What is incontinence surgery?
This is surgery performed to re-create support of the urethra, the tube that drains urine from the bladder to the outside. In women with stress incontinence (leakage with coughing or laughing) the urethra gets pushed down into the vagina by increases in pressure in the abdomen. This can open the outlet from the bladder and lead to leakage. Surgeries aim to provide extra support to the tube.
The surgery involves placement of a mesh tape (‘sling’) that sits between the urethra and the vagina, and then is tunnelled up behind the pubic bone. This tape is very carefully tensioned to avoid it being too tight, which would block the flow of urine. The procedure is called a ‘Tension-Free Vaginal Tape’ (TVT) and is coupled with a cystoscopy, where we look in the bladder to ensure there has been no damage during the surgery.
When is incontinence surgery performed?
Ideally after a trial of conservative options, including fixing any chronic cough or constipation, weight loss, pelvic floor training and lifestyle modification (eg avoiding repetitive high impact activity). Some women will try a particular type of support pessary that can be put in and taken out during activity to prevent leakage.
If conservative options aren’t effective, and if the leakage is bothersome enough to outweigh the risks of surgery, then an operation may be recommended.
There are a variety of different procedure that can be performed. Over the last 20 years, the majority of women have been treated with a mesh sling, of which there are different types. The majority of these women have had good results, but there can be complications.
Our experience with the alternative operations (colposuspension for example) has therefore been a lot less, but increasingly women are asking about non-mesh alternatives. All options are discussed if surgery is contemplated.
How is it the procedure performed?
Location: Wakefield Hospital
Anaesthetic: General or spinal
Duration of the operation: About 30 minutes for TVT
What should I expect after incontinence surgery?
When you wake up: You will have an IV line in your arm. If the TVT was the only procedure performed, in most cases you will not have a catheter. You will be able to eat and will be encouraged to drink to fill your bladder.
When you feel the need to pass urine, the nurse will help you measure how much you pass, and then perform a scan of the bladder to make sure it has emptied properly. If the measurements are good and you are comfortable, you will be able to go home.
Nights in hospital: Some people will go home the same day, otherwise one night.
Time off work: Depending on your job, 1-2 weeks may be required.
When back to normal functioning: You can drive when comfortable and off all strong pain medications. Avoid intercourse, baths/spas/swimming for 4 weeks after surgery.
You should be very careful to avoid heavy lifting or sudden strong movements for 4-6 weeks post surgery as this is the time the mesh is being integrated into the body tissues, and it could loosen slightly, making it less effective.
Usually 4 weeks after surgery, and again at 6 months.
It is very important to contact the Specialist Centre if you are having issues post-surgery such as:
- Vaginal bleeding beyond the first 4 days postop
- Difficulty emptying your bladder
- New incontinence, or a feeling of needing to rush all the time
- Significant pain not controlled with rest, Panadol and/or Neurofen (or similar).
- Australian Commission on Safety and Quality in Healthcare - Treatment options for Stress Urinary Incontinence (PDF)
- UroGynaecological Society of Australasia - Urinary Stress Incontinence Information Sheets
- Your Pelvic Floor - Mid-urethral Sling (MUS) Procedures for Stress Incontinence
- Royal College of Obstetricians and Gynaecologists - Mid-urethral sling operation for stress urinary incontinence