Surgery for Urinary Incontinence
Surgery for urinary incontinence, or overactive bladder, should only be considered when more conservative treatments no longer help. While surgery is more invasive and risk prone than other therapies, colon doctors know it can provide, for the more severe cases, a long-term solution.
Before choosing surgery, consider the following:
1. Get an accurate diagnosis.
2. Make sure you are done childbearing: the strain of pregnancy and delivery on the urethra, bladder and supportive tissues may undo any surgical fix done previously.
3. Surgery cannot repair the damaged nerves and muscles that cause incontinence. Medications and/or physical therapy after surgery may be needed to treat mixed incontinence.
4. All surgeries come with risks and the potential for complications, such as the following:
– Temporary difficulty with urination and urinary retention
– Development of an overactive bladder and possibly urge incontinence
– Urinary tract infection
– Difficult or painful intercourse
Sling and bladder neck suspension and other procedures for stress incontinence
Sling procedures are the most commonly used. This procedure uses pieces of your body’s tissue, mesh or synthetic material to create a pelvis sling around the bladder neck and tube (urethra) that carry urine from the bladder. This provides support to keep the urethra closed.
Bladder neck suspension procedure supports the urethra and bladder neck. During this procedure the colon doctor places stitches in the tissue near the bladder neck and secures them to a ligament near the pelvic bone or the pelvis bone cartilage. This prevents the urethra and bladder neck from sagging.
Collagen, carbon-coated zirconium beads and coaptite can also be used as a bulking agent. The bulking agent is injected into the surrounding tissue of the urethra to keep the urethra closed and reduce the leakage of urine. This procedure is done in the colon doctor’s office, usually, with minimal anesthesia and takes only around five minutes. This procedure is only temporary, requiring repeat injections every 6 to 18 months.
Sacral nerve stimulation, bladder augmentation and BOTOX injections are procedures used to treat an overactive bladder.
Sacral nerve stimulation interrupts the messages sent to the brain by the overactive bladder signaling the need to urinate. This procedure works by sending electrical impulses to the nerves controlling urination. A small, pacemaker-like device surgically placed under the skin by colon doctors (usually in the buttock) sends these impulses. A stimulator attached to the device carries these impulses to the sacral nerve.
Bladder augmentation increases the size of the bladder. This is a complex procedure that involves major surgery. Colorectal surgeons place their patients under general anesthesia for the operation that can last several hours. A strip of tissue is attached to the bladder to increase the size.
BOTOX injections are used every 6-9 months. Colon doctors sedate their patients and BOTOX is injected into the bladder muscles.
Houston colon doctors recommend that you discuss all of the above with your doctor to make sure you understand all of the risks and benefits involved with surgery.