Urgency and urge incontinence

Introduction

Urgency and urge incontinence are caused when the bladder squeezes out urine - even if you want to hold on. These problems are often caused by an overactive bladder, sometimes called an unstable or irritable bladder.

There are several ways that these problems can be helped. These include:

• Pelvic floor exercises
• Bladder retraining
• Changing what you eat and drink
• Electrical stimulation of the pelvic floor
• Herbal remedies, hypnotherapy or acupuncture
• Prescription medications

Operations for bladder problems involve major surgery and can cause several severe side effects. So it may be wise to make sure you have tried all the alternatives before choosing surgery. If you would like further information about any of the above, get in touch with Incontact or talk to your doctor, continence advisor or specialist physiotherapist.

Incontact
United House
North Road
London N7 9DP

Tel: 0870 770 3246
e-mail: info@incontact.org
www.incontact.org

There are two main operations for urgency and urge incontinence. One involves making the bladder larger, the other involves removing some of the muscle around the bladder. Both of these are designed to reduce the amount of unwanted bladder contractions and the leaks that these can cause.

Operation 1: Make the bladder bigger and weaken the bladder contractions

This operation has several names:

bladder augmentation
clam cystoplasty
ileocystoplasty
Bramble cystoplasty
enterocystoplasty

What is it?

This is a major operation. It involves cutting open the bladder - like a clam - and sewing a patch of intestine between the two halves. The patch can be made of small intestine (ileocystoplasty), large intestine (sigmoid cystoplasty) or stomach lining (gastro cystoplasty). The aim of all of these is to increase bladder capacity and reduce the instability.

How long does it take?

Usually 1 to 2 hours.

What happens after the operation?

A catheter is put in place during the operation. This is left in place of 7 to 10 days to keep the bladder empty while it heals.

The average time needed in hospital after the operation is 10 days, but complete recovery can take 3 to 4 months.

What are the chances of success?

Around two-thirds of all people who have this operation are cured, and three quarters are improved in some way.

The operation can cause extra problems, including:

The need to use a catheter

Mucus from the patch of intestine can block the bladder outlet. As well as this, the enlarged bladder cannot contract strongly enough to push out all the urine. So most people who have this operation have to use catheters to go to the toilet. This will be permanent, for the rest of their lives.

Diarrhoea

Since some of the bowel is cut out, diarrhoea and other bowel / nutritional problems can be caused.

Infections in the bladder

Bacteria from the patch of bowel can cause recurrent infections in the bladder and urinary tract.

Bladder stones
This operation makes it more likely that people will develop bladder stones. Regular check-up will make sure that these are spotted at an early stage.

Operation 2: Weaken the bladder contractions by removing some of the muscle

This operation is called detrusor myectomy or autoaugmentation

What is it?

This is a major operation. It involves removing part or all of the outer muscle layer that surrounds the bladder. This aims to reduce the amount and strength of bladder contractions.

How long does it take?

Usually 1 to 2 hours.

What happens after the operation?

A catheter is put in place during the operation. This is left in place of 7 to 10 days to keep the bladder empty while it heals.

The average time needed in hospital after the operation is 10 days, but complete recovery can take 3 to 4 months.

What are the chances of success?

Just over half of all people who have this operation are cured, and around two thirds are improved.

The operation can cause extra problems, including:

The need to use a catheter

Since the muscle has been removed, the bladder cannot contract strongly enough to push out all the urine. So many people who have this operation have to use catheters to go to the toilet. This will be permanent. It has been suggested that fewer people who have this operation need to self-catheterise than with the cystoplasty (above).

The unknown?

This is a fairly new operation, so we do not know about its success and problems in the long term.

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