Surgery for Stress Urinary Incontinence

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

This pamphlet explains

• cause and symptoms of stress urinary incontinence
• nonsurgical treatment options
• surgical treatment options
• risks and benefits of surgery
• recovery from surgery

Stress Urinary Incontinence

Urinary incontinence is uncontrolled leakage of urine. Most women with incontinence leak small amounts of urine. Frequent, more severe leakage is less common.

There are different types of urinary incontinence. In stress urinary incontinence, a woman leaks urine when she coughs, laughs, or sneezes. Leaks also can happen when a woman walks, runs, or exercises.

Stress urinary incontinence may be caused by a weakening of the sphincter muscle that controls the urethra, which may occur from pregnancy, childbirth, or aging. Pelvic support problems also are a leading cause of stress urinary incontinence. These problems occur when tissues and muscles that support the urethra, bladder, uterus, or rectum become weakened or stretched. These organs may drop down, causing urine leakage or making it hard to pass urine.

Nonsurgical Treatment Options

Options for treating stress urinary incontinence include lifestyle changes, physical therapy, the use of devices called pessaries that are placed in the vagina, special injections, and surgery. Your health care provider may first suggest nonsurgical treatment. Often, several treatments are used together for the best result. If these treatments do not improve the problem, surgery may help.

Surgical Treatment Options

Surgery improves stress urinary incontinence symptoms in most women. There are two main types of surgery: 1) urethral slings and 2) colposuspension. Surgery can be done through an incision in the abdomen (abdominal), through the vagina (vaginal), or with laparoscopy (laparoscopic). The type of surgery depends on many factors. You and your health care provider will discuss these factors before choosing which type of surgery is right for you:

• Age
• Lifestyle
• Need for hysterectomy or treatment of other pelvic problems
• Medical history (if you have had radiation therapy for pelvic cancer or have already had surgery for incontinence)
• General health
• Cause of the problem

If necessary, surgical procedures can be combined to give the best results. For example, a stress urinary incontinence procedure may be done along with surgery to correct a pelvic support problem.

Slings

A sling may be used when the urethra has dropped out of place or when the sphincter muscle of the urethra is weak. The sling is a narrow strap that is placed under the urethra. It acts as a hammock to lift or support the urethra and the neck of the bladder.

There are several kinds of sling procedures. They differ in the type of sling materials used and the way the sling is applied.

Traditional Sling. In this type of surgery, the sling is a strip of tissue or synthetic material. Your own tissue can be used, or it can be donated tissue. Two tunnels are made on either side of the vagina, and the sling is threaded behind the pubic bone and under the urethra, lifting it up. The ends of the sling are stitched in place through an incision (cut) in the abdomen.

Midurethral Sling. The midurethral sling is the most common type of surgery used to correct stress urinary incontinence. The sling is made of synthetic materials. A small incision is made vaginally under the urethra. The sling is placed under the urethra with special needles in one of two ways: 1) behind the pubic bone through two small incisions in the abdomen, or 2) under the pubic bone through small incisions at the top of the leg. The second type is called a transobturator sling.

These slings are held in place by friction with the surrounding tissues at first. They then stay in place naturally over time. Midurethral sling procedures take less than 30 minutes to do. They are outpatient procedures, meaning that you can go home the same day. Recovery time usually is quicker than with colposuspension procedures.

Colposuspension

This treatment is used when the bladder or urethra has dropped out of place. The most common type of colposuspension performed is called the Burch procedure. The bladder neck is raised back to the correct position using a few stitches placed in the wall of the vagina and the pelvic tissues. These stitches keep the bladder neck in place and help support the urethra. The Burch procedure can be done through an incision in the abdomen or with laparoscopy.

Risks of Surgery

All surgery has some risk. The following risks are associated with surgery for stress urinary incontinence:

• Injury to the bladder, bowel, or blood vessels
• Bleeding
• Infection of the urinary tract or wound infections
• Urinary problems after the procedure (difficulty urinating or urge symptoms)
• Problems related to the anesthesia used

Specific risks are associated with each procedure. Examples of specific risks include the following:

• Urinary tract infections and urinary problems are more common in women who have had sling procedures than in those who have had colposuspension.
• The bladder may be stuck by the needles used in the midurethral sling procedures, and this occurs more often when the sling passes behind the pubic bone. However, this injury usually does not lead to long-term problems.
• If a synthetic sling is used, there is a risk that the body will reject it. Occasionally, the sling material can erode through the vaginal tissue. If this complication occurs, surgery can be done to correct the problem.
• With some sling procedures, more surgery may be needed to adjust the sling if it is too tight.

Before you have surgery, you should know the risks and benefits of your surgical options. Your health care provider can discuss these risks with you.

Recovery

The time needed to recover varies. It is longer for abdominal surgery and shorter for laparoscopic or vaginal surgery. The hospital stay may be longer if other procedures are done at the same time.

After surgery, discomfort may last for a few days or weeks. The degree of discomfort may be different for each woman. If more than one procedure is done, there may be more pain than if only a stress urinary incontinence procedure is done.

Some women may find it hard to urinate for a while or notice that they urinate slower than before surgery. During this time, they may need to use a catheter to empty their bladders a few times each day. In rare cases, if a woman is not able to void on her own, the stitches or the sling may need to be adjusted or removed.

Be sure to contact your health care provider if you have problems (see box). To speed up recovery, you should avoid anything that puts stress on the surgical area, such as the following activities:

• Straining with bowel movements
• Strenuous exercises
• Heavy lifting

Ask your health care provider about when you can resume intercourse, using tampons, driving, exercise, and daily activities.

Finally…

Stress urinary incontinence is a common problem for women. If other treatments do not work, surgery may be an option. For many women who have surgery, recovery time is short and the success rates are good.

Glossary

Anesthesia: Relief of pain by loss of sensation.

Bladder: A muscular organ in which urine is stored.

Catheter: A tube used to drain fluid or urine from the body.

Hysterectomy: Removal of the uterus.

Incontinence: Inability to control bodily functions such as urination.

Laparoscopy: A surgical procedure in which a slender, light-transmitting instrument, the laparoscope, is used to view the pelvic organs or perform surgery.

Radiation Therapy: Treatment with high-energy radiation.

Sphincter Muscle: A muscle that can close a bodily opening, such as the sphincter muscle of the urethra.

Urethra: A tube-like structure through which urine flows from the bladder to the outside of the body.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tube-like structure surrounded by muscles leading from the uterus to the outside of the body.