Your Bladder Sling Stopped Working. Now What?

Here’s something I wish every woman over 50 knew: Leaking urine is common, but it’s not a normal part of aging that you simply have to live with. The first is a statistic. The second is a sentence, and too many of us have been handed it.

Kim, a member of the Wellness Experiment, asked: “I would like to know what you feel is the best solution for bladder incontinence. I am 70 years old and a colon cancer survivor. I had a colon resection, radiation and chemo. I had a bladder sling 15 years ago and it no longer seems to be working.”

Kim, you’re in very good company

As a gynecologist, I came to think of incontinence as the thing a woman mentions with a combination of dread and embarrassment. I want you to know how common an issue this is. In a national study published in JAMA, nearly one in four women ages 60 to 79 reported significant leakage, and close to a third of women over 80 did.

Your case has more than one layer

Stress incontinence is leakage when you cough, laugh, or lift. Urge incontinence, or overactive bladder, is that sudden “I need a bathroom right now” feeling. Many of us have both, and menopause plays a bigger role than most women realize, because falling estrogen thins the tissue of the vagina, urethra, and bladder.

Pelvic radiation can make the bladder stiffer and smaller, and pelvic surgery can affect its nerves. Slings don’t last forever either: In long-term follow-up of the Trial of Mid-Urethral Slings, success rates fell meaningfully within five years. Your sling “stopping” could mean the original leakage returned, or that something new, like overactive bladder, has developed. And, as I often say, it’s possible to have more than one thing going on at a time. You could have two different issues, and those need different fixes.

Get tested before anyone treats you

Expect a urine test, a pelvic exam, a check of how well your bladder empties, and a few days of a bladder diary. It’s tedious, I know, but it’s incredibly useful. With a prior sling and radiation, urodynamic testing is generally recommended before any new procedure, and, ideally, by a urogynecologist.

Vaginal estradiol is the most underused tool here

Low-dose vaginal estradiol, as a cream, a tablet like Vagifem, or a ring like Estring, helps restore the tissue that menopause thins, and may help tissue affected by radiation. A Cochrane review found it may improve incontinence, and the American Urological Association recommends it to help prevent recurrent UTIs. Very little reaches the bloodstream. It won’t repair a sling, but it strengthens the tissue every other treatment depends on. Colon cancer isn’t considered estrogen-driven, but loop in your oncologist just because it’s the smart thing to do.

Pelvic floor physical therapy is the first-line approach. For urge symptoms, Myrbetriq or Gemtesa is generally preferred over older anticholinergic drugs, which research in JAMA Internal Medicine has linked to higher dementia risk. Bladder Botox, nerve stimulation, bulking injections, and repeat procedures are also options, and because radiated tissue heals more slowly, less invasive choices often come first.

What to say to your doctor

Talk to a urogynecologist, bring a bladder diary, and say: “My sling has stopped working, and I’ve had pelvic radiation for colon cancer. I’d like urodynamic testing before we choose a treatment, and I’d like to try vaginal estradiol cream for a while to see how I respond.”

Kim, you’ve earned a bladder that cooperates. The right fix may take some trial and error, but the options are real, and so is the relief.

CAN VAGINAL ESTRADIOL
AFFECT YOUR PARTNER?

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