Urinary incontinence

Urine leakage takes different forms

If urine leaks when you cough, laugh, jump or lift something heavy, we call it stress urinary incontinence. The word “stress” here refers to physical strain, not psychological stress.

It’s a different situation when you suddenly feel a strong urge and can’t make it to the toilet in time. We call this urge incontinence. The two types can occur together. A frequent, urgent need to urinate may be linked to an overactive bladder, which may or may not be accompanied by urine leakage.

Telling them apart matters, because each type requires different treatment. Sling surgery designed for stress incontinence may not resolve an urgent need to urinate.

Treatment tailored to your needs

For stress incontinence, targeted pelvic floor physiotherapy is often an important first step. You’ll learn how to engage the muscles correctly and avoid putting unnecessary strain on them during everyday movement. If the problems persist, we can consider sling surgery or injection treatment. We describe these options in more detail in our text on treating stress incontinence.

For an urgent need to urinate, bladder training, changes to your habits and, depending on the situation, medication can help. If that isn’t enough, further treatment can be considered, for example botulinum toxin injected into the bladder wall. We’ll discuss the benefits and possible limitations in advance, including the risk of difficulty urinating.

TVT and TOT slings and other options

You hold back when you laugh, you wear a pad when you run, and a sneeze can catch you off guard. Leaking urine during physical exertion can gradually change even small everyday habits. If it’s limiting your life, we can look for a solution together.

Stress incontinence is related to insufficient support of the urethra or a weakening of its closure. We choose treatment based on the examination, the severity of your symptoms, previous care and your wishes. Targeted physiotherapy is an important option. If it doesn’t bring enough relief, a procedure can be considered.

How a sling works

In sling surgery, a narrow synthetic tape is placed under the urethra. It provides support that helps reduce urine leakage when you cough or when pressure in the abdomen rises in other ways. It is a permanent implant, most often made of polypropylene.

The TVT and TOT methods differ in the route of insertion. With TVT, the tape passes behind the pubic bone; with TOT, it passes through the sides of the pelvis toward the groin. The choice is made for specific reasons and is based on your findings. We’ll also discuss other surgical options if they might suit you better.

What to expect from surgery

For many women, a sling brings long-term improvement. However, the result cannot be guaranteed and also depends on the type of incontinence, your health and any previous procedures. If leakage on exertion is combined with a sudden urge, both components may need to be treated separately.

The risks are also part of the conversation. They include bleeding, infection, injury to surrounding structures, difficulty urinating or a new urge to urinate. Pain or exposure of the tape in the vagina may occur, and sometimes another procedure is needed. The range of complications differs between methods. Completely removing a sling once it has been placed may not be easy, or even possible.

The purpose of the consultation is for you to understand what the procedure can offer you and what limitations need to be weighed.

Injection treatment with Bulkamid

Bulkamid is a polyacrylamide hydrogel that is injected into the wall of the urethra and helps improve its closure. It is not hyaluronic acid. No tape is placed during this procedure.

The method may suit, for example, women who don’t want a sling or who need a less demanding procedure. However, it is usually less effective than sling surgery, and the injection may need to be repeated. Sometimes a different approach is needed later. Injection treatment also carries risks, such as infection or temporary difficulty urinating.

What about laser?

Laser treatment is often offered as a simple solution for urine leakage. However, reliable evidence of its long-term benefit is limited, and it cannot be considered an equivalent substitute for proven sling surgery. It’s important to be aware of this uncertainty, too, when making your decision.

You don’t need to know which method you want before your visit. First, we’ll find out what problem we’re dealing with, and then together we’ll discuss the options that make sense for you.