Exploring Surgical Options for Incontinence: A Detailed Guide

Involuntary leaks are often seen as something to be embarrassed about... but did you know that urinary incontinence affects roughly 30-50% of all adult women?

The causes of urinary incontinence are quite complex and can range from abdominal muscle damage to low estrogen caused by menopause and a recurring bladder infection. Fortunately, there are plenty of solutions available to help you manage your symptoms.

If you've tried all the recommended lifestyle adjustments and medications to prevent involuntary leaks, you could be a candidate for surgical treatments. In this article, we'll provide a detailed guide to the most common surgical options for overflow, stress, and urge incontinence.

If you're interested in any of the below-mentioned surgeries, remember to seek medical advice from a urologist or specialist who can tell you more about the risks, benefits, and suitability associated with each option.

Surgical Options for Stress Incontinence

Stress urinary incontinence is caused by physical strain on the bladder and is typically preceded by actions like sneezing, coughing, and laughing. Despite its name, urinary stress incontinence is in no way related to mental stress.

Colposuspension

Colposuspenison is one of the most popular surgeries for treating stress incontinence. It involves making a cut in your lower abdomen and lifting and securing the bladder in a higher position. This can be done through open or keyhole surgery and is praised for its effective, long-term results.

However, some of the possible complications post-surgery include recurring urinary tract infections and difficulty emptying your bladder fully.

Sling surgery

Sling surgery lifts the neck of the bladder by placing a sling around it. Sling procedures ensure the bladder is supported to prevent stress urinary incontinence symptoms. The sling is typically made from tissue from another part of your body (autologous sling), animal tissue, or donated tissue from another person.

Autologous slings are usually preferred as your body is less likely to reject them.

Vaginal mesh surgery

It is not possible to have this type of surgery on the NHS unless there is no alternative. This is because a few women have had serious complications after mesh surgery and the procedure has faced a lot of scrutiny due to reports of chronic pain and mesh erosion.

Also known as tape surgery, vaginal mesh surgery involves inserting a mesh strip behind the urethra to offer synthetic support. While you'll be under general anaesthetic during the surgery, most patients can go home on the same day.

Vaginal mesh surgery can come with complications, such as pain when peeing, problems with sex, and constipation.

Surgical Options for Urge Incontinence

Urge incontinence is characterised by the uncontrollable urge to pee followed by urine leakage. This condition can be incredibly frustrating as leaks often seem to come out of nowhere. Fortunately, there are several treatment options available.

Botox injections

Botulinum toxin A (botox) is injected into the bladder wall to treat urge incontinence symptoms. Botox relaxes the bladder muscles, which are usually overly tight in those who suffer from urge incontinence. Injections may need to be repeated every 3-6 months as the effects aren't permanent.

Some patients find it difficult to fully empty their bladders after this procedure. If this is the case, a catheter may also be needed.

Sacral nerve stimulation

The sacral nerves at the base of your back are responsible for carrying signals from your brain to your detrusor muscle (the bladder muscle responsible for contracting during peeing). Sometimes, these signals can get mixed up, which can lead to urge incontinence. Sacral nerve stimulation stimulates the sacral nerves with an electrical current.

This treatment can greatly improve the signals between the brain and bladder. Another type of nerve stimulation used to treat urge incontinence is posterior tibial nerve stimulation, which focuses on the nerve fibres that run along your bladder and pelvic floor.

Augmentation cystoplasty

Augmentation cystoplasty is an operation that makes your bladder bigger so that it can retain more urine. Typically, tissue from your intestine is used to enlarge your bladder wall. However, you may need to use a catheter after the surgery if you want to pass urine.

Urinary diversion

Urinary diversion is when your ureters are repositioned so that they flow into a bag kept outside your body. This option is usually only considered as a last resort if other treatments and procedures have been ruled out, as further surgery is sometimes necessary.

Surgical Options for Overflow Incontinence

Also known as chronic urinary retention, overflow incontinence happens when the bladder becomes overly full, leading to frequent or constant dribbling of small amounts of urine. Catheterisation is seen as the most effective surgical option to treat this type of incontinence.

Clean intermittent catheterisation

Clean intermittent catheterisation uses a catheter to empty the bladder at regular intervals to prevent leakage from occurring. You'll need to learn how to insert and use a catheter to empty your bladder into the toilet.

Using a catheter can feel quite uncomfortable at first but you should get used to it over time.

Indwelling catheterisation

Indwelling catheters stay in place and have a bag attached to the end of them for the urine to flow into. This urine-collecting bag can be emptied whenever it gets full. This option is only usually recommended if clean intermittent catheterisation is not enough.

Non-Surgical Ways of Managing Urinary Incontinence

Before you go the surgical route, most GPs advise you to try to manage your incontinence through non-surgical methods, such as the following:

Pelvic floor exercises

Pelvic floor therapy can help strengthen the muscles surrounding the pelvic organs and provide you with improved muscle control. These simple exercises can be done in the comfort of your home or with the help of a physiotherapist.

Lifestyle changes

You can manage your urinary incontinence symptoms by making a few adjustments to your lifestyle, including:

• Managing your stress levels

• Avoiding bladder stimulants, like coffee, tea, etc.

• Supporting an overactive bladder with home remedies

• Maintaining a healthy weight

• Drinking enough water

• Quitting smoking

• Not drinking too many fluids before bed to avoid nighttime incontinence

Incontinence pads and leak-proof underwear

One of the best ways to manage leaks is to wear incontinence pads or leak-proof pants. These specialised incontinence products will give you the confidence to go about your day as normal without the fear of urine leaks.

Urethral bulking agents

The urethral bulking agent is injected into the urethral walls to help the urethra stay closed. While this is an effective non-surgical way to treat stress incontinence, you'll need repeated injections as the effectiveness wears off over time.

Bladder support supplements

Our bladder care supplements are filled with natural ingredients, like soy phytoestrogen and pumpkin seed extract, to help support your bladder in just 12 weeks. Our supplements aim to relieve your need-to-go urgency and reduce the number of leaks you experience. As with any new supplement, it is best to discuss it with your GP to ensure it is suitable given your unique medical history.

FAQs

How do I know which incontinence operation is right for me?

The type of treatment that is right for you will depend on a variety of factors, including the type of incontinence you experience, potential causes, underlying conditions, and more. Your urologist will be able to advise on the most suitable options.

What are some of the symptoms of urinary incontinence?

The main symptom of urinary incontinence is unintentional urine leaks. These leaks may be preceded by the uncontrollable urge to pee (urge incontinence) or a physical action like sneezing or coughing (stress incontinence).

Does urinary incontinence surgery come with risks?

Each surgical treatment comes with its own set of risks. Some treatments have minimal risks while other procedures have higher chances of complications. If you are nervous about an upcoming procedure, make sure you speak to your urologist about your concerns.

Final Thoughts

Even though most women will experience some form of urinary incontinence in their lives, this is a topic that many people still find embarrassing to talk about.

Here at Jude, we are passionate about breaking the stigmas surrounding medical conditions like hypertonic pelvic floor disorder and overactive bladder syndrome. We do this by providing useful educational resources and creating specialised incontinence products.

If you experience urinary incontinence, know that plenty of treatment options are available. From bladder support supplements to surgical treatments, there is a solution out there that will help you live a leak-free life.

Jude’s clinically proven supplements give you better bladder and pelvic floor control, helping you sleep through the night and regain the freedom to live life on your own terms. With just one capsule morning and night, you'll have relief from need-to-go urgency in just 12 weeks.