Urinary Incontinence SurgeryBy
Catherine Spader, RN
What is urinary incontinence surgery?
Urinary incontinence surgery includes various procedures to treat urinary incontinence, or the involuntary leakage of urine. This article focuses on urinary incontinence surgery for women.
Incontinence commonly occurs when nerves, muscles and tissues that control urination or support a woman’s pelvic organs are weak or damaged. Childbirth and aging are common risk factors for urinary incontinence.
Urinary incontinence surgery can relieve or improve urinary incontinence so you can lead a more active, healthy life. However, urinary incontinence surgery entails risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having urinary incontinence surgery.
Types of urinary incontinence surgery
The types of urinary incontinence surgery include:
Bladder augmentation surgery treats overactive bladder by increasing the size of the bladder.
Bladder neck suspension surgery treats stress incontinence. It involves supporting the bladder and urethra by attaching them to surrounding bone or tissue.
Nerve stimulation procedures treat overactive bladder by applying electrical stimulation to the nerves that control urination.
Sling procedures treat stress incontinence by supporting the bladder neck and urethra with a sling-like device.
Vaginal prolapse surgeries help treat stress incontinence and possibly overactive bladder by repairing weak or damaged muscles, ligaments and tissues that hold a woman’s pelvic organs in place. Vaginal prolapse surgeries correct protrusion of the bladder, rectum, bowel, uterus, and vaginal vault (upper portion of the vagina) into the vagina.
Why is urinary incontinence surgery performed?
Your doctor may recommend surgery for incontinence that has not responded to medication, exercise, bladder retraining, dietary changes, and behavioral therapies. Your doctor may recommend urinary incontinence surgery to treat:
Overactive bladder is involuntary contractions of the bladder muscles. This leads to a strong, urgent need to urinate and difficulty getting to the toilet in time.
Stress incontinence is involuntary leakage of urine during physical activity, such as coughing, sneezing, or heavy lifting. Stress incontinence results from a sagging bladder and urethra, the tube that carries urine from the bladder to the outside of your body. This often occurs due to weakened muscles that support the bladder and urethra. Stress incontinence is the most common form of urinary incontinence and frequently affects women after childbirth or menopause.
Who performs urinary incontinence surgery?
The following specialists perform urinary incontinence surgery in women:
Urologists specialize in diseases and conditions of the urinary tract and the male reproductive organs.
Obstetrician-gynecologists specialize in women’s health and pregnancy.
Female pelvic medicine and reconstructive surgeons are urologists or gynecologists who have completed specialized training in women’s pelvic floor disorders.
How is urinary incontinence surgery performed?
Your urinary incontinence surgery will be performed in a hospital or surgery clinic. The types of procedures women have vary depending on the type of incontinence surgery:
Bladder augmentation surgery for overactive bladder involves an abdominal incision. Your surgeon will open the bladder and expand it using tissue grafts from the small intestine, stomach, or other graft site. This increases the bladder’s capacity to hold urine.
Bladder neck suspension surgery for stress incontinence involves an incision through the vagina or abdomen to reach the bladder. Your surgeon will lift the sagging bladder and urethra back into their normal places and attach them to surrounding bone or tissue.
Nerve stimulation procedures for overactive bladder include invasive and noninvasive options to apply electrical stimulation to the nerves that control urination
Sling procedures for stress incontinence involve incisions in the vagina and abdomen to reach the bladder. Your surgeon will loop a natural or synthetic sling under your urethra to provide support and then attach the sling to strong tissues in your lower abdomen.
Vaginal prolapse surgeries for stress incontinence and overactive bladder involve an incision through the vagina or abdomen. Your surgeon will repair the weakened vaginal wall or attach the prolapsed vagina to strong ligaments toward the back of pelvis. Another version lifts the prolapsed vagina by supporting it with mesh, which is attached to the pelvis.
Surgical approaches to urinary incontinence surgery
Urinary incontinence surgeries vary depending on the type of urinary incontinence and the procedure. Surgeons use one of the following approaches:
Minimally invasive surgery uses a laparoscope, which is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a video screen. Your surgeon will insert a laparoscope and special instruments through small incisions in the belly and vagina to perform the surgery. Your surgeon may also use a surgical robotic system for urinary incontinence surgery. Your surgeon directs a robotic device from a computer to perform many steps of the surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your surgeon will make a small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Open surgery allows your surgeon to directly view and access the inside of your body. Your surgeon will make an incision in your vagina and one or two incisions in your lower belly or in the creases of your thighs. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients.
Your doctor will advise you on which procedure is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different types of surgeries and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform urinary incontinence surgery using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. To numb a smaller area, your doctor injects the anesthetic in the skin and tissues around the procedure area (local anesthesia). You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your urinary incontinence surgery
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all valuables at home or with a family member if possible. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your general or regional anesthesia. Your surgeon will perform local anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A team member will insert a catheter into your bladder to collect urine.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of urinary incontinence surgery?
As with all surgeries, female urinary incontinence surgery involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of urinary incontinence surgery
There has been some concern about the safety of synthetic slings used in urinary incontinence sling procedures. Synthetic slings are used in some, but not all, types of sling procedures. Ask your doctor about the specific type of sling used and if a procedure that does not use a synthetic sling is an option for you.
Potential complications of urinary incontinence surgery vary depending on the specific procedure but can include:
Damage to the urethra, bladder, rectum or vagina
Difficulty emptying or inability to empty the bladder
Rejection or breakdown of the synthetic material used for the urinary incontinence sling procedure
Return of urinary incontinence
Urination problems including frequent need to urinate and worsening of urine leakage
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery, including lifting restrictions, limiting exercise, and abstaining from intercourse while healing.
Notifying your doctor immediately of any concerns, such as bleeding, bloody urine, fever, increase in pain, problems with urination, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my urinary incontinence surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for urinary incontinence surgery by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Asking your doctor if shaving your pubic area is necessary before surgery. A member of the nursing staff usually performs this before the procedure.
Following instructions to clear your bowels before surgery. Your doctor will give you directions if this is necessary.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need urinary incontinence surgery? Are there any other options for treating my condition?
What type of surgical procedure will I need? Will I need a sling procedure? Is a nonsynthetic sling an option for me?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work, sexual intercourse, and other activities?
What assistance will I need at home?
How long will I need to have a urinary catheter after the surgery?
How should I take my medications?
How will you treat my pain?
When should I follow up with you? When should I see you for follow-up? Ask for numbers to call during and after regular hours.
What can I expect after my urinary incontinence surgery?
Knowing what to expect can help make your road to recovery after urinary incontinence surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will have a tube in your bladder called a catheter. This tube drains urine from your bladder until you have healed enough to urinate normally by yourself. Your catheter will generally stay in place from one to three days, depending on the type of surgery.
You will go home the same day for an outpatient urinary incontinence surgery. Otherwise, you may stay in the hospital for one to four days, depending on the type of surgery and other factors. Your care team will monitor your healing during this time.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Full recovery takes one to three months.
Your doctor will give you specific instructions for rest during your recovery. Restrictions may include:
Not straining the lower abdomen for several weeks. This includes avoiding lifting, sneezing, coughing, and straining with bowel movements.
Not swimming, using a hot tub, or taking a bath for one to two weeks. It is generally okay to take a shower.
Not having sexual intercourse for six weeks or as directed by your doctor
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after urinary incontinence surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Bleeding of your incision, bloody urine, or unexpected vaginal bleeding
Breathing problems such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery. It is not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to have a bowel movement or pass gas
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication, new pain, or severe abdominal or pelvic pain
Problems with urination, such as not making urine
Unexpected drainage, pus, redness or swelling of your incision
How might urinary incontinence surgery affect my everyday life?
Urinary incontinence surgery is not 100% effective in all cases. However, it can greatly improve the symptoms of urinary incontinence so you can lead a more active, healthy life. Life after urinary incontinence surgery generally includes more freedom to perform many of your former everyday activities with fewer worries about incontinence.
There is a chance that your bladder may not be able to expel urine by itself after bladder augmentation surgery for overactive bladder. In this case, you will need to pass a small soft tube (catheter) through your urethra into your bladder to drain your urine on a regular basis every day.
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