Surgical Solutions for Incontinence

Date: 08/03/21

Surgical solutions for incontinence will normally only be considered as a last resort. Your continence team will work with you to try a range of other solutions first, including Kegel exercises, bladder training and catheterisation before you are considered for surgery. Adult incontinence pads can be worn during the process. 

Many cases of urinary incontinence will respond to these initial approaches, and many more that do not can be comfortably managed using adult incontinence pads or other similar products. You should only consider surgery if you have not responded to other forms of treatment and do not feel you can manage your condition without. For some people, it can be life changing, but it is not the right option for everyone.

Surgical solutions for stress incontinence
Stress incontinence occurs when the bladder is unable to hold in urine during sudden movements, such a sneezing or physical exercise. There are two ways that this can be surgically corrected, either by supporting the urethra or by supplementing it.

Urethral support may consist of one of three procedures:

  • Colposuspension – in which the neck of the bladder is lifted and stitched into a new position
  • Sling surgery – in which a small piece of tissue is used to support the neck of the bladder
  • Vaginal mesh surgery – in which an artificial mesh is used to support the urethra

Urethral supplementation may consist of:

  • Urethral bulking agents – injected into the wall of the urethra to help it to stay closed
  • An artificial urinary sphincter – which is placed around the urethra to aid the existing sphincter muscles

Surgical solutions for urge incontinence
Urge incontinence occurs when the bladder sends the wrong signals to the brain. This can be surgically corrected using one of two methods:

  • Sacral nerve stimulation – using a device in the buttocks to send electrical signals directly to the bladder
  • Posterior nerve stimulation – using indirect stimulation via the nerves in the leg via a small needle inserted into the heel

Urge incontinence may also be alleviated by the use of Botulinium Toxin, commonly known as Botox. This is injected into the bladder wall and serves to relax the muscles and reduce the urge to urinate. In rare cases, the bladder may be made larger using tissue from the intestines in a procedure called augmentation cystoplasty, enabling it to hold a larger volume.

The risks
It is important to remember that surgery always comes with a risk and should be avoided if at all possible. What’s more, surgery for incontinence is not always successful and may not provide long lasting relief. For example, a NICE study of surgery for stress incontinence in women found that none of the three most common solutions was more than 75% successful in reducing symptoms, with this dropping to 60% or less after just five years.

Mesh surgery has been particularly controversial in recent years, with some women experiencing significant complications. As a result, this procedure is no longer available on the NHS. Other surgery, such as bladder enlargement, may stop leaks but leave you incapable of emptying your bladder fully without a catheter.

Surgical solutions for incontinence should be avoided if you are pregnant or trying for a baby. The trauma of pregnancy can often cause the treatment to fail, and you can end up back at square one with nothing to show for your surgery.

Making the choice
As discussed above, opting for surgery for incontinence is a big decision. You should talk at length with your GP, consultant or continence team, should adult incontinence pads become more required, to get as much information as possible before you decide. You need to understand the chances of success, the length of time this effect may last for and the risks to your health and wellbeing before you make your choice. 

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