Stress Urinary Incontinence in Women: How a Mid-Urethral Sling Can Improve Your Quality of Life

Reviewed by Dr. Kenneth Barron, MD

Living with stress urinary incontinence can be frustrating and embarrassing and it's more common than you might think. At least 10-20% of women have significant symptoms of urinary incontinence, but many may not realize there are treatments available to help restore your confidence and improve your quality of life. One of these is the mid-urethral sling, a procedure designed to provide durable long-lasting relief from stress incontinence. Find out how this treatment works, who can benefit from it, and what you can expect from the process.

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What Is Stress Urinary Incontinence?

Stress urinary incontinence is a type of urinary incontinence that occurs when physical movement or activity—such as coughing, sneezing, running, or lifting heavy objects—puts pressure on your bladder, causing urine to leak out. It’s a condition that affects many women, especially after childbirth and becomes more common during menopause.

Symptoms of Stress Urinary Incontinence:

Leaking during physical activities or exertion
Difficulty holding urine when sneezing or coughing
Uncontrollable leaking when laughing or lifting
Involuntary leakage during exercise
Leaking with standing up
Leaking during intercourse
Constant worry about sudden urine leaks
Avoiding social activities due to fear of accidents
Leaking with minimal physical movement

Causes of Stress Urinary Incontinence

Stress urinary incontinence can result from a variety of factors, including pregnancy, childbirth, and aging, chronic cough and genetic factors. These factors can lead to weakness in the pelvic floor muscles that support the bladder and urethra (the tube that carries urine out of the body) or damage to the supportive connective tissue. Hormonal changes during menopause and previous pelvic surgeries can also contribute to the condition.

How a Mid-Urethral Sling Can Help

A mid-urethral sling is an innovative and minimally invasive surgical treatment that provides support to the mid-urethra when the normal supportive connective tissue has failed. The sling acts as a supportive hammock, lifting the urethra back into its proper position, which helps prevent leakage during activities that put pressure on the bladder. The procedure was developed in the mid 1990s and has been performed in the United States since 1998. The mid-urethral sling is considered the most durable long-term solution for stress urinary incontinence with studies showing the need for repeat surgery of 18% at 15 years of follow up and only 8% needing any revision to the original surgery (Dejene SZ et al. Female Pelvic Med Reconstr Surg. 2022 Apr 1;28(4):188-193).

How It Works and What To Expect

The mid-urethral sling procedure involves the placement of a thin mesh sling beneath the urethra. This mesh can be inserted through different approaches, depending on the type of sling used. Common methods include retropubic slings, which pass through a small incision behind the pubic bone, and transobturator slings, which go through incisions in the groin area. Additionally, single incision slings are available that only have one incision made below the urethra.

Once the sling is in place, it works to provide support by creating a backboard for the urethra to push against. When there is increased abdominal pressure through coughing, lifting, or other physical activities, the urethra is pushed against the sling material to close it off.. The entire procedure is relatively quick, typically lasting around 30 minutes, and is performed under local anesthesia or light sedation.

After the procedure, you may experience mild discomfort, but most patients can resume normal activities within a few days. It’s important to follow your surgeon’s guidelines to avoid any postoperative complications, such as urinary retention or mesh exposure. Although these complications are rare, they can occur, especially if proper care isn’t taken during recovery.

Receive Compassionate Care with The Center for Advanced Gynecology

At The Center for Advanced Gynecology, our team is dedicated to helping you regain control of your bladder and quality of life through expert care and advanced treatments. With years of experience in managing stress urinary incontinence and other pelvic floor disorders, we are committed to providing personalized treatment plans tailored to your specific needs.

If you’re struggling with urinary incontinence or considering surgical management for stress incontinence, we can help.

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