Surgery and procedures for stress incontinence
Colposuspension involves making a cut in your lower tummy (abdomen), lifting up the neck of your bladder, and stitching it in this lifted position.
This can help prevent involuntary leaks in women with stress incontinence.
There are 2 types of colposuspension:
- open colposuspension – where surgery is carried out through a large cut
- laparoscopic (keyhole) colposuspension – where surgery is carried out through 1 or more small cuts using small surgical instruments
Both types of colposuspension offer effective long-term treatment for stress incontinence, although laparoscopic colposuspension needs to be carried out by an experienced laparoscopic surgeon.
Problems that can occur after colposuspension include difficulty emptying the bladder fully when going to the toilet, recurrent urinary tract infections (UTIs), and discomfort during sex.
Sling surgery involves making a cut in your lower tummy and vagina so a sling can be placed around the neck of the bladder to support it and prevent accidental urine leaks.
The sling can be made of:
- tissue taken from another part of your body (autologous sling)
- tissue donated from another person (allograft sling)
- tissue taken from an animal (xenograft sling), such as cow or pig tissue
In many cases, an autologous sling is used and will be made using part of the layer of tissue that covers the abdominal muscles (rectus fascia).
These slings are generally preferred because more is known about their long-term safety and effectiveness.
The most commonly reported problem associated with the use of slings is difficulty emptying the bladder fully when going to the toilet.
A small number of women who have the procedure also find they develop urge incontinence afterwards.
Vaginal mesh surgery (tape surgery)
This is where a strip of synthetic mesh is inserted behind the tube that carries urine out of your body to support it in a sling.
Mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in your body permanently.
You'll be asleep during the operation. It's often done as day surgery so you do not need to stay in hospital. Some women need to stay in hospital overnight.
A few women have had serious complications after mesh surgery. Some, but not all, of these complications can also happen after other types of surgery.
- long-lasting pain
- permanent nerve damage
- sexual problems
- mesh exposure through vaginal tissues and occasionally injury to nearby organs, such as the bladder or bowel
Because of these possible complications, it's very important that you talk to your doctor about the risks and benefits of vaginal mesh surgery before you decide to go ahead with it.
You may want to ask some of these questions:
- What are the alternatives?
- What are the chances of success with the use of mesh versus use of other procedures?
- What are the pros and cons of using mesh, and what are the pros and cons of alternative procedures?
- What experience have you had with implanting mesh?
- How successful has it been for the people you have treated?
- What has been your experience in dealing with any complications?
- What if the mesh does not correct my problems?
- If I have a complication related to the mesh, can it be removed and what are the consequences associated with this?
- What happens to the mesh over time?
For the time being, vaginally inserted tapes and meshes will only be used when there's no alternative and the procedure cannot be delayed, and after detailed consultation between you and your doctor.
If you're on a waiting list for a tape procedure, your hospital will be in touch with you to discuss what will happen next.
If you're concerned about vaginal mesh
If you have previously had vaginal mesh or tape for incontinence inserted and think you're having complications, speak to a GP or surgeon.
If you're not having any complications, there's no need to do anything. Many women have had these types of surgery without developing any problems afterwards.
You can report a problem with a medicine or medical device on GOV.UK.
Urethral bulking agents
A urethral bulking agent is a substance that can be injected into the walls of the urethra in women with stress incontinence.
This increases the size of the urethral walls and allows the urethra to stay closed with more force.
A number of different bulking agents are available, and there's no evidence 1 is more beneficial than another.
This is less invasive than other surgical treatments for stress incontinence in women as it does not usually require any cuts.
Instead, the substances are normally injected through a cystoscope inserted directly into the urethra.
But this procedure is generally less effective than the other options available.
The effectiveness of the bulking agents will also reduce with time and you may need repeated injections.
Many women experience a slight burning sensation or bleeding when they pass urine for a short period after the bulking agents are injected.
Artificial urinary sphincter
The urinary sphincter is a ring of muscle that stays closed to prevent urine flowing from the bladder into your urethra.
In some cases, it may be suggested that you have an artificial urinary sphincter fitted to relieve your incontinence.
This tends to be used more often as a treatment for men with stress incontinence and is only rarely used in women.
An artificial sphincter consists of 3 parts:
- a circular cuff that's placed around the urethra – this can be filled with fluid when necessary to compress the urethra and prevent urine passing through it
- a small pump placed in the scrotum (when used in men) that contains the mechanism for controlling the flow of fluid to and from the cuff
- a small fluid-filled reservoir in the tummy – the fluid passes between this reservoir and the cuff as the device is activated and deactivated
The procedure to fit an artificial urinary sphincter often causes short-term bleeding and a burning sensation when you pass urine.
In the long term, it's not uncommon for the device to eventually stop working, in which case further surgery may be needed to remove it.
Surgery and procedures for urge incontinence
Botulinum toxin A injections
Botulinum toxin A (Botox) can be injected into the sides of your bladder to treat urge incontinence and overactive bladder syndrome.
This medicine can sometimes help relieve these problems by relaxing your bladder.
This effect can last for several months and the injections can be repeated if they help.
Although the symptoms of incontinence may improve after the injections, you may find it difficult to fully empty your bladder.
If this happens, you'll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the pee from your bladder.
Botulinum toxin A is not currently licensed to treat urge incontinence or overactive bladder syndrome, so you should be made aware of any risks before deciding to have the treatment.
The long-term effects of this treatment are not yet known.
Sacral nerve stimulation
The sacral nerves are located at the bottom of your back. They carry signals from your brain to some of the muscles used when you go to the toilet, such as the detrusor muscle that surrounds the bladder.
If your urge incontinence is the result of your detrusor muscles contracting too often, sacral nerve stimulation, also known as sacral neuromodulation, may be recommended.
During this operation, a device is inserted near 1 of your sacral nerves, usually in 1 of your buttocks. An electrical current is sent from this device into the sacral nerve.
This should improve the way signals are sent between your brain and your detrusor muscles, and so reduce your urges to pee.
Sacral nerve stimulation can be painful and uncomfortable, but some people report a substantial improvement in their symptoms or the end of their incontinence completely.
Posterior tibial nerve stimulation
Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor.
It's thought that stimulating the tibial nerve will affect these other nerves and help control bladder symptoms, such as the urge to pee.
During the procedure, a very thin needle is inserted through the skin of your ankle and a mild electric current is sent through it, causing a tingling feeling and your foot to move.
You may need 12 sessions of stimulation, each lasting around half an hour, 1 week apart.
Some studies have shown that this treatment can offer relief from overactive bladder syndrome and urge incontinence for some people, although there's not enough evidence yet to recommend tibial nerve stimulation as a routine treatment.
Tibial nerve stimulation is only recommended in a few cases where urge incontinence has not improved with medicine and you do not want to have botulinum toxin A injections or sacral nerve stimulation.
In rare cases, a procedure known as augmentation cystoplasty may be recommended to treat urge incontinence.
This procedure involves making your bladder bigger by adding a piece of tissue from your intestine into the bladder wall.
After the procedure, you may not be able to pass urine normally and may need to use a catheter.
Because of this, augmentation cystoplasty will only be considered if you're willing to use a catheter.
The difficulties passing urine can also mean that people who have augmentation cystoplasty can experience recurrent UTIs.
Urinary diversion is a procedure where the tubes that lead from your kidneys to your bladder (ureters) are redirected to the outside of your body.
The urine is then collected directly without it flowing into your bladder.
Urinary diversion should only be carried out if other treatments have been unsuccessful or are not suitable.
It can cause a number of complications, such as a bladder infection, and sometimes further surgery is needed to correct any problems that occur.
Catheterisation for overflow incontinence
Clean intermittent catheterisation
Clean intermittent catheterisation (CIC) is a technique that can be used to empty the bladder at regular intervals and so reduce overflow incontinence, also known as chronic urinary retention.
A continence adviser will teach you how to place a catheter through your urethra and into the bladder.
Your pee flows out of your bladder, through the catheter and into the toilet.
Using a catheter can feel a bit painful or uncomfortable at first, but any discomfort should subside over time.
How often CIC will need to be carried out will depend on your individual circumstances.
For example, you may only need CIC once a day, or you may need to use the technique several times a day.
Regular use of a catheter increases the risk of developing UTIs.
If using a catheter every now and then is not enough to treat your overflow incontinence, you can have an indwelling catheter fitted instead.
This is a catheter inserted in the same way as for CIC, but left in place. A bag is attached to the end of the catheter to collect the pee.
There are several incontinence products that you might find useful for managing your urinary incontinence while you're waiting for surgery.
- absorbent products, such as incontinence pants or pads
- handheld urinals
- a catheter
- devices that are placed into the vagina or urethra to prevent pee leaking while you exercise, for example