The non-surgical and surgical treatment options on this page are available for stress incontinence (not urge incontinence). Talk to your GP, pelvic floor physio or continence nurse to find out the best treatment in your case.
Non-surgical treatment options
Non-surgical treatment options are often tried before considering surgical treatment. Examples of non-surgical treatment options include:
- pelvic floor exercise
- weight loss
- continence pessaries
- incontinence pants or pads
- lifestyle changes such as reducing high impact activities that cause incontinence
- other self-care for bladder control problems.
Surgical treatment options
When non-surgical treatment options have been tried and been unsuccessful, surgical treatment options may be considered. It is important to ensure that you know what specific questions to ask of your surgeon. Finding a credentialed surgeon with experience in these procedures is essential.
Not everyone will undergo the same procedure. Your doctor or surgeon may recommend one method over another for different clinical reasons. Discuss with your doctor or surgeon to find out which procedure is most suitable for you. Your doctor or surgeon will consider all relevant issues, including your previous surgical history and your wishes.
Surgical treatment can be further divided into procedures that do not involve a mesh implant and procedures that do use surgical mesh. Procedures not involving mesh are summarised in the table below.
Procedures not involving mesh currently recommended by the Ministry of Health
|Type of surgery
An operation that is carried out through open or keyhole surgery through your abdomen. Permanent synthetic sutures (stitches) are used to lift your vagina and support your urethra (the pipe through which your bladder empties).
Natural or biological tissue sling
Open surgery through your abdomen to lift your urethra using a sling from your own abdominal wall.
Type of slings that are used include:
- natural sling such as fascia
- biological sling such as biological material of animal origin.
Urethral bulking agents
Vaginal operation where a synthetic ‘bulking’ material is injected in or around your urethra to improve the seal. This material may be permanent or absorbed by your body.
Procedures involving surgical mesh implants
The term ‘surgical mesh’ refers to a permanent synthetic implant that is made from a non-absorbable polypropylene (plastic) material. It is known by multiple names including tape, sling, TVT, patch, ribbon, graft or hammock.
A mesh implant is used to support and hold your urethra, similar to the function of ligaments that are weakened in the case of incontinence. It will stay in your body permanently as it is non-absorbable.
The most common procedure involving mesh is known as a mid-urethral sling (MUS) procedure.
Two procedures can be used to place the sling:
- retropubic method – inserted from behind your pubic bone
- transobturater method – inserted via the top of your inner thigh on each side.
However, the Ministry of Health only recommends that surgeons use the retropubic approach, not the transobturator method. A diagram of this process can be found on page 7 of this MOH guide.(external link)
Complications and adverse events from surgical mesh implants
Unfortunately, all surgical procedures have complications and risks. The most common complications from mesh surgery include:
- pain, including pelvis, back, leg, groin, buttock and vaginal pain
- mesh erosion through your vagina (also called exposure, extrusion or protrusion)
- damage to your bladder
- urinary problems, including urinary tract infections (UTI)
- recurrent incontinence
- pain during sexual intercourse
- organ perforation (hole)
- neuromuscular problems, including acute pain and/or chronic pain in your groin, thigh, leg, pelvic and/or abdominal area
- vaginal scarring
- potentially the new onset of autoimmune conditions (research into this is ongoing as this link has not yet been fully established).
Read more about surgical mesh, including questions to ask your doctor before considering a surgical mesh implant.