Bladder Surgery For Stress Incontinence

Risk Of Reoperation 10 Years After Surgical Treatment For Stress Urinary Incontinence: A National Population

• London School of Hygiene & Tropical Medicine, London, United KingdomRoyal College of Obstetricians and Gynaecologists, London, United Kingdom
• London School of Hygiene & Tropical Medicine, London, United KingdomRoyal College of Obstetricians and Gynaecologists, London, United Kingdom
• London School of Hygiene & Tropical Medicine, London, United KingdomRoyal College of Obstetricians and Gynaecologists, London, United Kingdom
• Royal College of Obstetricians and Gynaecologists, London, United KingdomCroydon University Hospital, Croydon, London, United Kingdom
• The British Society of Urogynaecology, London, United KingdomSheffield Teaching Hospitals, London, United Kingdom

Faqs: Stress Urinary Incontinence

Weve compiled some of the most common questions that women ask when learning about stress urinary incontinence. Read for yourself or find a specialist today to learn more about stress urinary incontinence solutions and treatments.

What is urinary incontinence?

Urinary incontinence is the loss of voluntary control over your urinary functions. Approximately 18 million women in the U.S. suffer from urinary incontinence2. Thats 1 in 4 women over the age of 18.2

Are there different types of urinary incontinence?

Yes. The most common types are stress, urge and mixed, which is a combination of the two. Stress incontinence happens when urine leaks during coughing, laughing or exercise because the urethra does not function properly. Urge incontinence involves the sudden sensation of the need to urinate that can be hard to put off the sudden urge to go. Mixed is a combination of stress and urge incontinence.3

What causes female stress urinary incontinence?

Female stress incontinence generally occurs when your pelvic muscles are not strong enough to keep the opening of the bladder neck closed when theres pressure on your bladder from laughing, coughing, lifting, exercising or other activities that cause abdominal pressure. It can slowly develop as you age and may be the result of a specific event such as childbirth, or be a result of smoking, obesity or other previous tissue traumas in the area.1114

Can stress urinary incontinence be successfully treated?

What Causes Urinary Incontinence

We dont always know what causes incontinence in a particular woman. You are most likely to have urinary incontinence if youve had children and/or been through menopause.

During pregnancy, the extra weight and changes in hormones weaken your pelvic floor the hammock of muscles, ligaments and tissues that support your bladder. The pelvic floor is then weakened again during labour by pushing and then after menopause, when your body makes less of the female hormone oestrogen that helps keep the pelvic floor strong.

You are also more likely to have urinary incontinence if you:

• often have constipation and strain to empty your bowels or cannot empty them completely or easily
• have a long history of poor bladder habits
• are over 65 years of age
• have had a condition affecting your brains ability to send messages to your bladder
• have bad eyesight, trouble moving around or using your hands

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Types Of Bladder Surgery For Incontinence

Sometimes incontinence can have an adverse effect on your quality of life.

When youve exhausted conventional treatments and the ever-present symptoms still pose as a major disruption to your every day activities, it may be time to look at a more radical solution, like surgery.

Although it is more invasive and has a higher risk of complications than other therapies, urinary incontinence surgery can also provide a long-term solution in severe or persistent cases.

Your surgical options depend on the type of urinary incontinenceyou have. Most options for urinary incontinence surgery treat stress incontinence. However, surgical alternatives are available for other bladder problems, including urge incontinence.

What Is The Colposuspension Procedure

This is a more invasive operation which requires a 45-60 minute procedure and a hospital stay of 3-4 nights. Longer recovery times and resulting scarring, much like a caesarean section scar, means this procedure is less common in modern times. A more popular treatment option now is the newer mid-urethral tape procedures, which have a shorter operating time, fast recovery and minimal scarring.

However, colposuspension may be recommended by a subspecialist urogynaecologist if a previous continence operation has failed.

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How Are Minimally Invasive Surgical Procedures Performed

The most commonly used and effective treatments for urinary incontinence, both male and female, imply a small procedure. These are more effective and definitive than non-invasive techniques. For each specific patient, the pros and cons of each type of treatment have to be considered. These procedures use anaesthetic, but patients are usually discharged from hospital on the same or next day.

Surgical procedures and the way they are performed depend on the technique chosen. Some are performed endoscopically, such as bulking injections, while others involve making a small incision in the skin.

The most common treatments are the following:

• Bulking injections
• Insertion of inflatable or non-inflatable suburethral slings
• Artificial urinary sphincter.

Some surgeries, such as the insertion of an artificial sphincter, may be recommended for some patients, e.g., when changes to cognitive or motor capacity exist

Botulinum Toxin A For Overactive Bladder

Overactive Bladder symptoms are caused by the bladder muscle squeezing to empty out urine inappropriately, even when the bladder isn’t full. This causes urgency and incontinence. It often happens without warning and when you do not want it to for example, when hearing the sound of running water, or putting the key into the latch.

Initial treatment involves bladder training exercises with a physiotherapist, and lifestyle changes including relaxation techniques and removing bladder irritants from your diet. There are medications called Anticholinergics that are excellent at calming the bladder muscle and giving you more control. However, if these treatments fail, then BOTA is an option.

BOTA is injected under cystoscopic vision into the bladder muscle. It works by relaxing the muscle of the bladder wall , reducing urinary urgency and incontinence. Following treatment, the effect of the toxins effects last for several months before the muscles return to their normal strength .

It is a day-stay procedure and you can return to work once you recover from the anaesthetic . It usually requires repeat treatments.

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Bladder Tests Before Urinary Incontinence Surgery In Women May Be Unnecessary

NIH-funded study finds pre-operative office visit alone sufficient for comparable outcomes.

An invasive and costly test commonly done in women before surgery for stress urinary incontinence may not be necessary, according to a study funded by the National Institutes of Health. The study compared results after both a pre-operative check-up in a doctor’s office and bladder function tests to results after only the office check-up. Women who had only the office check-up had equally successful outcomes after surgery.

Results of the study, done by researchers in the Urinary Incontinence Treatment Network , are posted on the New England Journal of Medicine’s website and will be in the journal’s May 24 print issue.

Urinary incontinence is conservatively estimated to affect 13 million Americans, most of them women. Stress urinary incontinence occurs when the bladder leaks urine when a person coughs, laughs, sneezes or exercises. The stress refers to pressure on the bladder, not emotional stress. Strong pelvic and sphincter muscles can handle the extra pressure from a cough or other sources of stress, but when these muscles are weak, sudden pressure can push urine out of the bladder. Among other causes, childbirth can injure or weaken the nerves, muscles and structures that help support the bladder in women.

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What Are The Types Of Bladder Surgeries

Most bladder surgeries are now done robotically, meaning that your surgeon will just make a small number of incisions and then place ports that allow the use of robotic arms to perform the surgery. Few are open surgeries where theres a long cut. Types of surgeries include:

Bladder cancer is the most common reason for people to undergo bladder surgery. Depending on the stage and progression of bladder cancer, surgery can be used in combination with other therapies such as chemotherapy or radiation therapy. To treat bladder cancer, many different types of procedures may be done. Those procedures include:

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When Is Surgery Done For Stress Incontinence

Surgery may be done when other treatments have not worked. Surgery is done to support, lift, or strengthen the bladder or the urethra. This makes it less likely that urine will leak from the bladder when you sneeze, cough, or laugh.

The kind of surgery you have depends on what you prefer. It also depends on your health, the severity of urine leakage, and your doctor’s experience. Types of surgery include:

• Retropubic suspension. This surgery lifts the sagging bladder neck and urethra that have dropped abnormally low in the pelvic area.
• Urethral sling. The surgeon places a sling around the urethra. There are different types of urethral slings, but they all help support the urethra to aid in urine retention.
• Urethral bulking. Material is injected around the urethra. This may be done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.

Talk with your doctor about things you can do to increase the chance of having a successful surgery. You may have better results if you lose weight or do Kegels before surgery. If you smoke, quit.

Your doctor may suggest surgery if:

• You have tried other treatments, and they have not helped.
• You and your doctor know the cause of your stress incontinence. Surgery is more likely to fail if the true cause isn’t known.

Bladder Surgery For Stress Incontinence: What Are Your Options

The term bladder surgery is one which many people edge away from. It can be invasive and extreme. However, when desperately needed, it can make a life-changing difference.

Harvey Winkler, MD, co-chief of urogynaecology and director of female pelvic medicine asserts everyone needs to make their own decision about surgery. He explains that surgery is the best approach if youre looking for the one-shot deal thats going to give you the best dryness option.

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Stress incontinence is the unintentional loss of urine during physical movement or activity. This condition is due to having weak pelvic floor muscles, which causes you to leak when stress is placed on the bladder. Often, childbirth is the most common cause of stress incontinence in women, with prostate surgery being the most common cause in men.

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Frequently Asked Questions Expand All

• What is stress urinary incontinence ?

  Stress urinary incontinence is the leakage of urine with physical activity, such as exercise, or when coughing, laughing, or sneezing. It is a common problem in women. SUI can be treated with both nonsurgical and surgical treatment methods.

• What causes SUI?

  SUI is a pelvic floor disorder. These disorders occur when tissues and muscles that support the urethra, bladder, uterus, or rectum are damaged.

  In SUI, the sphincter muscle that controls the flow of urine from the bladder to the urethra may weaken. Or the muscles that support the position of the bladder and the urethra may weaken. Weakness in these muscles may occur from pregnancy, childbirth, or aging.

• What nonsurgical treatments may help with SUI?

  If you have SUI and your symptoms bother you, your health care professional may suggest nonsurgical treatments first. Lifestyle changes, such as drinking less fluid, limiting caffeine, stopping smoking, and losing weight, can help decrease the number of times you leak urine.

  Other nonsurgical options include pelvic muscle exercises , physical therapy and biofeedback, or use of a pessary. Another option is an over-the-counter product that is inserted into the like a tampon. If these treatments do not improve the problem, surgery may help.

• What are the surgical treatments for SUI?

  Surgery improves SUI symptoms in most women. There are different types of surgery for SUI:

• Colposuspension

What Is Surgical Bladder Suspension

Bladder suspension surgery, also known as bladder neck suspension, is a procedure that is used to treat stress incontinence in women. There are a variety of types of bladder suspension surgeries that use stitches to support the bladder and urethra.

The goal of the procedure is to lift the bladder and urethra by lifting it and securing it to nearby structures such as the pelvic bone. The bladder is less likely to leak after the procedure.

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Surgery May Benefit Women With Two Types Of Urinary Incontinence

NIH-funded study contrasts with current treatment guidelines.

Surgery for stress urinary incontinence improves symptoms of another form of incontinence, called urgency urinary incontinence, in women who have both types, according to a study supported by the National Institutes of Health. The findings challenge current treatment guidelines, which suggest that the surgery may worsen urgency urinary incontinence in women with both forms, also called mixed urinary incontinence. The study appears in the Journal of the American Medical Association. Funding was provided by NIHs Eunice Kennedy Shriver National Institute of Child Health and Human Development and Office of Research on Womens Health.

Women with mixed urinary incontinence may have more bothersome symptoms than women with either stress or urgency urinary incontinence alone, said Donna Mazloomdoost, M.D., study author and program director of the NICHD Pelvic Floor Disorders Network. The findings show promise in treating a condition that can be hard to manage under existing practices.

Roughly one-third to one-half of all women with urinary incontinence have mixed urinary incontinence. Urgency urinary incontinence results from the spontaneous contraction of bladder muscles, leading to a strong and sudden need to urinate. Stress urinary incontinence occurs when urine leaks out after abdominal pressure increases following a sneeze, cough, laugh or movement, which squeezes the bladder.

NIHTurning Discovery Into Health®

What Is Incontinence Surgery

Sometimes incontinence can have an adverse effect on your quality of life.

When youve exhausted conventional treatments and the ever-present symptoms still pose as a major disruption to your every day activities, it may be time to look at a more radical solution, like surgery.

Although it is more invasive and has a higher risk of complications than other therapies, urinary incontinence surgery can also provide a long-term solution in severe or persistent cases.

Your surgical options depend on the type of urinary incontinenceyou have. Most options for urinary incontinence surgery treat stress incontinence. However, surgical alternatives are available for other bladder problems, including urge incontinence.

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When You’re In The Hospital

Stress incontinence is a leakage of urine that happens when you are active or when there is pressure on your pelvic area. Walking or doing other exercise, lifting, coughing, sneezing, and laughing can all cause stress incontinence. You had surgery to correct this problem. Your doctor operated on the ligaments and other body tissues that hold your bladder or urethra in place.

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Key Points To Remember

• Surgery is usually done only after other treatments for stress incontinence have failed.
• You may be able to treat stress incontinence by doing pelvic floor exercises . They may help you control your bladder when you cough, laugh, sneeze, or exercise.
• Medicines may help you control urine leaks, but they don’t work for everyone. Other methods to help prevent leaks include using a medical device, such as a pessary.
• Incontinence can have more than one cause. Surgery can fix stress urinary incontinence. But if you have mixed urinary incontinence, you may still have urgency symptoms after surgery.
• Surgery works better than any other treatment for stress urinary incontinence in women. But sometimes surgery for stress incontinence causes new symptoms of urgency or urge incontinence. And sometimes symptoms come back.
• Surgery has risks, including trouble urinating after surgery, injury to the bladder or other pelvic organs, problems caused by the mesh tape used in surgery, infection, and problems linked to anesthesia.

When Is Surgery Required

There are a range of surgical procedures to treat many bladder related conditions and you should consult your doctor about which best suits you.

Kimberly-Clark Australia makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional medical or other health professional advice.

Other urinary incontinence causes

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What Are The Advantages Of The Male Sling Procedure

The male sling procedure is not a major surgery. One of the advantages is that the male sling procedure only requires a small incision in the perineum . Because of this small incision, the recovery time is fairly short. Most patients have their catheters stay in for one to three days depending on surgeon preference.

What Is A Pubovaginal Sling To Treat Stress Urinary Incontinence

A pubovaginal sling is thin ribbon of tissue that lies under the neck of the bladder . The sling acts by providing support under the bladder neck when there is a rise in intraabdominal pressure to help prevent stress incontinence.

Surgery for a pubovaginal sling is not minimally invasive as the sling needs to be harvested and is obtained through an abdominal incision which results in a longer stay in hospital and longer recovery time than mid-urethral sling surgery.

Diagram of a Pubovaginal or Fascial sling to treat stress urinary incontinence.Copyright Dr Karen McKertich – Not for use without attribution.

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