What Are The Potential Side Effects Of A Pubovaginal Sling Surgery For Stress Incontinence
All surgery for stress urinary incontinence has potential side effects.
Specific risks associated with pubovaginal sling surgery include:
- Failure to improve or rarely worsening of stress urinary incontinence
- Development of new overactive bladder symptoms or worsening of pre-existing OAB symptoms
- Damage to nearby structures on insertion of the sling such as the bladder, urethra, blood vessels or bowel
- Difficulty in urination that may result in a need to loosen or divide the sling or the need for temporary intermittent self-catheterisation to drain the bladder
- Urinary tract infection
What Questions Should I Ask My Surgeon If I Am Considering Surgery To Treat Stress Urinary Incontinence
Ask your surgeon about all SUI treatment options, including non-surgical options and surgical options that do and do not use mesh slings. It is important for you to understand why your surgeon may be recommending a particular treatment option to treat your SUI.
Any surgery for SUI may put you at risk for complications, including additional surgery. One complication that may occur when mesh slings are used is vaginal mesh erosion, which could require additional surgery to resolve.
If mesh erosion occurs through the vaginal tissue, it is possible that men may experience penile irritation and/or pain during sexual intercourse.
Ask your surgeon the following questions before you decide to have SUI surgery:
What Should You Ask Your Surgeon
Talk with your surgeon before you agree to have surgery. Make a list of questions that you want to ask. You might ask:
- Why this type of surgery has been chosen for you? How well it will work?About the details of the surgery.
- What is your best option if you have not yet completed your family?
- What are the risks?
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How Is Urinary Incontinence Treated
The kind of treatment you have will depend on:
- the type of urinary incontinence you have
- how severe it is
- your age, health and medical history.
Your doctor may refer you to a womens health physiotherapist or a doctor who specialises in womens pelvic floor problems . They may recommend one or more of these treatment options:
- Lifestyle changes such as losing weight, quitting smoking, eating more fibre, drinking more water or lifting less.
- Medication to help relax the bladder muscles, which play an important role in urge incontinence.
- Physiotherapy to strengthen the pelvic floor, which supports your bladder. A physiotherapist can design a special pelvic exercise program for you.
- Surgery to support or hold up your bladder or urethra . Surgery is usually only considered if medication or physiotherapy have not been successful.
- The success of treatment can vary. While treatment may not cure your incontinence, it can still help you live more comfortably with it.
When Will A Doctor Recommend Surgery For Urinary Incontinence
Urinary incontinence is a common problem that doctors see all the time, and they understand youll want to do all you can to help improve it. Discussing your symptoms and how theyre affecting your life is the best way to find the right treatment for you so dont let any feelings of embarrassment hold you back.
But when might your discussion turn to surgery? Your doctor might recommend it if youve tried to manage your condition in other ways such as with lifestyle changes and pelvic floor or bladder exercises (read about urinary incontinence treatment without surgery but these havent helped.
Before surgery is considered, its important you have an accurate diagnosis about the type of urinary incontinence you have . You should also discuss whether you plan to have children if you do, your doctor may suggest delaying surgery.
If youre worried about your symptoms, you can use our Smart Symptom Checker to help you work out what conversation to have with your doctor next.
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Less Commonly Used Treatments For Urge Incontinence
Posterior tibial nerve stimulation
Your posterior tibial nerve goes down your leg and into your ankle. Its thought that stimulating it may have an effect on nerves that go to your bladder and pelvic floor, to help with urge incontinence.Key things to know about posterior tibial nerve stimulation:
- its only recommended if other treatments havent helped or arent suitable, as theres not enough evidence to prove its effective
- a thin needle is inserted in your ankle to send an electric current to your tibial nerve
- treatment takes about half an hour, and you may need multiple sessions
- its only recommended in rare cases of urge incontinence
- it involves keyhole surgery to add tissue from a section of your bowel to your bladder
- it usually takes at least 6 months to fully recover
- afterwards, theres a chance you may not be able to fully empty your bladder when you pee, so you may need to use a catheter
Urinary diversion
Urinary diversion is surgery to stop pee passing through your bladder, to avoid the problems of an overactive bladder that can cause urge incontinence.Key things to know about urinary diversion:
How Does Stress Urinary Incontinence Affect The Bladder
Not all women will experience SUI in the same way. Some women will only leak when they exercise vigorously or when they have a full bladder. Other women, however, may experience bladder leakage from daily living activities, such as walking or sneezing. While the amount of urine leakage may differ, at some point SUI may interfere with your activities, intrude on your social life, or be just plain inconvenient and embarrassing.
- Bladder leakage in SUI is due to the weakening of the pelvic muscles and tissue that normally support the bladder.
- In a standard functioning bladder, the muscles in your urethra stay closed to prevent urine from escaping the bladder until you have reached the bathroom.
- With SUI, however, any force that is exerted on the bladder through physical movement such as running, sneezing or laughing, may cause your bladder to leak since weakened pelvic muscles are no longer staying closed.
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What Matters Most To You
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have surgery
Reasons not to have surgery
I’ve tried Kegel exercises, but they haven’t worked for me.
I think that Kegels might work for me.
I don’t want to wear absorbent pads or try a pessary to avoid leakage.
I don’t mind wearing pads or trying a pessary.
I’ve tried medicines, but they don’t work for me.
I think that medicines might work for me.
Stress incontinence lowers my quality of life.
My quality of life is not too bad.
I think surgery can help me.
I don’t want to have surgery for any reason.
What Are Stress Incontinence Treatments For Women
Stress incontinence treatments for women include:
- Vaginal estrogen creams, gels, rings or patches that strengthen vaginal muscles and tissues after menopause.
- Insertable vaginal pessary devices that support the bladder and urethra.
- Urethral injections to temporarily bulk up the urethral muscle and keep the sphincter closed.
- Surgery to place a sling made of your tissue, donor tissue or surgical mesh under the urethra to support it.
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Stress & Urinary Incontinence Treatment Options
Several stress incontinence treatment exists and our team of doctors and womens health physiotherapists will recommend treatment for incontinence based on several health factors including age, condition and severity of urinary symptoms.
Sometimes it might be necessary to conduct a bladder operation however these procedures are commonly carried out with manageable symptoms and normally have a quick recovery time with the right after care. Read more about incontinence treatments below.
What Are The Risk Factors For Stress Incontinence
Anyone can have urinary incontinence, but the problem affects twice as many people AFAB as people assigned male at birth . Its estimated half of women over age 65 have stress urinary incontinence. But urinary incontinence is not a normal part of aging. Its a sign of a problem that can get better with appropriate treatment.
Risk factors for stress incontinence include:
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How Is Urinary Incontinence Managed
Your GP will first suggest making lifestyle changes to improve symptoms, including weight loss and cutting down on alcohol and caffeine. Pelvic floor exercises are also recommended to strengthen pelvic floor muscles, which often weaken following childbirth or as a natural result of ageing.
Many women also benefit from using incontinence products, like pads, absorbent pants, or handheld urinals. Sometimes, medicine may be prescribed to help manage symptoms.
If these measures fail, you may be referred for bladder training, guided by a specialist who can help teach you ways to train yourself to wait longer to pass urine.
In some cases, medication or surgery may be the best option where all other means have been unsuccessful.
What Is Stress Incontinence
Stress incontinence is the accidental release of urine that occurs when you sneeze, cough, laugh, jog, or do other things that put pressure on your bladder. It’s the most common type of incontinence in women.
Stress incontinence can be caused by childbirth, weight gain, or other problems that stretch the pelvic floor muscles. When these muscles can’t support your bladder, the bladder drops down and pushes against the vagina. You’re not able to tighten the muscles that close off the urethra. Urine may leak because of the extra pressure on your bladder.
Incontinence can have more than one cause, so your doctor will treat the main cause first. Surgery for stress incontinence is usually done only after other treatments have failed.
Other treatments you might try include:
- Kegel exercises. These are also called pelvic floor exercises. They strengthen the pelvic muscles that control urination.
- Medicine. An example is vaginal estrogen cream.
- Mechanical devices. These are products used to prevent urine from leaking, such as a pessary. A pessary is a device that fits into the vagina to support the pelvic organs.
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Surgery For Stress Urinary Incontinence In Women
Medically reviewed by Drugs.com. Last updated on May 14, 2022.
Stress urinary incontinence is the loss of bladder control when you exert pressure on your bladder by coughing, sneezing, laughing, exercising or lifting something heavy.
Usually, stress incontinence can be treated with a number of conservative treatments. These include lifestyle changes, exercises, weight loss or devices inserted into the vagina to support the bladder. When these options don’t work, surgery may be an option for women with bothersome stress incontinence.
Although surgery has a higher risk of complications than other therapies, it may provide a long-term solution. Finding the best option for stress incontinence surgery depends on the benefits and risks associated with each procedure, as well as your particular health and treatment needs.
How Is Stress Incontinence Diagnosed
Your healthcare provider will perform a physical exam and ask about symptoms. You may need to keep a bladder diary for two to three days to monitor your fluid intake, bathroom use and urine leakage. Your notes should include what you were doing before the leakage. This information can help your provider make a diagnosis.
Tests for stress incontinence include:
- Urinary pad test: You wear an absorbent pad for 24 hours at home. Your provider weighs the pad after use to determine the volume of leaked urine.
- Urinalysis: This test checks for signs of infection in a urine sample. Urinalysis can help determine if you have a urinary tract infection or blood in your urine . These signs may indicate a different problem.
- Bladder scan: A brief ultrasound in your healthcare providers office to make sure you are emptying your bladder when you pee.
- Ultrasound: A pelvic or abdominal ultrasound assesses the health of the bladder, kidneys and other organs.
- Cystoscopy: During a cystoscopy, your provider uses a scope to examine your urinary tract.
- Urodynamic testing: This group of tests gauges how well your urinary system holds and releases urine. Urodynamic testing includes a postvoid residual urine test. The test measures how much urine is still in the bladder after you pee.
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Common Types Of Surgery For Stress Incontinence
Midurethralslings
If the urethra is not supported properly, this can cause poor bladder control. There are ways to place synthetic tapes inside to improve support of the urethra and reduce or stop the leakage of urine. This type of surgery can be done under general or local anaesthetic. It is most often only day surgery.
Colposuspension
The Burch colposuspension is surgery that involves placing stitches inside the vagina. The stitches attach to supportive ligaments either side of the urethra to elevate the vagina and support the urethra, reducing or stopping the leakage of urine. This can be done using open or keyhole surgery.
Bulking agents
The Burch colposuspension is surgery that involves placing stitches inside the vagina. The stitches attach to supportive ligaments either side of the urethra to elevate the vagina and support the urethra, reducing or stopping the leakage of urine. This can be done using open or keyhole surgery.
What Is Stress Urinary Incontinence
Stress urinary incontinence is a leakage of urine during moments of physical activity that increases abdominal pressure, such as coughing, sneezing, laughing, or exercise. SUI is the most common type of urinary incontinence in women.
SUI can happen when pelvic tissues and muscles, which support the bladder and urethra, become weak and allow the bladder “neck” to descend during bursts of physical activity. This descent can prevent the urethra from working properly to control the flow of urine. SUI can also occur when the sphincter muscle that controls the urethra weakens. The weakened sphincter muscle is not able to stop the flow of urine under normal circumstances and when there is an increase in abdominal pressure. Weakness may occur from pregnancy, childbirth, aging, or prior pelvic surgery. Other risk factors for SUI include chronic coughing or straining, obesity and smoking.
It is important for you to consult with your health care provider for proper diagnosis of SUI.
Image Source: National Kidney and Urologic Diseases Information Clearinghouse
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What Kind Of Surgery Is Effective For Female Urinary Incontinence
If you have stress incontinence, the 3 surgical options are usually colposuspension, sling surgery and vaginal mesh surgery. All 3 are known to effectively treat some women. But they dont help everyone, and its not possible to say for certain whether a particular surgery will be better for you.
Some women also get problems called complications after these types of surgery. These can include problems emptying your bladder fully, needing to pee urgently, or damage to your bladder or bowel. Generally, studies show that about 1 to 10 in 100 women get these problems .
In most cases, it isnt possible to say if 1 type of surgery is more likely to cause complications. For example, research suggests that pelvic organ prolapse may be more common after colposuspension than mesh surgery, with up to 25 women in 100 getting this at some point after colposuspension . But other complications can happen after mesh surgery and in fact its not recommended on the NHS at the moment because of these .
If you have urge incontinence, surgery is less likely to be effective, and procedures such as nerve stimulation or botox injections are more commonly recommended . Surgery is usually only considered in rare cases, if other treatments havent worked.
Strength And Limitations Of This Study
To our knowledge, the current evidence synthesis is the first, comprehensive attempt to estimate the clinical effects and safety across all available surgical interventions for the treatment of women with stress urinary incontinence based on published clinical trials evidence. In particular, the strength of our study includes comprehensive coverage of all published randomised controlled trials on available surgery for stress urinary incontinence, and application of current best practice for undertaking systematic reviews. The network meta-analysis enabled comparison of any pair of surgical procedures under consideration, including those that were not directly compared in clinical trials. This greatly enhances the usefulness of the findings to patients, health professionals, and policy makers. Our multidisciplinary research team comprised clinicians, health service researchers, methodologists, statisticians, and patient representatives, who all contributed to the design and conduct of this evidence synthesis.
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Types Of Urinary Incontinence
If your doctor says that treatments and medications are not effective, surgery or an implant may be recommended. Depending on the type of urinary incontinence one suffers from, different options exist. Here are the different types of urinary incontinence patients may experience:
