Conservative (non-invasive) management of female urinary incontinence
There’s no question that all types of surgery carry risk, so it’s usually only considered for incontinence after non-invasive treatments have failed, and the condition is interfering with the individual’s quality of life. Conservative (non-invasive) options for the management of incontinence surgery include:
- Lifestyle changes such as losing weight or quitting smoking
- Pelvic floor muscle exercises, including specialist physiotherapy
- Bladder retraining
When bladder surgery for female incontinence may be considered
The most common procedure for women is to correct a prolapse (when organs in the pelvis have slipped out of position) that’s contributing to stress incontinence. You can read more about prolapses and bladder weakness on the Jean Hailes Women’s Health website.
- When exercise and other non-invasive treatments have failed to improve a weak pelvic floor muscle, resulting in poor bladder control and severe stress incontinence, surgery to repair or support the muscle may be an option. You can find more information on this procedure on the Bladder And Bowel UK website
- Less common, but surgery may be necessary to remove a cancer or other type of tumour that’s causing an obstruction, restricting flow and may result in urinary retention and overflow incontinence
- To augment the bladder (make it bigger) to relieve an overactive bladder that’s causing urge incontinence. This is a rare approach as retraining and medication are usually effective treatments. Surgery involves sewing a ‘patch’ of tissue taken from the bowel or stomach into the bladder to make it larger.
Treatment of stress incontinence
The pelvic floor muscle supports the vagina, uterus, bladder and bowel and when it becomes weak, the organs can drop out of place which is a vaginal prolapse. These surgical procedures are designed to restore support to affected organs so they can function correctly.
- Rectus Fascial Sling, which uses a small section of the patient’s own abdominal tissue in a U-shape to support the urethra. You can read more about this procedure on the Urology Associates, New Zealand website.
- Colposuspension, which is where the neck of the bladder is stitched to the pubic bone to lift and hold it back into place
- Urethral Bulking Agents that are injected into the neck of the bladder to make it tighter and stronger
Essential questions to ask if you’re contemplating incontinence surgery
Following are some essential questions to ask if you are considering surgery.
What are the risks of the operation being considered?
Aside from the general risks mentioned above (infection, bleeding, etc.) insist that you understand all the possible outcomes. For example, if you’re still of child-bearing age, ask if there is any possibility of surgery impacting your fertility. Some women experience painful intercourse post-surgery, so if that is a risk, ask how it’s corrected.
What are the non-surgical options?
Before committing to surgery, check with your doctor that all conservative (non-invasive) options have been explored. Operations shouldn’t be viewed as a quick and easy fix. Incontinence can often be improved with lifestyle changes, pelvic floor exercises, bladder retraining or medication, which should be tried first.
How effective will female incontinence surgery be?
Surgery won’t always completely fix the problem. Many women suffer from Mixed Incontinence which, as the name suggests, involves both stress and urge incontinence. If the intent of surgery is to remedy stress incontinence (the most common type), it won’t correct any urge issues. Further, success is variable. Although studies suggest around 85- 90% of women are dry within 12 months of surgery, other studies suggest 15-20% of sling surgery is unsuccessful and needs to be repeated.
What to expect?
Ask to be stepped through precisely what’s going to happen if you proceed with the operation. Do you need to undertake pre-operation preparation, when do you meet with the anaesthetist, do you have other health issues that need to be taken into account, how long will you be in the hospital, will you need a catheter after surgery, how long is the recovery, when can you go back to work?
How much will the incontinence surgery cost?
Make sure you understand all the costs involved, what’s covered by Medicare (Australia) or your PHO (New Zealand) and how much you’ll be out of pocket. Ask if you’ll need physiotherapy or other allied health services after the operation and how much that costs.
The Australian Government website, HealthDirect has a general list of questions to ask before any type of surgery, which may be helpful.
Surgery is a big decision, and for some women, it has been positively life-changing. Just make sure that if you are considering it, you have everything you need to make an informed decision.
Asaleo Care makes no warranties or representations regarding the completeness or accuracy of the information. This information should be used only as a guide and should not be relied upon as a substitute for professional, medical or other health professional advice.