Colette Bouchez is the author Your Perfectly Pampered Menopause
Although many women find relief wonderful relief from incontinence problems with a wide array of
medications and devices now available, for some, like my friend Stephanie, surgery becomes the
"I just want the problem to be over - I don't want to mess with devices and I tried the exercises and they just don't help enough," she said one day as we discussed the pros and cons of urogential surgery. And the more we talked, the more it seemed that surgery would be her best option.
As a fashion photographer she frequently traveled all over the world, and often found herself not only on long flights but also in exotic locations which, as she is fond of reminding me is "not so glamorous as you would imagine." Indeed, she one time found herself having to take a cargo flight through the jungles of South America to reach a fashion shoot for a top magazine - on a plane, she said, that didn't even have seats, let alone a toilet. So for her, surgery was beginning to sound as if it was the right option.
If you too want the problem to "just be over" with minimal maintenance in the future, then you should definitely speak to your doctor about the advantages of having a surgical procedure to correct your incontinence.
To help facilitate that conversation what follows is a quick rundown of some of the most popular and successful treatment options. While not every one is right for every woman, or even every type of incontinence, your doctor will be able to help guide you to the one that IS right for you.
Remember, you will have to consult with a urogynecologist or urological surgeon in order to get the best advice. Most gynecologists have only basic knowledge about these procedures.
In addition, because stress and urge incontinence are treated somewhat differently, particularly in the surgery arena, it's imperative that you are correctly diagnosed before planning any type of operation.
Having the wrong procedure will not only fail to correct your problem, it could make things worse.
Although there are several types of surgeries for stress incontinence they all have the same goal: To provide something for the urethra to press against, in order to help it remain closed whenever pressure is applied - such as during a sneeze, a laugh or a cough. This can be accomplished n one of the following three ways:
Among the newest and most successful surgical treatments of incontinence involves collagen - the very same substance that dermataologists use to erase wrinkles and plump lips!
In this condition, however, the collagen - or occasionally another similar substance - is injected around the urethra to give it added support. It is most useful in women diagnosed with a type of stress incontinence known as "intrinsic sphincter deficiency". In this instance the muscle controlling the closing of the urethra no longer functions to its fullest, thus causing urine to leak.
The collagen injection works to narrow down the urethra opening so it closes more easily after urination. The injections take less than a half hour, and can be done in your doctor's office under light sedation. Recovery time is fairly quick, with most women back to normal activity within several days. Occasionally, you may need a series of shots administered about a month apart to achieve the full effect. You will also need a collagen allergy test at least once, if not twice, starting several weeks before each of your planned injections.
About 80% of women who try this surgery improve, and about 40% become completely dry. This procedure is not likely to help you if you have urge incontinence, if you have an abnormally small bladder, or if the neck of your bladder is not well supported. In addition, the effects of this injection last only about two years and then it must be repeated. However, newer, more long lasting materials are under development, and might be available in the near future, yielding a much longer-lasting effect.
Bladder Neck Suspension
In this procedure your doctor will make an incision into your lower abdomen and literally "lift" the tissue next to the neck of your bladder into a higher position, closer to the pubic bone. The tissue is stitched in place, thus creating a new system of support.
Recovery for this surgery takes a few days in the hospital and about six weeks at home. At least part of the time you may need to use a catheter to drain urine until healing takes place. In a slightly different version the operation is performed "laparascopically"- through one or more tiny incisions.
You can return home the same day and recovery is generally quicker. In still another version a tiny incision is made in your vagina and stitches are placed through the tissue supporting the urethra and then pulling them upwards, attaching them to a stronger layer of connective tissue. This also achieves the "lift" effect and offers the much needed support. Experts say this is the least effective of the three techniques.
During this surgery your doctor will insert a "sling" made of either your own tissue grafted from another site or a nylon synthetic "skin". It is placed underneath the urethra and then anchored to supporting ligaments, bones or connecting tissue on both sides. Acting as a kind of "hammock" of support, it gives added strength to the bladder neck and helps hold the urethra in the proper position. This, in turn, helps hold in urine during times of physiological stress. Recovery can take several weeks.
There are also several ways of performing this surgery. In the traditional procedure, the sling is inserted through a small incision in the vagina, attached on or into the pubic bone, and the ends are brought up and out through a tiny incision in the abdomen. In the newest version doctors use a "Tension-Free Vaginal Tape" to hold the urethra in place. As your body reacts to the tape, it creates a mesh of scar tissue around it, which further "cements" it in place and adds to the support. Faster and easier than the traditional surgery, this version can often be done under local anesthesia, and you can return to normal activities in about 10 days.
Either way, if the sling is pulled too tight during the surgery, it may block urine flow completely. If this happens you'll need a second surgery to correct the problem. In addition, while this operation can be helpful for stress incontinence, at the same time it can actually cause "urge" incontinence to develop. This however, can often be controlled with medication.
This treatment involves surgically implanting a fluid-filled cuff around the urethra to prevent urine leakage. The compression involved helps keep the urethra shut, so no urine can actually pass. In order to urinate, a small pump is implanted into the lips of your vulva, which you squeeze. When you do, the fluid drains from the cuff into a storage balloon, which is implanted in your abdomen. This releases pressure on the urethra and allows urine to flow. Within a few minutes the fluid returns to the cuff and tightens the urethra -much the way you might screw on the lid of a jar.
The whole procedure takes about two hours under general anesthesia, and requires three incisions. Recovery time is several days of hospitalization and 4 to 6 weeks at home, during which time the pump is not yet activated. This surgery carries a risk of infection, erosion around the implants, and a moderate degree of "equipment failure" - all requiring additional surgery to correct. This complex procedure is generally only used in women with severe stress incontinence due to intrinsic sphincter deficiency, who fail to find help using any other option.