strip of surgical mesh beneath the urethra. The sling acts like a supportive hammock, helping the urethra stay closed when pressure is placed on your bladder.
The goal is simple: fewer leaks and more freedom to enjoy everyday activities without worrying about an accident.
What Type of Bladder Leakage Does a Sling Treat?
Bladder sling surgery is primarily used to treat stress urinary incontinence.
You may have stress incontinence if you leak when you:
- Cough or sneeze
- Laugh
- Run, jump or exercise
- Bend over
- Lift something heavy
- Make other movements that put pressure on your bladder
A sling does not treat every type of urinary incontinence.
For example, if your main problem is a sudden, overwhelming urge to urinate and you sometimes can’t reach the bathroom in time, you may have urge incontinence or overactive bladder.
Some women have both stress and urge incontinence. That’s why determining why you’re leaking is an important first step before choosing a treatment.
When Should I Consider Bladder Sling Surgery?
There isn’t a specific amount of leakage you have to experience before considering treatment.
The more important question is: How much is bladder leakage affecting your life?
It may be time to discuss a sling with your urologist if you:
- Regularly wear pads because of leakage
- Avoid running, exercise or other physical activities
- Leak frequently when coughing, sneezing or laughing
- Plan activities around the possibility of an accident
- Have tried pelvic floor exercises or physical therapy without enough improvement
- Want a longer-term treatment for stress urinary incontinence
- Feel that bladder leakage is interfering with your comfort, confidence or quality of life
Having these symptoms doesn’t automatically mean you need surgery. It simply means it’s reasonable to talk about your options.
Do I Have to Try Other Treatments Before Getting a Sling?
Not necessarily. Treatment for stress urinary incontinence should be based on your symptoms, health, preferences and goals.
For some women, pelvic floor physical therapy may provide enough improvement.
Others may prefer a minimally invasive urethral bulking treatment such as Bulkamid®.
And some women may decide that a midurethral sling is the treatment that best fits what they are looking for.
Your urologist can explain the benefits and considerations of each option so you can make an informed decision.
Bulkamid or a Sling: What’s the Difference?
This is an important question for women considering treatment for stress urinary incontinence.
Both treatments are designed to reduce stress-related bladder leakage, but they work differently.
Bulkamid is a minimally invasive treatment that involves injecting a soft, water-based gel into the walls of the urethra. The gel adds cushioning that helps the urethra close more effectively.
A midurethral sling is a surgical procedure. A narrow strip of surgical mesh is placed underneath the urethra to provide additional support.
Some women prefer Bulkamid because it is less invasive. Others may prefer a sling based on the severity of their symptoms, their goals and the potential benefits of the procedure.
You don’t have to make that decision on your own. Your urologist can help you compare the options based on your individual situation.
What Is Recovery Like after a Sling Surgey?
It’s normal to have some soreness, discomfort or light bleeding during the early part of your recovery.
Before you go home, your care team may make sure you can empty your bladder normally. Occasionally, a temporary catheter is needed if urinating is difficult immediately after surgery.
You’ll also need to give your body time to heal.
Your urologist may temporarily limit:
- Heavy lifting
- Strenuous exercise
- Sexual activity
- Other activities that put pressure on the surgical area
Even if you’re feeling good, it’s important to follow your urologist’s instructions about when you can safely return to all of your normal activities.
How Well Does a Bladder Sling Work?
Midurethral sling surgery can significantly reduce or eliminate stress urinary incontinence for many women.
Your individual results can depend on several factors, including the type and severity of your incontinence, your health and whether you have other bladder or pelvic floor conditions.
It’s also important to remember that a sling specifically treats stress incontinence. If you also experience urinary urgency, frequent urination or other bladder symptoms, those symptoms may need to be treated separately.
What Should I Ask My Urologist Before Deciding?
You should feel comfortable understanding your choices before deciding on surgery.
Helpful questions include:
- What type of urinary incontinence do I have?
- Why do you think a sling may be appropriate for me?
- What are my nonsurgical options?
- Should I consider Bulkamid?
- What are the potential benefits and risks of sling surgery?
- What type of sling would you recommend?
- How much recovery time should I expect?
- Are there activities I’ll need to avoid?
- What results can I realistically expect?
- What happens if I still have leakage after treatment?
The goal isn’t simply to choose a procedure. It’s to choose a treatment that fits your symptoms, your health and the way you want to live.
Finding the Right Treatment for Bladder Leakage
If you’re changing your activities, wearing pads every day or worrying about the next cough or sneeze, you don’t have to simply live with bladder leakage.
The first step is determining what type of urinary incontinence you have.
At Urology Associates, Dr. Ramy Goueli is a board-certified, fellowship-trained urologist with specialized expertise in female pelvic medicine, reconstructive urology, neuro-urology and complex voiding conditions.
Dr. Goueli offers both surgical and nonsurgical treatments for urinary incontinence, including midurethral sling surgery and Bulkamid®. He works with each patient to understand her symptoms, explain the available options and develop a treatment plan based on her individual needs and goals.
If bladder leakage is interfering with the things you enjoy, schedule an appointment with Dr. Goueli at Urology Associates. Together, you can determine what’s causing your leakage and whether a bladder sling or another treatment may be right for you.
