A bladder tack is a surgical procedure that lifts and secures the bladder neck or urethra to nearby tissue in the pelvis, preventing urine from leaking during physical activities like coughing, sneezing, or exercise. The formal medical name is bladder neck suspension, with the most common version being the Burch colposuspension. The term “tack” comes from the idea of stitching the bladder into a higher, more supported position, much like tacking fabric in place.
Why the Procedure Is Done
A bladder tack treats stress urinary incontinence, which is leaking that happens when pressure is placed on the bladder. This is different from the sudden, intense urge to urinate that comes with an overactive bladder. Stress incontinence is common in women after pregnancy, childbirth, or menopause, when the muscles and connective tissue supporting the urethra weaken or stretch. When that support gives way, the urethra can shift out of its normal position, and physical movements create enough force to push urine past the weakened seal.
Surgery is typically considered after non-surgical options like pelvic floor exercises, physical therapy, or pessary devices haven’t provided enough relief. You don’t need to meet a single diagnostic threshold to qualify. Instead, the decision usually comes down to how much the leaking affects your daily life and whether conservative treatments have had a fair trial.
How the Procedure Works
The core idea is straightforward: a surgeon places stitches in the tissue alongside the urethra and anchors them to a strong ligament behind the pubic bone (called Cooper’s ligament). This lifts the bladder neck back into a position where it can resist downward pressure during movement. The stitches hold the tissue in place permanently, and over time, scar tissue forms around the repair to add further stability.
The surgery can be performed through a traditional open incision in the lower abdomen or through small laparoscopic incisions using a camera and specialized instruments. A study comparing the two approaches in 157 patients found that the actual suspension technique, including suture placement and the degree of tension, was the same regardless of approach. The laparoscopic version generally means less post-operative pain and a shorter hospital stay, though the open approach gives the surgeon a wider view of the surgical area.
What Recovery Looks Like
Most people can expect to limit their activities for a full six weeks after surgery. During that window, you should avoid lifting anything heavier than about 20 pounds. Roughly 30 to 40 percent of patients go home with a catheter, which is usually removed at a follow-up visit about one week later, when you’ll do a “voiding trial” to confirm you can empty your bladder on your own.
Pain after surgery is common but usually short-lived. About 45 percent of patients report some new pain at the two-week mark, but by six weeks that number drops to under 7 percent. Severe pain at six weeks is rare, affecting less than 1 percent of patients. Over-the-counter anti-inflammatory medication is the primary tool for managing discomfort, with stronger pain medication prescribed in small quantities for the first few days.
Success Rates and Long-Term Results
A five-year follow-up study found that the Burch colposuspension had an objective cure rate of about 74 percent and a subjective cure rate (meaning patients felt their symptoms were resolved) of roughly 77 percent. Those numbers hold up well over time, though some patients do need a repeat procedure. In a major trial called the SISTEr study, 13 percent of Burch patients required retreatment within five years, compared to 4 percent of those who had an alternative procedure using the body’s own tissue as a sling.
Surgical complications within five years, including the need for a second surgery or urinary retention (difficulty emptying the bladder), occur in about 5 percent of patients. Urinary retention is the most commonly reported issue. Women who had slow urine flow before surgery appear to be at higher risk for this complication.
How It Compares to Sling Procedures
Mid-urethral slings have largely replaced the traditional bladder tack as the go-to surgical option for stress incontinence. Slings use a small strip of synthetic mesh or the patient’s own tissue, placed under the urethra like a hammock, to provide support. They’re faster to perform, require smaller incisions, and have comparable or better long-term cure rates.
That said, the Burch colposuspension still has a recognized role. The American Urological Association lists it alongside sling procedures as a recommended surgical option with strong evidence behind it. It’s a particularly good fit for women who want to avoid synthetic mesh or who are already having abdominal or pelvic surgery for another reason, such as a hysterectomy or pelvic organ prolapse repair. In those cases, the bladder tack can be added during the same operation without a separate recovery period.
Who Is a Good Candidate
The best candidates are women with confirmed stress urinary incontinence whose urethra has lost its normal support. If your leaking is primarily triggered by physical effort rather than sudden urges, and you’ve tried non-surgical options without adequate improvement, a bladder tack may be worth discussing. Women with mixed incontinence (both stress and urge symptoms) can still benefit, though the procedure only addresses the stress component.
Your surgeon will likely want a clear picture of how your bladder functions before recommending surgery. This sometimes includes urodynamic testing, which measures how well your bladder stores and releases urine, though the value of this testing in predicting surgical outcomes is debated among specialists. What matters most is a thorough conversation about your symptoms, your goals, and which surgical approach fits your situation.