Bladder Suspension

Medically Reviewed by Minesh Khatri, MD on April 09, 2023
5 min read

Bladder suspension refers to surgery that helps place a sagging bladder back into its normal position. Is this type of surgery right for you? Here are answers to some of the most common questions, from who may need this procedure to possible complications.

Bladder suspension (or bladder neck suspension) surgery is a procedure that can be used to treat urine leakage that occurs when a person sneezes, laughs, or coughs -- a condition called stress incontinence. Childbirth, as well as hormonal changes that come with menopause, can cause a woman to lose muscle tone along the pelvic floor. That can lead to stress incontinence.

Your doctor may recommend bladder suspension surgery if you have moderate to severe stress incontinence that does not get better with non-invasive treatments such as Kegel exercises, medications, and electrical stimulation.

For example, bladder suspension surgery may be an option if you develop stress incontinence because of:

  • Childbirth
  • Menopause
  • Problems with the muscles in the bladder and urethra (the tube that carries urine from the body)
  • Surgery

Before considering bladder suspension surgery, make sure your symptoms are actually brought on by stress incontinence. If need be, seek a second opinion. Bladder suspension surgery only helps treat stress incontinence. It is not helpful for other forms of incontinence. The No. 1 reason surgery fails is an incorrect diagnosis.

There are different ways to place the bladder back to its normal position. Bladder suspension surgical techniques include:

  • Open retropubic suspension surgery
  • Laparoscopic retropubic suspension surgery
  • Needle bladder neck suspension surgery

Open retropubic suspension surgery involves pulling up the bladder neck and sewing it to the surrounding bone or tissue with sutures. It is a form of abdominal surgery. The surgeon makes an incision in the belly area a few inches below the belly button and locates the bladder and urethra, the tube through which urine flows out of the body. The procedure improves symptoms of stress incontinence that result from sagging of the bladder neck or urethra.

Laparoscopic retropubic suspension surgery has been around since the early 1990s. It uses a smaller incision than the open procedure. However, some studies show that laparoscopic bladder suspension results in a higher complication rate, and that the open technique tends to produce higher cure rates. Recent research suggests that these procedures could allow for a speedier recovery and offer other advantages, but more research is needed to check long-term safety and effectiveness.

Needle bladder neck suspension surgery may be done through the abdomen or vagina. However, it does not appear to work as well as stress incontinence surgeries that are done through the abdominal wall.

Sling surgery uses a piece of body tissue, called fascia, or a man-made material to create a sling or hammock-like structure that cradles the sagging bladder neck. This supports the bladder neck and urethra. You can use your own tissue for the surgery (if so, it is removed from your abdominal wall) or donated tissue.

You and your doctor will discuss which procedure is best for you. Your doctor will consider the following factors when choosing your procedure: Other health conditions you may have, the anatomy of your urinary tract and surrounding structures, and the surgeon's experience. Open retropubic suspension surgery and sling surgery require a hospital stay. The insertion of mesh slings to support the urethra can be done as an outpatient procedure.

All surgeries have risks. The most common complication after any type of retropubic suspension surgery is trouble urinating. Less than 5% of patients have permanent urinary retention. This may require urinary catheterization from time to time but rarely requires surgery.

Other complications associated with retropubic suspension surgery are rare but may include:

  • Abscess
  • Bladder spasms
  • Bleeding
  • Blood clots
  • Injury to the bladder, urethra, and other urinary tract structures
  • Infection (catheter-related infections are the most common)
  • Overactive bladder
  • Reactions to anesthesia
  • Vaginal prolapse

Complications associated with sling surgery may include:

  • Injury to the bladder, urethra, and other urinary tract structures
  • Infection (catheter-related infections are the most common)
  • Man-made sling material may wear away, leading to infection or reduced effectiveness
  • Reactions to anesthesia
  • Overactive bladder
  • Trouble urinating after the procedure
  • Painful intercourse
  • Pelvic or groin pain

Bladder suspension surgery works well to treat stress incontinence in most cases. Success rates for open retropubic suspension surgery range from 85%-90%. But, the effects do not last forever. Symptoms can return over time, usually after five years. Success rates also drop as the number of bladder suspension surgeries you have go up.

How successful the surgery is for you depends on:

  • Activities after surgery
  • How long you have had stress incontinence
  • Other surgeries and medical conditions you may have
  • Your age
  • Your weight

The following can make bladder suspension surgery less effective:

Reasons the surgery may not work may include:

  • You have a different type of incontinence (such as urge incontinence)
  • Problems with healing
  • Obesity
  • The surgical technique used


How fast you recover depends on the specific procedure. Open retropubic suspension surgery is done under general anesthesia, and requires a hospital stay. The surgery itself takes about one hour, but discomfort can last 6-8 weeks. Some sling procedures may be done under local anesthesia in an outpatient clinic. In general, recovery times are longer for procedures done through the abdomen, and shorter for those done through the vagina or via laparoscopic incisions.

Follow your doctor's instructions carefully after surgery. Avoid activities that put stress on the bladder and vaginal area. For example:

  • Do not use tampons or douches for 6 weeks
  • Avoid intercourse for 6 weeks
  • Do not strain during bowel movements
  • Avoid strenuous exercise
  • Do not do any heavy lifting

Remember, the most common reason surgery fails to improve symptoms is an incorrect diagnosis. That means, if you still have urinary leakage when you cough and sneeze after bladder suspension surgery, be sure to tell your doctor. You may have another medical condition causing the problem, and may need additional treatment or tests.