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Women may use a soft, plastic device called a pessary, which is inserted into the vagina for stress incontinence. The pessary presses against the wall of your vagina and the nearby urethra. The pressure helps hold up the urethra, so you have less leaking.
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Another newer product to treat stress incontinence is a tampon-like disposable device that you can insert into your vagina for up to 12 hours at a time. The product expands to push up against your urethra to help decrease leaks.
The most common surgery to treat stress incontinence in women is sling surgery. In sling surgery for women, a surgeon works through the vagina to insert a strip of material between the vagina and urethra. The surgeon may choose to use a synthetic mesh, a screen-like material that supports weakened or damaged tissue, or the surgeon may choose a biologic graft made from human or animal tissue.
Usually, stress incontinence can be treated with a number of conservative treatments. These include lifestyle changes, exercises, weight loss or devices inserted into the vagina to support the bladder. When these options don't work, surgery may be an option for women with bothersome stress incontinence.
During a retropubic sling procedure, a surgeon makes a small cut in the vagina and uses a needle to pass each end of the sling from the vagina to the abdomen. The sling is held in place by the soft tissue along its path.
During a transobturator sling procedure, a surgeon makes a small cut in the vagina and two small cuts in the groin muscles on either side. Using a needle, the surgeon guides each end of a piece of mesh from the vagina to the groin muscles. The mesh forms a sling to support the urethra, the tube that carries urine from the body. The sling is held in place by the soft tissue along its path.
Another tension-free sling is the single-incision mini procedure. The surgeon makes a single small cut in the vagina. A small mesh hammock is suspended from tissues the pelvic region. The surgeon takes care to avoid the groin muscles. The results of the single-incision mini procedure are generally less effective. More research is needed to determine the safety and effectiveness of this method.
A conventional sling uses tissue from your own body to support the bladder neck. The surgeon collects the tissue to make the sling from either your abdomen or thigh. The surgeon then makes an incision in the vagina to place the sling below the urethra at the bladder neck. From an incision in the abdomen, the surgeon stitches each end of the sling to the abdominal wall.
The most common method is the Burch procedure. The surgeon attaches one end of surgical threads to the outer wall of the vagina and the other end to ligaments near the top of the pelvic bone. The stitches (sutures) essentially suspend the vagina to the pelvic ligament. When the sutures are tightened, the vagina is shifted up to support the bladder neck from below.
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