Females experience stress incontinence (or urine leakage) when they cough, sneeze, laugh, exercise vigorously or, very commonly, simply by swinging a golf club. Urodynamic testing conducted in the doctor’s office is used to determine the type of incontinence.

Treatments include exercises (Kegels), bladder training or medication.  When these treatments fail to solve the problem, bladder incontinence surgery is the next step.

“The goal of surgery is to help the outlet for urine (officially the urethra) stay closed during abdominal pressure, halting potentially embarrassing leakage,” says McLeod Gynecologist Dr. Gary Emerson.  “When it’s used for stress incontinence, surgery is performed through incisions in the abdomen, through the vagina, or with a thin surgical tool called a laparoscope.”

Common female incontinence surgery includes:

• Bladder Sling Surgery
  • The traditional sling is made through an incision in the vagina, using tissue from the patient or other medical source. The tissue is attached to the pubic bone or in front of the abdomen, supporting the urethra.
  • In a newer procedure (Midurethral Sling), the surgeon inserts tape (Tension-free Vaginal Tape – TVT) through small incisions in the pelvic area and positions it under the urethra. She/he adjusts the tape to support the tube leading from the bladder.
  • Slings generally give the patient long-term bladder control.

• Burch Colosuspension. Threads are used to create a hammock-like cradle that supports the urethra. A few stitches in the vagina wall and pelvic tissue support the urethra and bladder. Surgery can be performed with small incisions below the “bikini line” and recovery is reasonably quick.  Some view this as the most effective treatment for female urinary incontinence. After one year, 85-90% of women still avoid leakage.  After 5 years, about 70% of women remain cured.

If surgery is performed using so-called minimally invasive technique, the patient may go home the same day or only require an overnight stay.  Discomfort may last a few days or weeks. A survey of women two years after their surgery showed that 78% of women with a suspension and 86% with a sling were satisfied with their results.

In some cases, the surgeon will suggest a hysterectomy be performed at the same time as the incontinence surgery.

Other possible surgical treatments for stress incontinence in women include:

• Bulking agents involves injecting fat, collagen or similar material around the bladder entrance to help keep it closed.  Some women see this as an alternative to surgery, although it is less successful and does not usually last as long as sling or suspension surgery. Additional injections may be required
• With serious incontinence that can’t be repaired with the other methods, the surgeon may insert an artificial sphincter.  Placed around the urethra at the bladder entrance, the device must be opened and closed manually by the patient.

Your gynecologist can determine if surgery is needed and, if so, which of the options will work best for you.

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Sources: McLeod Health, Federal Drug Administration, National Institutes of Health, National Association for Continence, UK National Health Service, American College of Obstetricians & Gynecologists, Royal College of Obstetricians & Gynecologists, Urinary Incontinence, Treatment Network