Surgery for stress incontinence

Surgery for stress incontinence

If lifestyle changes and pelvic floor muscle exercises are not successful, your healthcare professional may suggest surgery to treat your stress incontinence.

Your healthcare professional should carefully discuss the risks and benefits of surgery with you before you make a decision. When recommending treatment the healthcare professional should take into account your preferences, any illnesses or other treatment you have had. The discussion should include any plans you may have for having children in the future, because this may affect the choice of treatment. You should only be offered surgery for stress incontinence after the whole healthcare team has discussed your care and possible treatments.

There are several surgical procedures you may be offered:

  • One procedure is to insert a strip of plastic tape to form a sling that supports the urethra. This helps to stop urine from leaking out.Your surgeon should discuss with you how safe and effective the different types of slings are. If the surgeon isn't trained to insert the sling you choose, he or she should refer you to another surgeon. You should be invited back for a follow-up appointment within 6 months of your operation.

  • Another procedure is called colposuspension, which also works by supporting the urethra, but this is not routinely used and can only be carried out by a few surgeons.

  • Another option is to inject a substance called a bulking agent into the sides of the urethra to make it harder for the urine to leak out. Your healthcare professional should tell you that:

    • you may need several injections for the procedure to work

    • the effect will reduce over time

    • the injections are less likely to cure your incontinence than the techniques described above.

  • A further procedure is to insert a device called an artificial sphincter (valve) to control the flow of urine from the bladder into the urethra. Some of the side effects of this operation can be serious, so your healthcare professional should suggest this only if previous surgery has not helped. If you have this operation, you should be offered regular check-ups for the rest of your life.

If the first procedure you tried does not work, before having another operation you should be referred to a specialist team and have urodynamic tests again. These are tests to find out why your bladder and urethra (the tube from the bladder to the outside of the body) are not working properly. You may need additional tests.

You also might decide that you don't want any more treatment at this time – see Making decisions about treatment.

There are some surgical procedures that should not be offered for treating stress incontinence. The medical names for these are anterior colporrhaphy, needle suspensions, paravaginal defect repair and the Marshall–Marchetti–Kranz procedure.

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