Stress incontinence#Transobturator tape

Stress incontinence is the loss of small amounts of urine associated with coughing, laughing, sneezing, exercising or other movements that increase intra-abdominal pressure and thus increasing the pressure on the bladder. The urethra is normally supported by fascia and muscles of the pelvic floor. If this support is insufficient due to any reason, the urethra would not close properly at times of increased abdominal pressure, allowing urine to pass involuntarily.{{cn|date=June 2022}}

Most lab results such as urine analysis, cystometry and post-void residual volume are normal.

Some sources distinguish between urethral hypermobility and intrinsic sphincter deficiency. The latter is more rare, and requires different surgical approaches.{{cite journal |last1=Ghoniem |first1=G. M. |last2=Elgamasy |first2=A.-N. |last3=Elsergany |first3=R. |last4=Kapoor |first4=D. S. |s2cid=29667668 |title=Grades of Intrinsic Sphincteric Deficiency (ISD) Associated with Female Stress Urinary Incontinence |journal=International Urogynecology Journal |date=18 March 2014 |volume=13 |issue=2 |pages=99–105 |doi=10.1007/s001920200023 |pmid=12054190 }}

Stress incontinence in men is most commonly seen after prostate surgery,{{Cite journal|last=Nitti|first=Victor W|date=2001|title=The Prevalence of Urinary Incontinence|journal=Reviews in Urology|volume=3|issue=Suppl 1|pages=S2–S6|issn=1523-6161|pmc=1476070|pmid=16985992}} such as prostatectomy, transurethral resection of the prostate, laparoscopic prostatectomy, or robotic prostatectomy.{{cn|date=June 2022}}

Stress incontinence is more common in women.{{Citation |last=Lugo |first=Tania |title=Stress Urinary Incontinence |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK539769/ |access-date=2025-04-01 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30969591 |last2=Leslie |first2=Stephen W. |last3=Mikes |first3=Beverly A. |last4=Riggs |first4=John}} In women, pregnancy, childbirth, obesity, and menopause often contribute to stress incontinence by causing weakness to the pelvic floor or damaging the urethral sphincter, leading to its inadequate closure, and hence the leakage of urine.{{Cite journal|last1=Subak|first1=Leslee L.|last2=Richter|first2=Holly E.|last3=Hunskaar|first3=Steinar|date=December 2009|title=Obesity and urinary incontinence: epidemiology and clinical research update|journal=The Journal of Urology|volume=182|issue=6 Suppl|pages=S2–7|doi=10.1016/j.juro.2009.08.071|issn=1527-3792|pmc=2866035|pmid=19846133}}{{Cite journal|last1=Rortveit|first1=G.|last2=Hannestad|first2=Y. S.|last3=Daltveit|first3=A. K.|last4=Hunskaar|first4=S.|date=December 2001|title=Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study|url=https://pubmed.ncbi.nlm.nih.gov/11755545/|journal=Obstetrics and Gynecology|volume=98|issue=6|pages=1004–1010|doi=10.1016/s0029-7844(01)01566-6|issn=0029-7844|pmid=11755545|s2cid=20932466}}{{Cite journal|last1=Lukacz|first1=Emily S.|last2=Lawrence|first2=Jean M.|last3=Contreras|first3=Richard|last4=Nager|first4=Charles W.|last5=Luber|first5=Karl M.|s2cid=1399950|date=June 2006|title=Parity, mode of delivery, and pelvic floor disorders|url=https://pubmed.ncbi.nlm.nih.gov/16738149/|journal=Obstetrics and Gynecology|volume=107|issue=6|pages=1253–1260|doi=10.1097/01.AOG.0000218096.54169.34|issn=0029-7844|pmid=16738149}} Stress incontinence can worsen during the week before the menstrual period.{{Citation needed|date=April 2025}} At that time, lowered estrogen levels may lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause, similarly because of lowered estrogen levels.{{Citation needed|date=April 2025}} In female high-level athletes, effort incontinence may occur in any sports involving abrupt repeated increases in intra-abdominal pressure that may exceed perineal floor resistance.{{cite journal |last1=Crepin |first1=G |last2=Biserte |first2=J |last3=Cosson |first3=M |last4=Duchene |first4=F |title=Appareil génital féminin et sport de haut niveau |trans-title=The female urogenital system and high level sports |language=French |journal=Bulletin de l'Académie Nationale de Médecine |date=October 2006 |volume=190 |issue=7 |pages=1479–91; discussion 1491–3 |pmid=17450681 |url=http://www.bdsp.ehesp.fr/Base/357044/ |doi=10.1016/S0001-4079(19)33208-X |doi-access=free }}

Medications are not recommended for those with stress incontinence.{{cite journal |vauthors=Qaseem A, Dallas P, Forciea MA, Starkey M, Denberg TD, Shekelle P |date=September 2014 |title=Nonsurgical management of urinary incontinence in women: a clinical practice guideline from the American College of Physicians |journal=Annals of Internal Medicine |volume=161 |issue=6 |pages=429–440 |doi=10.7326/m13-2410 |pmid=25222388 |doi-access=}} Recommendation 4

Some behavioral changes can improve stress incontinence. It is recommended to decrease overall consumption of liquids and avoid drinking caffeinated beverages because they irritate the bladder.{{Citation needed|date=April 2025}} Spicy foods, carbonated beverages, alcohol and citrus also irritate the bladder and should be avoided. Quitting smoking can also improve stress incontinence because smoking irritates the bladder and can induce coughing (putting stress on the bladder).{{medcn|date=June 2018}} The effectiveness of these approaches to treat people for whom synthetic midurethral tape surgery did not result in a cure (failed surgery) is not clear.

Results of a 2019 systematic review of urinary incontinence in women found that most individual, active treatments are better than no treatment.{{Cite journal|last1=Balk|first1=Ethan M.|last2=Rofeberg|first2=Valerie N.|last3=Adam|first3=Gaelen P.|last4=Kimmel|first4=Hannah J.|last5=Trikalinos|first5=Thomas A.|last6=Jeppson|first6=Peter C.|s2cid=83458685|date=2019|title=Pharmacologic and Nonpharmacologic Treatments for Urinary Incontinence in Women: A Systematic Review and Network Meta-analysis of Clinical Outcomes|journal=Annals of Internal Medicine|language=en|volume=170|issue=7|pages=465–480|doi=10.7326/M18-3227|pmid=30884526|issn=0003-4819}} Behavioral therapy, alone or combined with other interventions such as hormones, is generally more effective than other treatments alone.{{Cite journal|last1=Balk|first1=Ethan|last2=Adam|first2=Gaelen P.|last3=Kimmel|first3=Hannah|last4=Rofeberg|first4=Valerie|last5=Saeed|first5=Iman|last6=Jeppson|first6=Peter|last7=Trikalinos|first7=Thomas|date=2018-08-08|title=Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update|url=https://effectivehealthcare.ahrq.gov/topics/urinary-incontinence-update/final-report-2018|doi=10.23970/ahrqepccer212|s2cid=80659370 |doi-access=free|url-access=subscription}}

One of the most common treatment recommendations includes exercising the muscles of the pelvis. Kegel exercises to strengthen or retrain pelvic floor muscles and sphincter muscles can reduce stress leakage.{{cite journal |vauthors=Choi H, Palmer MH, Park J |s2cid=13508756 |title=Meta-analysis of pelvic floor muscle training: randomized controlled trials in incontinent women |journal=Nursing Research |volume=56 |issue=4 |pages=226–34 |year=2007 |pmid=17625461 |doi=10.1097/01.NNR.0000280610.93373.e1}} Patients younger than 60 years old benefit the most. The patient should do at least 24 daily contractions for at least 6 weeks. It is possible to assess pelvic floor muscle strength using a Kegel perineometer.{{cn|date=June 2022}}

Bladder training is a technique that encourages people to modify their voiding habits (lengthening the time between voiding). Weak evidence suggests that bladder training may be helpful for the treatment of urinary incontinence.{{cite journal |last1=Wallace |first1=Sheila A |last2=Roe |first2=Brenda |last3=Williams |first3=Kate |last4=Palmer |first4=Mary |title=Bladder training for urinary incontinence in adults |journal=Cochrane Database of Systematic Reviews |issue=1 |pages=CD001308 |date=26 January 2004 |doi=10.1002/14651858.CD001308.pub2 |pmid=14973967 |pmc=7027684 }} This type of intervention can take a person months to learn and would not be a therapy option for people who are not physically or mentally able to control their voiding.

An incontinence pad is a multi-layered, absorbent sheet that collects urine resulting from urinary incontinence. Similar solutions include absorbent undergarments and adult diapers. Absorbent products may cause side effects of leaks, odors, skin breakdown, and UTI. Incontinence pads may also come in the form of a small sheet placed underneath a patient in the hospital, for situations when it is not practical for the patient to wear a diaper.{{medcn|date=June 2018}}

People have different preferences regarding the type of pad they use to stay dry when they have incontinence.{{cite journal |last1=Fader |first1=Mandy |last2=Cottenden |first2=Alan M |last3=Getliffe |first3=Kathryn |title=Absorbent products for moderate-heavy urinary and/or faecal incontinence in women and men |journal=Cochrane Database of Systematic Reviews |issue=4 |pages=CD007408 |date=8 October 2008 |doi=10.1002/14651858.CD007408 |pmid=18843748 }} In addition, the effectiveness of incontinence pads differ between people. Using different designs depending on the activity (sleeping/going out/staying in) is recommended. For men, the most cost-effective design is an incontinence pad in a diaper format. For women, incontinence pads that are in the form of disposable pull-ups are generally preferred, however there is a higher cost associated with this type of solution. For women who are in nursing homes, diapers are preferred at night. Washable diapers are cost effective, however, most people do not prefer washable diapers with the exception of some men who prefer as a means to control incontinence at night. There is no evidence that one type of incontinence pad is superior with regard to skin health.

A pessary is a medical device that is inserted into the vagina. The most common kind is ring shaped, and is typically recommended to correct vaginal prolapse. The pessary compresses the urethra against the symphysis pubis and elevates the bladder neck. For some women this may reduce stress leakage, however it is not clear how well these mechanical devices help women with stress urinary incontinence.{{Cite journal|last1=Lipp|first1=Allyson|last2=Shaw|first2=Christine|last3=Glavind|first3=Karin|date=2014-12-17|title=Mechanical devices for urinary incontinence in women|journal=The Cochrane Database of Systematic Reviews|issue=12|pages=CD001756|doi=10.1002/14651858.CD001756.pub6|issn=1469-493X|pmc=7061494|pmid=25517397}}

Doctors usually suggest surgery to alleviate incontinence only after other treatments have been tried. Many surgical options have high rates of success. Less-invasive variants of the sling operation have been shown to be equally effective in treating stress incontinence as surgical sling operations.{{cite journal |last1=Ford |first1=AA |last2=Rogerson |first2=L |last3=Cody |first3=JD |last4=Aluko |first4=P |last5=Ogah |first5=JA |title=Mid-urethral sling operations for stress urinary incontinence in women. |journal=The Cochrane Database of Systematic Reviews |date=31 July 2017 |volume=2017 |issue=7 |pages=CD006375 |doi=10.1002/14651858.CD006375.pub4 |pmid=28756647|pmc=6483329 }} One such surgery is urethropexy.{{Citation needed|date=September 2019}} Insertion of a sling through the vagina (rather than by opening the lower abdomen) is called intravaginal slingplasty (IVS).{{medcn|date=June 2018}}

The procedure of choice for stress urinary incontinence in females is what is called a sling procedure. A sling implant usually consists of a synthetic mesh material in the shape of a narrow ribbon but sometimes a biomaterial (bovine or porcine) or the patients own tissue that is placed under the urethra through one vaginal incision and two small abdominal incisions. The idea is to replace the deficient pelvic floor muscles and provide a backboard of support under the urethra. Transvaginal mesh has recently come under scrutiny due to controversy relating to the Food and Drug Administration. Initially, the FDA approved implantable mesh devices due to their similarity to earlier prototypes, known as the 510(k) process.Shaw JS. Old wine into new wineskins: an update for female stress urinary incontinence. Curr Opin Obstet Gynecol. 2019;31(6):494-500. doi:10.1097/GCO.0000000000000579.Heneghan CJ, Goldacre B, Onakpoya I,etal.Trials of transvaginal meshdevices for pelvic organ prolapse: a systematic database review of the USFDA approval process. BMJ Open 2017; 7:e017125. As patients allege long-term harm and suffering as a result of implanted mesh; the FDA released a safety communication in 2008, and led to the reclassification of surgical mesh to a class 3 or high risk device in January 2016Shaw JS. Old wine into new wineskins: an update for female stress urinary incontinence. Curr Opin Obstet Gynecol. 2019;31(6):494-500. doi:10.1097/GCO.0000000000000579..{{medcn|date=June 2018}} Insertion of a sling through the vagina (rather than by opening the lower abdomen) is called intravaginal slingplasty (IVS).{{medcn|date=June 2018}}

The transobturator tape (TOT or Monarc) sling procedure aims to eliminate stress urinary incontinence by providing support under the urethra. The minimally-invasive procedure eliminates retropubic needle passage and involves inserting a mesh tape under the urethra through three small incisions in the groin area.{{cite book |author=Stenchever MA |contribution=Chapter 21. Physiology of micturition, diagnosis of voiding dysfunction and incontinence: surgical and nonsurgical treatment section of Urogynecology |title=Comprehensive Gynecology |edition=4 |pages=607–639 |year=2001 |isbn=978-0-323-01402-1 }}

A procedure that involves placing polypropylene tape under the outlet from the bladder to improve stress incontinence.{{Cite journal|last1=Bakali|first1=Evangelia|last2=Johnson|first2=Eugenie|last3=Buckley|first3=Brian S|last4=Hilton|first4=Paul|last5=Walker|first5=Ben|last6=Tincello|first6=Douglas G|date=2019-09-04|editor-last=Cochrane Incontinence Group|title=Interventions for treating recurrent stress urinary incontinence after failed minimally invasive synthetic midurethral tape surgery in women|journal=Cochrane Database of Systematic Reviews|volume=2019|issue=9 |pages=CD009407|language=en|doi=10.1002/14651858.CD009407.pub3|pmid=31482580|pmc=6722049}}

Most stress incontinence in women results from the urethra dropping down toward the vagina. Therefore, common surgery for stress incontinence involves pulling the urethra up to a more normal position. Working through an incision in the vagina or abdomen, the surgeon raises the urethra and secures it with a string attached to muscle, ligament, or bone. For severe cases of stress incontinence, the surgeon may secure the urethra with a wide sling. This not only holds up the bladder but also compresses the bottom of the bladder and the top of the urethra, further preventing leakage.{{medcn|date=June 2018}}

A variety of materials have been historically used to add bulk to the urethra and thereby increase outlet resistance. This is most effective in patients with a relatively fixed urethra. Blood and fat have been used with limited success. The most widely used substance, gluteraldehyde crosslinked collagen (GAX collagen) proved to be of value in many patients. The main downfall was the need to repeat the procedure over time.{{medcn|date=June 2018}}

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File:Artificial urethral sphincter - CT coronar 001.jpg

Another procedure to treat incontinence is the use of an artificial urinary sphincter, more used in men than in women. In this procedure, the surgeon enters and wraps the cuff of the artificial urinary sphincter around the urethra, in the same manner a blood pressure cuff wraps around your arm. The device includes a pump implanted under the skin that, when pressed by the patient, loosens the cuff, allowing for free urination. After that, the artificial sphincter automatically regains its pressure, closing the urethra again, and providing proper continence.{{Cite journal |last1=Suarez |first1=Oscar A. |last2=McCammon |first2=Kurt A. |author-link2=Kurt A. McCammon |date=June 2016 |title=The Artificial Urinary Sphincter in the Management of Incontinence |url=https://pubmed.ncbi.nlm.nih.gov/26845050/ |journal=Urology |volume=92 |pages=14–19 |doi=10.1016/j.urology.2016.01.016 |issn=1527-9995 |pmid=26845050}}

No useful studies have been done to determine whether acupuncture can help people with stress urinary incontinence.{{cite journal |last1=Wang |first1=Yang |last2=Zhishun |first2=Liu |last3=Peng |first3=Weina |last4=Zhao |first4=Jie |last5=Liu |first5=Baoyan |title=Acupuncture for stress urinary incontinence in adults |journal=Cochrane Database of Systematic Reviews |issue=7 |pages=CD009408 |date=1 July 2013 |doi=10.1002/14651858.CD009408.pub2 |pmid=23818069 |doi-access=free |pmc=11262557 }}

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• Pelvic organ prolapse
• Artificial urinary sphincter
• Urinary incontinence
• Pelvic floor
• Kegel exercises

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{{Medical resources

| DiseasesDB = 12550

| ICD10 = {{ICD10|N|39|3}}

| ICD9 = {{ICD9|625.6}}{{ICD9|788.32}}

| ICDO =

| OMIM =

| MedlinePlus = 000891

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D014550

}}

{{Urinary tract disease}}

{{Urinary system symptoms and signs}}

Category:Urinary incontinence