Stress Urinary Incontinence: the Treatment Options
Leaking urine when you cough, sneeze or exercise. The type has to be established first, and treatment should begin with the least invasive step — surgery is not the first option.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
Where surgery is needed, the mid-urethral sling is the most common method; the details, and an honest discussion of mesh, are on a separate page. Go to the TOT sling surgery page
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- Procedure time
- Sling surgery 30–45 minutes
- Anesthesia
- Spinal or general anaesthesia
- Hospital stay
- Day case or 1 night
- Stay in Türkiye
- 5–7 days
- Return to work
- 1–2 weeks
- Flight clearance
- 5–7 days
About the condition
Stress urinary incontinence is the involuntary loss of urine at moments when pressure inside the abdomen rises — coughing, sneezing, laughing, lifting or exercising. The "stress" here is not emotional tension but the physical load placed on the bladder. The cause is weakening of the muscles and supporting structures that keep the urinary passage closed; childbirth, the menopause, a chronic cough, constipation and excess weight are the main contributing factors.
THE TYPE MUST BE ESTABLISHED FIRST, AND THAT DISTINCTION CHANGES EVERYTHING. In the stress type, leaking occurs with physical strain and without any preceding urge. In the urgency type, an overwhelming need to pass urine comes first and the leak happens before the toilet can be reached. These are different conditions: in the stress type the supporting structure is at fault, in the urgency type the bladder muscle is overactive.
WHY DOES THIS DISTINCTION MATTER SO MUCH? Because the treatments are opposites. A sling operation brings no benefit in the urgency type and can cause difficulty passing urine. Many women are treated for the wrong type. Where the picture is mixed, it is established which complaint predominates and that one is addressed first.
PELVIC FLOOR TRAINING IS THE FIRST STEP AND IT GENUINELY WORKS. Exercising the right muscle in the right way, kept up regularly for at least three months, markedly reduces symptoms in many women. There are two pitfalls here: tightening the wrong muscle (abdomen or buttocks), and giving up after a few weeks. For that reason learning it with a physiotherapist is advisable where possible. Skipping this step and going straight to surgery is not the right course.
Losing weight, relieving constipation and treating a chronic cough are also part of treatment. These are not "side recommendations"; they act directly by reducing pressure inside the abdomen.
SURGERY: THE MID-URETHRAL SLING. When exercise and lifestyle changes are not enough, a sling is placed beneath the middle part of the urinary passage so that it is supported at the moment of a cough. The sling may be a synthetic tape (mesh) or may be fashioned from the patient’s own tissue (autologous fascia).
Who is it suitable for?
May be suitable
- Women in whom the stress type has been confirmed by history and examination
- Women who have gained insufficient benefit despite at least three months of regular pelvic floor training
- Women whose symptoms restrict daily life, work or social activity
- Women in whom contributing factors such as weight, constipation and chronic cough have been addressed
- Women who have completed their family — pregnancy can undo the effect of a sling
May not be suitable
- Women in whom the urgency type predominates — a sling brings no benefit in this type and can cause difficulty passing urine
- Women who have not tried the exercise step at all — that step comes first
- Women planning a pregnancy — surgery is deferred until afterwards
- Women with an active urinary tract infection — this is treated first
- Women who do not empty the bladder fully — urodynamic assessment is needed first
- Women with marked accompanying pelvic organ prolapse — the treatment plan is drawn up together
Technology used
- Detailed history and a bladder diary — the most valuable tool for establishing the type
- Demonstrating the leak with a cough (stress) test
- Measuring residual urine after voiding
- Urodynamic study — in mixed type, after previous surgery, or where the diagnosis is not clear
- Mid-urethral sling (synthetic tape or autologous fascia)
- Urethral bulking agent injection — in selected women
Surgeon's experience
Verifiable information
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Step 1
Establishing the type
You are asked in detail about the circumstances in which leaking occurs and a bladder diary is requested for a few days. A cough test is carried out at examination. This step matters far more than the decision to operate.
- Step 2
Addressing contributing factors
Weight, constipation, chronic cough and urinary infection are assessed. Treatment given without correcting these produces poorer results.
- Step 3
Pelvic floor training (at least 3 months)
You are taught to exercise the right muscle in the right way, preferably with a physiotherapist. Kept up regularly, this spares many women an operation.
- Step 4
Surgical assessment if benefit is insufficient
A urodynamic study is carried out if needed. The type of sling (synthetic or your own tissue) and the alternatives are discussed with you.
- Day of surgery
Placing the sling
Under spinal or general anaesthesia, the sling is placed beneath the middle of the urinary passage through a small vaginal incision. The procedure takes 30–45 minutes.
- Week 6 onwards
Assessment and follow-up
The outcome is assessed. Continuing pelvic floor exercises after surgery is advised.
Method comparison
| Criterion | Stress type | Urgency type |
|---|---|---|
| When leaking occurs | On coughing, sneezing, straining | After a sudden overwhelming urge |
| Preceding urge | None | Marked |
| Leaking at night | Uncommon | More common |
| Underlying problem | Weakened supporting structures | Overactive bladder muscle |
| First step | Pelvic floor training | Bladder training and medication |
| Sling surgery | May be appropriate | Not appropriate — brings no benefit |
In the mixed type both complaints occur together; whichever predominates is treated first. Treating the wrong type means both that the symptom persists and that an unnecessary operation has been performed.
Risks
- THE SYNTHETIC SLING (MESH) CONTROVERSY: in some countries the use of synthetic slings has been restricted or suspended because of reported complications. That is a fact and it should not be withheld from you. The problems reported include the sling becoming exposed through the tissue (erosion), persistent groin or intercourse pain, and complications that are difficult to put right by removal. For that reason the decision should be taken together with you, after the alternatives have been set out plainly
- New-onset urgency (de novo urgency) — this can begin after surgery
- Difficulty passing urine or incomplete emptying — if the sling is too tight
- Urinary tract infection
- Bleeding and bladder injury — during surgery, uncommon
- The leaking not resolving completely, or partially returning over time
- Pain — in the groin, inner thigh or during intercourse
- The effect lessening after a pregnancy — which is why surgery is deferred in women who have not completed their family
Alternatives
- Pelvic floor training — the first step; with a physiotherapist where possible, for at least 3 months
- Weight loss and treatment of constipation and chronic cough
- A vaginal pessary (support ring) — for women who do not want, or are unsuited to, surgery
- Urethral bulking agent injection — less invasive; the effect is usually temporary and it can be repeated
- AUTOLOGOUS FASCIAL SLING — a sling fashioned from the patient’s own tissue; an important option for women who do not want synthetic material
- Colposuspension — an older but still valid operation that uses no synthetic material
- Doing nothing and using pads — a legitimate choice where symptoms are mild
Recovery
First 48 hours
Mild discomfort and spotting are expected. Whether the bladder empties fully is checked.
Week 1
Gentle walking is allowed. Heavy lifting, straining and movements that load the abdominal muscles are not.
Weeks 2–4
A return to desk work is possible. Avoiding constipation matters; straining puts load on the sling.
Week 6
A return to sexual activity and sport is planned during this period with the surgeon’s approval. The outcome is assessed.
Long term
Continuing pelvic floor exercises is advised. If a new symptom appears (pain, difficulty passing urine, bleeding), seek advice without delay.
Frequently asked questions
Is mesh safe? I have read negative reports.
What you have read is true. In some countries the use of synthetic slings has been restricted or suspended because of reported complications. The problems reported include the sling becoming exposed through the tissue, persistent groin or intercourse pain, and difficulty in removing it. Do not trust anyone who does not tell you this. At the same time, the method has given good results for many women. The right thing is to explain both the benefit and the risk to you and to set out plainly the alternatives that contain no synthetic material (a sling from your own tissue, colposuspension, a bulking agent). The decision is yours.
Can a sling be made from my own tissue?
Yes. In an autologous fascial sling, tissue taken from your own abdominal wall or thigh is used as the sling. The risk of erosion associated with synthetic material disappears. In return, a second incision is needed and the operation takes longer. If you do not want synthetic material, this option must be discussed.
Must I do the exercises first? Can I not go straight to surgery?
Pelvic floor training is the first step and should not be skipped. Done correctly and kept up for at least three months, it markedly reduces symptoms in many women and spares them an operation. Surgery is hard to reverse; it makes sense to try the reversible step first.
How do I know I am doing the exercises correctly?
The commonest mistake is tightening the abdominal, buttock or leg muscles. The right muscle is the one you tighten when trying to hold urine in. It should be done without holding your breath or squeezing your abdomen. Learn it with a physiotherapist if you can; exercises done wrongly not only fail to work but lead to the mistaken conclusion that "exercise did not help".
Will the leaking stop completely?
The aim is to bring symptoms down to a level that does not restrict your daily life. In some women the leaking stops altogether, in others it is markedly reduced. It can also return partially over time. Be wary of anyone guaranteeing complete and permanent dryness.
Can urgency start after the operation?
In some women a new sensation of urgency appears after surgery (de novo urgency). This is a recognised occurrence and can usually be managed with bladder training and medication. What matters is that the possibility was discussed before surgery.
I am planning to have a baby — can I have the operation?
Deferring surgery until you have completed your family is advised. Pregnancy and childbirth can reduce the effect of a sling, so an operation done beforehand may be short-lived in its benefit.
Does everyone have a urodynamic study?
No. If the history and examination establish the diagnosis clearly, it may not be needed. But urodynamics is requested where the picture is mixed, where you have had previous surgery in this area, where the bladder does not empty fully, or where the findings conflict — because an operation based on the wrong diagnosis does not work.
When can I return to work and sport?
A return to desk work is usually possible within 1–2 weeks. For sport, heavy lifting and sexual activity, waiting 6 weeks and obtaining the surgeon’s approval is advised. Returning early puts load on the sling.
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