15 Facts About Urine Incontinence Surgery
Urine incontinence treatments
When you leak urine when you sneeze, cough, or laugh, it's known as stress incontinence. If you aren't having much luck controlling your symptoms with noninvasive approaches, you may be considering surgery.
These days, operations to treat stress incontinence are often successful, covered by health insurance, and done on an outpatient basis. (If you have urge incontinence, check out slides 14-16.) Here are key facts to know if you're considering urinary incontinence surgery.
Success is variable
"Everyone needs to make their own decision," says Harvey Winkler, MD, co-chief of urogynecology and director of female pelvic medicine and reconstructive surgery at North Shore–Long Island Jewish Health System in Great Neck, N.Y. Surgery is the best approach, he says, "if you're looking for the one-shot deal that's going to give you the best dryness option."
It's no guarantee of a cure, but studies have found that 85% to 90% of women are completely dry within a year after surgery.
Try Kegels first
If you're willing to do these exercises several times a day, indefinitely, you can expect a 70% improvement in your symptoms, says Dr. Winkler.
Consider bulking agents
There also are several medications that are sometimes prescribed, including drugs for treating muscle spasms and antidepressants, but they tend to be more effective for treating mild or moderate stress incontinence.
The sling's the thing
The surgeon loops a thin strip of materialusually synthetic mesh, but occasionally some of your own tissue or tissue taken from a cadaverto support the bladder and urethra.
This helps you shut off the flow of urine when you sneeze, cough, or do something else that could cause leakage, says Thinh Duong, MD, an associate at Southern California Permanente Medical Group, in Los Angeles.
Mesh can be a problem
Dr. Duong says the risk of complications is low for sling procedures because they require a relatively small piece of mesh (other procedures use larger pieces of mesh). In addition, synthetic materials that have been associated with higher rates of infection have been taken off the market.
Here are some important questions to ask your doctor before a procedure, according to the FDA.
Find the right surgeon
It's also key, he says, to ask about the complications associated with the procedure, as well as which complications your potential surgeon has seen and how he or she dealt with them.
It's often an outpatient procedure
They can be done under local anesthesia, Dr. Winkler says, whereas a different type of procedure called retropubic suspension is usually done under general or spinal anesthesia and involves a hospital stay.
Post-surgical pain can usually be tamed with ibuprofen, he says.
You may need a catheter at first
You may need to use a catheter at first to empty your bladder a few times a day. Difficulty in urinating rarely persists, and you may need to have the sling readjusted or removed.
You'll need to limit activity
If, at this point, you aren't leaking or experiencing pain, your doctor may allow you to return to your normal activities.
"I tell people to plan for a week off," says Dr. Winkler, although he says some of his patients have had the procedure on a Thursday and gone back to work on a Monday.
Complications are possible
Major complications, such as significant bleeding and blood vessel injuries, occur about 1% of the time, says Dr. Duong.
The mesh may also find its way out of the vaginal incision, and while this can be distressing, it's an easy complication to fix.
You may need a repeat surgery
You can take steps to help make the second surgery more successful, such as making sure you get adequate rest after the procedure, losing weight if you are overweight, not smoking, and keeping your pelvic muscles strong with Kegels. But if you did all these things and the surgery still didn't work for you, your chances might not be as good the second time around.
In general, Dr. Duong tells patients to expect a 50% to 60% success rate with repeat surgery.
It may change your life
"I have four kids and I just was at the point where I couldn't sneeze or laugh without leaking," she recalls. After talking with friends, she opted for the sling. "It's just a quick, easy, in-and-out procedure," she says.
"It was actually, literally, a life-changer," says Debbie, about a year after having the surgery. She says she can now enjoy a good laugh with no fear of leaking. "I would really recommend it to anybody."
Surgery is less common for urge incontinence
Medications for urge incontinence, which can be caused by overactive bladder, usually work by relaxing the overly twitchy organ.
Bladder training, which involves teaching yourself to urinate less frequently, can also be effective.
Options for urge incontinence
There's also neuromodulation, which involves implanting a wire in the sacrum at the base of the spine, with the goal of delivering electrical impulses to the nerves controlling the bladder, thus helping it relax. Your doctor first tests how well you respond to this therapy by delivering impulses to your skin. If the therapy gives you at least a 50% improvement in symptoms, you could be eligible to have the stimulator implanted.
Botox injections also are being researched as a bladder relaxer.
Tibial nerve stimulation
A 2010 study found that about half of people reported a significant improvement in their urge incontinence symptoms after 12 weeks of once-weekly half-hour sessions, compared with 20% of people in the placebo group.