Urethral Sling Procedures: What You Need to Know

Understanding Urethral Slings & Tape, from a Double Board Certified Pelvic PT

👋🏼 Hi, there! 👋🏼 Do you have questions on pelvic surgeries?  I can help!  It's me, Dr. Kelly, double board certified Pelvic Physio and YOUR go-to expert for all things pelvis and pelvic floor related!   Today, I want to help answer your questions on urethral sling and urethral tape procedures, from a physical therapy or musculoskeletal perspective. 

In a nutshell, a urethral sling or tape is used to support the base of the bladder and/or urethra to help control leaks.  But the terminology can be confusing, so let's start there. 

Deciphering Urethral Sling Procedures 

What are Urethral Slings / Bladder Slings Made out of?

Urethral slings / bladder slings can be crafted from the patient's tissue (autologous), a cadaver donor (cadaveric), or surgical mesh.

Crucially, urethral slings or tape should support the urethra without crimping or kinking it too much.  If they are too tight, they can cause pain and difficulty peeing when you want to.  

While some amount of post-procedure discomfort is normal, excessive pain, or inability to pee is a red flag, so talk to your surgeon immediately, as in rare cases, the sling/tape does need to be loosened, and in those rare cases, the sooner the sling/tape is loosened, the better the outcomes.

Procedure Options

Transvaginal Sling/Tape (TVT): 

Involves small incisions made anterior to (in front of) the urethra (pee hole).  Incisions are in the lowest part of your belly, just under where your underpants would rest.

Transobturator Sling/Tape (TOT): 

Supports the bladder/urethra via small incisions underneath the vagina, near the upper thigh.

Potential Side Effects of Urethral Sling or Tape:

Local discomfort is a common but manageable occurrence.  Pain can be in the abdomen, low back, tailbone, or actual crotch and inner thigh region.  TOT has a higher incidence of upper/inner thigh pain, and TVT has higher incidence of lower abdominal pain...which makes sense because that's where the incisions are :)

Pelvic floor muscle hypertonicity may manifest and can be effectively treated with Pelvic Floor PT.  Remember that while EVERYONE needs post-operative Pelvic PT, pre-hab of the pelvic floor can be HUGE here in preparing your tissues for surgery!   

I do preoperative Pelvic Floor Connection Exercises with all of my urethral sling clients, most with a tool called a Cooch Ball.  Here is a video on Vimeo, and here is the same link on You Tube.  You can purchase the ball here, but please note while you can do the exercises on the ball before the surgery, you will not be permitted to use the ball for a period of time post-operatively (up to the surgeon) in order to protect the surgical sites.  You will need to discuss the time to return to the ball with your surgeon. 

In rare instances, compression of the urethra may necessitate adjustments to the tape, and it is important that this loosening is done in the first 10 days for optimal outcomes, so talk to your surgeon if you are having excessive pain or problems peeing.

Post-Procedure Care after Urethral Sling or Tape

Immediate consultation with the surgeon is imperative if difficulties with urination persist.

Post-procedure ICE PACKS (like these, from Amazon) can be a GAME0-CHANGER for swelling and pain-control, but frozen peas can also be just as good, just be sure to label them as "mom's peas" or "Kelly's peas" to be sure that everyone in the house knows that "those peas" have gone through a few "freeze-thaw" cycles and maybe aren't the best to be eaten afterwards :)

Pelvic Physiotherapy is important to address common post-procedure pelvic muscle hypertonicity, as well as to correct abnormal movement patterns that we may have developed due to our history of leaks.  Now is the perfect time to reconnect with your pelvis!  It is common to start in weeks 4-6 post-operative, but if you are having high pain levels, sometimes you will start sooner. 

You can expect as few as 2-3 visits, if you did prehab work, or as many as 6 months of post-surgical physical therapy to rebuild foundational movement patterns to return to a full lifestyle with excellent movement patterns with great pressure management.  You should expect to be trained in functional weight lifting and movement patterns regardless of your age, and if your surgeon tells you "to limit lifting", then you should find a new doctor, because that advice is VERY old-school, and is given because they don't know a Physical Therapist who knows how to train you in proper load management.  

K--I hope this was informative for you.  Please comment below if you have more questions, as I am here to help !!

XOXO Dr. Kelly

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