Stress, urge or mixed: which urine leakage do you have?
The urethra (the tube that carries urine out of the bladder) is held closed by the pelvic floor muscles and the tissues beneath it. Childbirth, menopause, age, weight gain, a long-standing cough, constipation and years of heavy lifting can weaken this support.
| Type | What happens | Main treatment |
|---|---|---|
| Stress incontinence | Leakage with coughing, sneezing, laughing, lifting or exercise | Pelvic floor training; sling surgery if needed |
| Urge incontinence | A sudden, strong urge and leakage before reaching the toilet; frequent trips day and night | Bladder training and medicines; surgery does not help this type |
| Mixed incontinence | Both patterns together | The more troublesome part is treated first |
Getting the type right matters, because a sling treats stress leakage but can make urgency worse. Read more about urinary incontinence.
Who needs urine leakage treatment, and who is suited to sling surgery
Any woman whose leakage bothers her deserves an assessment, whatever her age. Sling surgery is usually suited to women who:
- have stress leakage confirmed on examination or tests
- have tried supervised pelvic floor training for about three months without enough improvement
- have completed their family, since pregnancy and delivery can strain the repair
- are fit for a short operation under anaesthesia
A sling is not the right choice for leakage that is mainly urge, for a bladder that does not empty well, or while an infection is untreated. Women with a bulge in the vagina may need prolapse surgery, sometimes along with a sling. Urge leakage is covered in our overactive bladder guide.
Treatment without surgery: pelvic floor training and lifestyle
Guidelines advise supervised pelvic floor muscle training as the first treatment for stress leakage. A physiotherapist or trained nurse checks that you are squeezing the right muscles, then you practise at least eight squeezes, three times a day, for about three months.
- Lose weight if you are overweight; even a modest loss can reduce leakage
- Treat a chronic cough and constipation, which strain the pelvic floor
- Keep fluids steady; cutting down too much makes urine concentrated and irritating
- Reduce tea, coffee and fizzy drinks if urgency is part of the problem
- Squeeze your pelvic floor just before you cough, sneeze or lift
For urge symptoms, bladder training (slowly stretching the time between toilet visits) and medicines that calm the bladder muscle are added. After menopause, vaginal oestrogen cream can help the tissues. Read more in our guide to female urinary incontinence.
Tests and preparation before sling surgery
- Urine culture to rule out infection
- Bladder diary for three days
- Cough stress test: coughing with a comfortably full bladder to see the leak
- Ultrasound with residual urine and uroflowmetry to check emptying
- Urodynamics when the picture is mixed or unclear, after previous surgery, or with emptying problems (see what a urodynamic test involves); in clear stress leakage it may not be needed
- Cystoscopy if there is blood in the urine or a previous tape
Before surgery you will have blood tests and an anaesthesia check. Tell the team about blood thinners and diabetes medicines. Stopping smoking helps wound healing.
How sling surgery for stress incontinence is done (TOT, TVT and fascial sling)
A mid-urethral sling places a narrow strip of synthetic tape (polypropylene mesh) under the middle of the urethra, like a hammock. When you cough, the urethra is pressed against the tape and stays closed. The tape is not tightened; tissue grows into it and holds it in place.
- You receive spinal or general anaesthesia, or sometimes local anaesthesia with sedation.
- A small cut is made in the front wall of the vagina, under the urethra.
- TVT (retropubic): the tape passes behind the pubic bone and out through two tiny cuts just above it. A cystoscope is used during the operation to check that the bladder is not injured.
- TOT (transobturator): the tape passes outwards through two tiny cuts in the groin creases, away from the bladder.
- The cuts are closed with dissolving stitches. The operation usually takes 30-45 minutes.
Autologous fascial sling: a strip of your own tissue (fascia, the tough layer over the tummy muscles) is taken through a cut above the pubic bone and placed under the urethra. No permanent synthetic material is left, but the wound is larger, the stay is longer and temporary emptying difficulty is more likely. It suits women who prefer not to have a tape, or who have had tape problems.
Equipment and where it is done
Surgery is done at ManglamPlus Medicity, Mansarovar, using a sling tape kit with thin introducer needles, a cystoscope and fine dissolving stitches.
Tape complications and informed consent
Mid-urethral tapes help many women, but they can cause problems, and you should know about them before deciding. Guidelines from bodies such as NICE in the UK and the European Association of Urology ask that women are told about these risks, offered non-tape options, and given time to decide.
- Pain: in the groin or inner thigh (more common after TOT), the pelvis, or during intercourse; usually settles, but can last
- Tape exposure or erosion: the tape showing through the vaginal wall, or rarely wearing into the bladder or urethra
- Voiding difficulty: a slow stream or inability to pass urine; sometimes the tape needs loosening or cutting
- New or worse urgency
- Bladder injury during TVT, usually seen and corrected at the time
- Leakage continuing or returning over the years
The tape is permanent. If it causes trouble, it can be trimmed, cut or partly removed, but complete removal is a bigger operation and may not relieve all pain. You will receive written information and can ask questions over more than one visit. Choosing not to have a tape is always an option.
Hospital stay and recovery after sling surgery
| Time | What usually happens |
|---|---|
| Day of surgery | A catheter for a few hours or overnight; when it is removed, the urine you leave behind is checked on ultrasound |
| Day 1 | Home after a TOT or TVT; after a fascial sling, usually two to three days in hospital |
| Weeks 1-2 | Walking and light work; desk work after one to two weeks; mild groin discomfort and spotting are common |
| Weeks 3-6 | No heavy lifting, straining or intercourse until about six weeks; avoid constipation |
Continue pelvic floor exercises afterwards. Call +91 9649888222 if you cannot pass urine, have fever, bleeding more than a period, increasing pain, or a foul discharge.
Comparing treatments for stress urinary incontinence
| Option | Stay | Points to weigh |
|---|---|---|
| Pelvic floor training | None | No surgical risk; needs daily practice for months |
| TVT (retropubic tape) | Day-care or overnight | Small risk of bladder injury, checked at the time; less groin pain |
| TOT (transobturator tape) | Day-care or overnight | Bladder injury less likely; groin and thigh pain more common |
| Fascial sling | Two to three days | No permanent tape; larger wound and more emptying difficulty |
The decision is made together after your tests. If repeated infections are part of the picture, see recurrent UTI treatment. All women’s bladder services are listed on the female urology page.
Cost of urine leakage treatment for women in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- Whether urodynamics or cystoscopy is needed before surgery
- The type of sling: a synthetic tape (TOT or TVT) or a fascial sling using your own tissue
- Whether the operation is day-care or needs one or more nights in hospital
- The room category you choose at ManglamPlus Medicity
- Whether prolapse repair is done at the same time
- Your insurance policy’s terms, such as waiting periods and room-rent limits
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Urine leakage treatment for women with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Will I be completely dry after sling surgery?
The aim is to stop or greatly reduce leakage on coughing and effort, and many women notice a clear improvement. Some leakage may remain, and urge symptoms may continue and need separate treatment.
Is the sling tape the same as the vaginal mesh in the news?
Most concerns relate to larger mesh sheets placed through the vagina for prolapse. The sling tape is a narrow strip, but it is still mesh and can cause the problems described above, which is why they are discussed before consent.
Can I have a sling if I want more children?
It is usually advised to wait until your family is complete, because pregnancy and delivery can strain the repair. Pelvic floor training is used in the meantime.
Will sling surgery affect my sex life?
Most women resume intercourse after about six weeks. Some notice pain or a change, often temporary. Dr. Negi presented research on sexual function after TVT at SZUSICON 2013, and you can discuss this openly.
What happens if the tape causes problems later?
Depending on the problem, the tape can be loosened, cut, or partly or fully removed. Tell the clinic about new pain, discharge, bleeding or difficulty passing urine at any time after surgery.
Is peshab tapakna just part of getting older?
It is common with age and after childbirth, but it is not something you must accept. Treatment usually starts with exercises and simple changes.
Is sling surgery covered by insurance?
Cover depends on your policy and the hospital’s empanelment. Please confirm with the ManglamPlus Medicity billing desk. See payment and insurance.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.