Vaginal Laser for Bladder Leaks: What the Trials Show

Some clinics offer vaginal laser as a non-surgical treatment for stress incontinence, the leaks that come with coughing, sneezing or exercise. The lasers were designed for vaginal dryness after menopause and have since been tried for leaks.¹ Here is what the trials show.

Two trials that looked good

Both trials compared laser with a sham, a fake treatment, and used a pad test, which weighs how much urine leaks in an hour.

Trial	Women	Sessions	Success at 6 months
Multicenter trial	110 with stress leaks2	2, a month apart2	59% laser vs 36% sham2
UK, Switzerland and Germany	79 with mild to moderate leaks3	33	63% laser vs 18% sham, counting at least half less leakage3

The review that pooled them

A Cochrane review gathered 9 trials with 689 women, using two kinds of laser.¹

• In the short term, laser may make little or no difference compared with sham or other treatments.¹
• Women’s symptom scores improved by about 1.4 points on average, but that’s below the size women would notice.¹
• One trial of 76 women suggested more women might be dry at 1 to 5 years.¹
• No major side effects were reported in the trials.¹
• The certainty of all of this was rated very low, because of study flaws and wide uncertainty.¹

So the encouraging single trials sit inside a body of evidence that, taken together, can’t yet say whether laser helps in a way women notice.

What regulators say

US regulators have not cleared or approved any energy-based device, laser included, for treating urinary incontinence.⁴ It warned that these treatments may cause burns, scarring, pain during sex and lasting pain.⁴ See vaginal rejuvenation devices and the FDA warning.

Where it fits

Other options to discuss with a clinician:

1. Pelvic floor muscle training, ideally supervised. See can pelvic floor exercises help?
2. A bladder support insert or pessary. See continence pessaries for stress leaks.
3. Procedures such as a sling or bulking injections, after a specialist assessment. See what stress incontinence is.

If you’re offered laser, ask what it costs, how many sessions, what happens if it wears off, and what results the clinic has measured.

Try: “I’ve been offered vaginal laser for my stress leaks. How does it compare with supervised pelvic floor training or a pessary for someone like me, and what are the risks?”

Laugh, Sneeze, Jump covers the options above pelvic floor training in Chapter 9, “When It’s Been Years,” in a section called “The Next Rungs.” Its Three-Day Read, a bladder diary with a bowel column, shows whether your leaks line up with effort or urges, which decides which rungs fit. See the book.