Stress Incontinence

Introduction

A surgical operation is never a first choice. For stress incontinence, when a person leaks urine when he or she coughs, sneezes or lifts something heavy, there are several less risky treatments to try out first. Pelvic floor exercise, bio-feedback and electrical stimulation of the pelvic floor have all been shown to help in certain cases.

But stress incontinence in some people does not improve with these treatments. That is when some people begin to consider surgery. Every person is different, and a surgeon will be able to discuss with you what exactly is causing your problem - and how he or she can help to cure it. The surgeon can also explain why he or she considers one operation particularly suitable for you.

Whatever your particular condition, it is important to really think through the pros and cons of having surgery. Ask your doctor as many questions as you want, and never be afraid to go back or telephone to get more information or a clearer explanation.

If your doctor or nurse refers you to see a surgeon, then this is an ideal time to ask lots of questions. It may help to note down your questions on a piece of paper beforehand - so you don't forget what you want to ask. Make sure you write down the answers you are given - it's easy to come out of a meeting with a doctor and forget what they have said. Again - if you are not clear about anything the doctor says, ask them to explain again...a bit slower this time, please.

Colpo-suspension

The most common operation to treat stress incontinence is called a colpo-suspension. This is a major operation that requires a general anaesthetic. The abdomen is opened and the bladder neck is stitched to a nearby ligament. This lifts up the bladder neck and helps to stop leaks from the bladder.

No surgical operations can guarantee success in treating incontinence. This procedure has a success rate of between 50% and 70%. That means that over half the women having the operation will be cured or greatly improved. The other half may still suffer from incontinence. This operation is still the "gold standard" for operations for stress incontinence - it has the best long-term cure rates of any operation.

There are two versions of the operation. Open colpo-suspension gives better long-term success rates, but involves making a large cut in the abdomen. Laproscopic colpo-suspension involves making a smaller cut to do the operation - sometimes called 'keyhole surgery'. After this operation, most people recover and get back to work quicker than with the open colpo-suspension...but it's success rate is not so good.

This operation can cause extra problems - problems with emptying the bladder (some people need to use catheters after the operation), irritable bladder and urgency, and pain during sexual intercourse. "My incontinence is a hundred times worse since I had the operation", one consumer commented.

Sometimes it is not possible to do a colpo-suspension, perhaps because of operations done before that have not worked. There are other similar operations that can be performed in these cases: the aim is still to provide extra support to the bladder neck and reduce the risk of leaking. Sometimes, for example, a "sling" is sewn in under the bladder neck.

Other operations have been mostly given up - they are not particularly effective in helping people with stress incontinence. Amongst these, both "needle suspensions" and "anterior repair" have poor success rates and normally would not be considered.

Tension-free vaginal tape (TVT)

Tension-free vaginal tape (TVT) is a relatively new operation for women with stress incontinence. It is usually not suitable for women with neurological disease, for women who have not had their menopause yet or are considering further children, or for women with other conditions like a cystocele or vaginal prolapse.

The operation is gaining popularity because of its relative simplicity and cost-effectiveness. The procedure can de done as day surgery, with only a local anaesthetic. Recovery time after the operation is less than some operations for this problem. However it should still not be considered a minor procedure.

The patient is normally fully conscious during the operation. However it can be performed under general anaesthetic. The tape is inserted through two vaginal incisions. It runs between the vagina and the urethra, lifting the middle of the urethra. This support can reduce the effect of sudden abdominal stress...the cause of stress incontinence.

There can be problems associated with this operation. Bleeding, bladder injury, difficulty emptying the bladder, urgency and urinary infection are all possible. In addition tape erosion is a small possibility. Of course the operation is still fairly new so long term success rates and side-effects are not known.

As with all treatments, this operation has its advantages and its risks. Every one needs to discuss with their doctor the options available to them - and the pros and cons of each. More research over the next decade will give us a clearer idea of this operation's potential for success and failure.

Anyone considering any kind of surgery should get the maximum information from their doctor. You can't try before you buy, but you can make a carefully calculated decision.

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