If you have incontinence, it is likely that your Doctor and others around you have already recommended treatment such as pelvic floor exercises, dietary changes and exercises. When these conventional treatments do not work however, it may be time to look at a more radical solution such as surgery.
What are the surgical options for treating incontinence?
Your surgical options depend on the type of urinary incontinence you have. Most options of surgery for incontinence treatment are effective for stress incontinence. However, surgical alternatives are available for other kinds of incontinence such as urge and overflow incontinence. Your options also depend on your health and your doctor’s experience.
Some common surgery options offered for each type of incontinence include the following:
Treatment for Stress Incontinence
Sling procedures involve making an incision in your lower abdomen and vagina so a sling can be placed around the neck of the bladder to support it and prevent accidental urine leaks.
The sling can be made of:
> A synthetic material
> Tissue taken from another part of your body (autologous sling)
> Tissue donated from another person (allograft sling)
> Tissue taken from an animal (xenograft sling), such as cow or pig tissue
In many cases, an autologous sling is used and will be made using part of the layer of tissue that covers the abdominal muscles (rectus fascia).
How effective are sling procedures?
Slings are generally preferred because more is known about their long-term safety and effectiveness. The procedure is minimally invasive, where a small, thin strip of material is placed under the black neck to provide support for the Urethra. Studies have shown an 88 to 95 percent success rate in correcting urinary incontinence with the sling procedure. Slings are also durable for 10-15 years, making them a worthwhile and long-term solution.
The most commonly reported problem associated with the use of slings, however, is difficulty emptying the bladder fully when going to the toilet. A small number of women who have the procedure also find they develop urge incontinence after the surgery.
Tape procedures are a popular treatment option for women with stress incontinence. During a tape procedure, a piece of plastic tape is inserted through a cut inside the vagina and threaded behind the tube that carries urine out of the body.
The middle part of the tape supports the urethra, and the two ends are threaded through two incisions in either the tops of the inner thigh in a trans-obturator tape procedure or the abdomen in a retropubic tape procedure.
Some advantages and disadvantages of tape procedures include the following:
By holding the urethra up in the correct position, the piece of tape can help reduce the leaking of urine associated with stress incontinence.
Around two in every three women do not experience any leaking after the surgery. Even those who still have some leaking after surgery often find this is less severe than it was before the operation.
It is not uncommon for women to need to go to the toilet more frequently and urgently after this procedure, and some find they’re unable to completely empty their bladder when they go to the toilet.
In some cases, the tape can wear away or move over time and further surgery may be needed at a later stage to adjust it – for example, to make it looser – or remove it.
Treatment for Urge Incontinence
Tibial Nerve Stimulation
The working principle of tibial nerve stimulation is to apply indirect electrical stimulation to the nerves that are responsible for sensory and motor control of pelvic floor muscles and bladder function. A needle containing an electrode is placed near your ankle, stimulating one of the nerves responsible for bladder control. During nerve stimulation, the foot of the patient is comfortably supported and stabilised with the help of a stand. The technician then applies a small needle electrode at the tibial nerve as part of the procedure.
What are the advantages and disadvantages of tibial nerve stimulation?
Research and clinical studies have suggested that percutaneous tibial nerve stimulation can improve the functioning of bladder function and urinary activity in more than 60-80% patients. Tibial nerve stimulation is not associated with a high rate of complication and has no long-term risks of side effects. The procedure is considered to be a relatively pain-free procedure and patients describe it as tingling sensation or a feeling of pulsations in the ankle or foot.
Patients of the procedure however are often bound to 12 weekly, 30-minute sessions to achieve significant improvement in the symptomatology. On some occasions, results begin to appear after 5 to 6 weeks of initiating the therapy. The results can also vary from individual to individual depending on the type and severity of bladder dysfunction.
Botox (onabotulinumtoxinA) injections
Injection of Botox is a common method to treat urgency and frequency of urination of adults when another type of medication is ineffective. In this treatment procedure, Botox is injected into the sides of your bladder to treat urge incontinence. This involves passing a small telescope into your bladder through your urethra (the tube that carries urine from the bladder to outside the body) and injecting between 10 and 20 injections of Botox® into your bladder wall from the inside. Botox® is a muscle relaxant, which works by reducing uncontrolled contractions of the bladder muscle and increasing bladder capacity. This helps to improve the symptoms of overactive bladder.
What are the benefits and risks of Botox injections?
The aim of the injections is to reduce urinary symptoms such as urgency (sudden desire to pass urine which cannot be deferred), frequency (passing urine often) and urge incontinence (urinary leakage associated with urgency). The effects of the Botox® usually take between three days to three weeks to appear, so you will not notice a difference immediately after the injections. Most patients find the effects of the injections last between six and nine months, although they can last longer. Repeated injections will be required each time the effects wear off.
Occasionally however, Botox injections may cause loss of strength or general muscle weakness, vision problems, or dizziness. Although the symptoms of incontinence may improve after the injections, you may find it difficult to fully empty your bladder. If this happens, you’ll need to be taught how to insert a thin, flexible tube called a catheter into your urethra to drain the urine from your bladder.
Treatment for Overflow Incontinence
Clean intermittent catheterisation is a procedure that has been commonly used to reduce overflow incontinence. When you are recommended this treatment, a continence adviser will teach you how to place a catheter through your urethra and into the bladder. Your urine can then flow out of your bladder, through the catheter and into the toilet. If CWC does not work, you have the option of getting an indwelling catheter fitted. This catheter remains in place continuously, meaning you can relax knowing the catheter is always fitted.
Using a catheter can feel a bit painful or uncomfortable at first, however, any discomfort should subside over time. Regular use of a catheter, however, has been proven to increase the risk of developing urinary tract infections, therefore it is important to regularly check for symptoms if you do use a catheter regularly.