Harvard Women's Health Watch

Midurethral sling surgery for stress incontinence

A minimally invasive approach is now the norm for treating this common urinary problem.

Stress incontinence is leakage of urine under physical pressure — for example, coughing, sneezing, laughing, or jumping. It affects up to about one-third of women at some point, and although it's a passing annoyance for some, for others it can be persistent and severe enough to disrupt their lives.

Surgery to support the urethra has been the mainstay of treatment in bothersome cases, but women are generally encouraged to try more conservative measures first, such as Kegel exercises to strengthen pelvic floor muscles or a pessary (a device inserted in the vagina to help support the urethra). Now, advances in surgical techniques have shifted the balance toward considering surgery sooner rather than later, making it available to women with less severe incontinence. The new minimally invasive surgical approaches have broadened the range of likely candidates to include both older and younger women. (However, younger women are generally advised to complete childbearing before they undergo surgery, because a vaginal birth may undo the effects of surgery.)

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