Incontinence sling surgery for women is a procedure to treat female stress incontinence. Stress incontinence is the leakage of urine during physical activity, such as coughing, sneezing, or heavy lifting. For incontinence sling surgery, the doctor places a natural or synthetic sling under your urethra. Your urethra carries urine from the bladder to the outside of your body. The sling supports and compresses the urethra to control urination. Incontinence sling surgery is also called a vaginal or bladder sling procedure. It is a surgery with risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having incontinence sling surgery. Other procedures that may be performed Stress incontinence often occurs due to prolapse of pelvic organs, such as the bladder, uterus or rectum. Prolapse is a condition in which the organ slips out of its normal place and protrudes into the vagina. Bladder or uterus prolapse can make incontinence problems worse. As a result, your doctor may perform other procedures during your incontinence sling surgery to treat incontinence. Other procedures can include: Colporrhaphy treats a prolapsed bladder (cystocele) or rectum (rectocele) by repairing the weakened wall between the vagina and the bladder or rectum. The surgery is performed through the vagina. Hysterectomy treats a prolapsed uterus by removing it. Uterine suspension treats a prolapsed uterus by shortening stretched-out ligaments that support the uterus. Alternatively, your surgeon may suspend the uterus with mesh attached to the pelvis. Vaginal vault suspension treats a prolapsed vagina by stitching the upper part of the vagina (vaginal vault) to strong ligaments toward the back of the pelvis. Another version, called a sacrocolpopexy, lifts the vaginal vault by supporting it with mesh, which is attached to the pelvis. Vaginal vault suspension can also treat a uterus, bladder, or small bowel that has slipped out of place due to a weakness in the vaginal wall. Your doctor may recommend incontinence sling surgery to treat stress incontinence. Stress incontinence usually occurs when muscles that support the bladder and hold in urine are weak. It is very common in women who have had children. It is also associated with, or made worse, by the following: Bladder infection Caffeine and alcohol Coughing, sneezing and laughing Diabetes, which can cause excess urine production and nerve damage High impact or contact sports, such as running, softball and tennis Medications that increase urine production, such as “water pills” (diuretics) Obesity Smoking The following specialists perform incontinence sling surgery: Obstetrician-gynecologists specialize in women’s health and pregnancy. Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs. Female pelvic medicine and reconstructive surgeons are urologists or gynecologists who have completed specialized training in women’s pelvic floor disorders. Another name for this specialty is urogynecology. Your incontinence sling surgery will be performed in a hospital or surgery clinic. The procedure varies depending on the type of incontinence sling. The sling can be made of tissue from your own body, someone else’s body, or from a synthetic material. The surgery generally involves looping the sling under your urethra to provide support and compress it to control urination. Your surgeon then attaches the sling to strong tissues in your lower abdomen. Techniques for incontinence sling surgery Your doctor will perform incontinence sling surgery using one of the following approaches: Minimally invasive incontinence sling surgery uses a laparoscope, which is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon will insert a laparoscope and special instruments through small incisions in the belly and vagina to perform the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incision(s) instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. Open incontinence sling surgery allows your surgeon to directly see and access the inside of your body. Your surgeon will make an incision in your vagina and one or two incisions in your lower belly or in the creases of your thighs. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients. Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of incontinence slings and ask why your surgeon will use a particular type for you. Types of anesthesia that may be used Your doctor will perform incontinence sling surgery using either general anesthesia or regional anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable. What to expect the day of your incontinence sling surgery The day of your surgery, you can generally expect to: Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form. Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth. Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive. A surgical team member will start an IV. The anesthesiologist or nurse anesthetist will start your general or regional anesthesia. Your surgeon will perform local anesthesia. A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen. A team member will insert a catheter into your bladder to collect urine. The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable. As with all surgeries, an incontinence sling surgery involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery. General risks of surgery The general risks of surgery include: Anesthesia reaction, such as an allergic reaction and problems with breathing Bleeding, which can lead to shock Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke. Infection and septicemia, which is the spread of a local infection to the blood Potential complications of an incontinence sling surgery There has been some concern about the safety of synthetic slings. Synthetic slings are used in some, but not all, types of incontinence sling procedures. Ask your surgeon about the type of sling you will have and if a procedure that does not use a synthetic sling is an option for you. Potential complications of an incontinence sling procedure include: Damage to the urethra, bladder or vagina Rejection or breakdown of the synthetic material used for the sling Urination problems including frequent need to urinate, difficulty emptying your bladder, and worsening of urine leakage Reducing your risk of complications You can reduce the risk of certain complications by following your treatment plan and: Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery Informing your doctor if you are nursing or if there is any possibility of pregnancy Notifying your doctor right away of any concerns such as bleeding, bloody urine, fever, increase in pain, problems with urination, or wound redness, swelling or drainage Taking your medications exactly as directed Telling all members of your care team if you have any allergies You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for an incontinence sling surgery by: Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times. Asking your doctor if shaving your pubic area is necessary before surgery. Nursing staff usually performs this before the procedure. Following instructions to clear your bowels before surgery. Your doctor will give you directions if this is necessary. Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Pre-operative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed. Losing excess weight before the surgery through a healthy diet and exercise plan Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia. Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process. Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Questions to ask your doctor Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. Contact your surgeon with concerns and questions before surgery and between appointments. It is also a good idea to bring a list of questions to your appointments. Questions can include: Why do I need an incontinence sling surgery? Are there any other options for treating my condition? What type of incontinence sling will I need? Is a non-synthetic sling an option for me? How long will the surgery take? When can I go home? What restrictions will I have after the surgery? When can I return to work, sexual intercourse, and other activities? What assistance will I need at home? How long will I need to have a urinary catheter after the surgery? What medications will I need before and after the surgery? How should a I take my regular medications? How will you treat my pain? When should I follow up with you? How should I contact you? Ask for numbers to call during and after regular hours. Knowing what to expect can help make your road to recovery after incontinence sling surgery as smooth as possible. How long will it take to recover? You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You will have a tube in your bladder called a catheter when you wake up from surgery. This tube drains urine from your bladder until you have healed enough to urinate normally by yourself. Your catheter will generally stay in place for one day or less, depending on the type of incontinence sling procedure you had. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable. You may go home the same day of surgery or stay in the hospital for one to two days, depending on the type of surgery and other factors. Your care team will monitor your healing during this time. Recovery after surgery is a gradual process. Recovery time varies depending on the type of procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes one to three months. Your doctor will give you instructions for rest during your recovery. Restrictions generally include: Applying ice compresses to your genital area for 10 minutes at a time for the first day Not swimming, using a hot tub, or taking a bath for one to two weeks. It is generally okay to take a shower. Not having sexual intercourse for one to three months as directed by your doctor Will I feel pain? Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your surgeon will treat your pain so you are comfortable and can get the rest you need. Call your surgeon if your pain gets worse or changes because it may be a sign of a complication. When should I call my doctor? It is important to keep your follow-up appointments after an incontinence sling surgery. Call your surgeon if you have any concerns between appointments. Call your surgeon right away or seek immediate medical care if you have: Bleeding of your incision, bloody urine, or unexpected vaginal bleeding Breathing problems such as shortness of breath, difficulty breathing, labored breathing, or wheezing Change alertness such as passing out, unresponsiveness, or confusion Chest pain, chest tightness, chest pressure, or palpitations Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever. Inability to have a bowel movement or pass gas Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot Pain that is not controlled by your pain medication, new pain, or severe abdominal or pelvic pain Problems with urination such as not making urine Unexpected drainage, pus, redness or swelling of your incision How might an incontinence sling surgery affect my everyday life? Incontinence sling procedures are not 100% effective in all cases. However, they can relieve or greatly improve the symptoms of stress incontinence so you can lead a more active, healthy life. Life after incontinence sling surgery generally includes more freedom to perform many of your former everyday activities with fewer worries about incontinence.