Live, Laugh Leak? How Penn Can Help Women with Urinary Incontinence

woman sitting with hands in lap

Coughing, sneezing, laughing...leaking? If you are a woman who experiences the loss of bladder control during some of your daily activities, you aren’t alone. Occurring after childbirth or as another side effect of aging, urinary incontinence is an uncomfortable and sometimes embarrassing problem that affects millions of American women.

The good news is there are many treatment options that you can discuss with your physician.

What Causes Urinary Incontinence

A variety of issues can cause the bladder to leak. A common cause is a weakening or stretching of the pelvic muscles during childbirth. Some women develop bladder control problems during menopause. Why? Some experts think the loss of estrogen may contribute, though it hasn’t been proven.

You can also have bladder control problems because of:

  • Chronic constipation
  • Certain medicines
  • Caffeine and alcohol
  • Infection
  • Nerve damage from diabetes, neuropathy, childbirth, stroke, trauma, or other causes
  • Being overweight

While not everyone has bothersome symptoms, some people encounter some serious quality-of-life issues,” says Ariana Smith, MD, Director of Pelvic Medicine and Reconstructive Surgery at Penn Medicine.

Treatment Options for Urinary Incontinence

Fortunately, there are many ways to treat urinary incontinence. Your physician might suggest simple lifestyle changes like:

  • a different diet
  • going to the bathroom at specific times
  • performing Kegel exercises (a way to strengthen your pelvic muscles)
  • a pessary— a plastic device that supports the walls of the vagina

Treatment isn’t a one size fits all approach. In more severe cases, surgery is something to consider.

How can surgery for urinary incontinence help me?

There are many types of surgery that have a strong record of success in treating urinary incontinence, such as:

  • Autologous Pubovaginal Sling: The surgeon makes a small cut bikini style in the lower abdomen and removes some tissue that lines the muscles. This tissue is then used to make a sling that supports the urethra and bladder neck.
  • Transvaginal Mesh Surgery: Transvaginal mesh is a knitted plastic mesh implanted through the vagina. It is positioned either to strengthen (support) the vaginal walls in the proper position, or support the urethra and bladder neck. Transvaginal mesh is used for the treatment of prolapse.

Each type of surgery has its own risks, advantages, and disadvantages. For example, in a small number of women, transvaginal mesh surgery has caused serious complications such as pain, bleeding, and infection. In extreme cases, the mesh has eroded the walls of the vagina and pushed into surrounding tissue or organs.

However, In most patients, it provides real relief from the symptoms of pelvic organ prolapse or stress urinary incontinence, Dr. Smith says. Most patients who have undergone transvaginal mesh surgery have a successful, desirable outcome. A minority have complications, and of those, a very small minority have severe ones like mesh erosion.

The autologous pubovaginal sling surgery uses the body’s own tissues, avoiding the potential issues of mesh. But it involves recovery from an abdominal incision, which is generally longer than the recovery from the transvaginal mesh procedure.

infographic of a quote from Dr. Ariana Smith, that reads "the best way to reduce the risk of a complication from a transvaginal mesh implant is to go to a surgeon with great experience in this field"

What can I do about my urinary incontinence?

The best approach is to talk to a highly experienced physician. Your doctor can assess your needs and guide you through the right treatment options for you.

Much of the decision-making about surgery, or any other type of treatment, is based on both physician judgment and patient preference,” Dr. Smith adds. “So it’s important to work with a physician who is highly knowledgeable, who understands your medical situation completely, and who respects your personal wishes.

If you have bothersome symptoms of stress urinary incontinence, contact Penn Urology. Our staff is dedicated to providing expert diagnosis and treatment of disorders of the urinary tract.


After giving birth to her second son, Amy suffered from severe urinary incontinence. It got so bad that she could barely walk across the room or play with her kids without fear of leakage. She decided she had to do something. Watch her story above.

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