What is female incontinence surgery?
Surgery for female incontinence is appropriate for women who demonstrate leakage of urine and whose symptoms have failed to improve with other more conservative treatments. There are several different procedures that are commonly performed for female urinary incontinence. These include:
- Pubovaginal sling: placement of a strip of natural tissue (either human or animal-derived) under the bladder that then is anchored to the other pelvic tissues. This strip of tissue supports the bladder and helps prevent leakage.
- Tension-free tape mid-urethral sling: A narrow strip of synthetic mesh is placed below the urethra and placed behind the pubic bone (or into pelvis tissues) using minimally invasive techniques. This strip of mesh supports the urethra and helps prevent leakage. This is not the same mesh that has been used for pelvic reconstruction and was found to have problems of erosion and infections. These risks are much less with the mid-urethral slings.
What is the purpose of female incontinence surgery?
Women who leak urine typically do so because of one of two types of incontinence.
The first type of incontinence is described as urge incontinence, which is an involuntary contraction of the bladder during filling. This is generally manifested with leakage of large volumes of urine with associated urge or need to urinate. This type of leakage typically responds well to medical therapy.
The second type of leakage is termed stress incontinence, which is leakage of urine, usually small to moderate volumes, in association with some type of physical activity. Many women report leakage that occurs with cough, sneeze, and exercise. This type of incontinence often occurs due to usually stems from an abnormality in the bladder’s support system which can occur with aging or after pregnancies.
Female incontinence surgery is indicated for the treatment of stress urinary incontinence. The surgeries listed above accomplish their goal by restoring the natural support system underneath the urethra and bladder. Typically, the surgery is performed through a vaginal approach which minimizes pain and discomfort for the patient following surgery. The surgery can be performed as an outpatient surgery with a brief anesthetic or may be combined with other gynecological surgeries if indicated based upon the patient’s condition.
What are the symptoms following female incontinence surgery?
Once you initially recuperate and leave the surgery center or hospital, patients are advised to reduce their activity level for several days and avoid straining for 6 weeks. It is very common to have variable amounts of fatigue that generally improve over 2-3 weeks.
Pain is generally mild but may be noted for 1-3 weeks in the vagina or in the lower abdomen on either side of the pubic bone.
Typically, patients will have a vaginal discharge that resembles a menstrual flow for approximately one week which then becomes a clear or white vaginal discharge for 3-4 weeks as stitches heal and dissolve.
It is very common to have temporary changes in your bladder activity after any type of incontinence surgery. These changes include an increased sensation of urgency and frequent need to urinate, as well as perhaps a small amount of leakage associated with urgency. Typically, these symptoms are caused by irritability of the bladder, which will resolve spontaneously over 6-8 weeks following the surgery. It is also very common to have some slowing of the urinary stream. This will more gradually change and improve over a period of 2-3 months.
When should I seek advice from my physician?
Elevated temperature to 101 degrees or greater following the procedure.
Inability to urinate for greater than 6 hours despite feeling the urge or urinating very small amounts (1-2 tablespoons) every 15 minutes.
While some minor bleeding is common following the procedure, more significant bleeding is rarely encountered. This type of bleeding, however, would manifest itself with the soaking of multiple pads over an hour’s period of time. If this occurs, either contact your doctor or go to the emergency room for more evaluation.
Most women experience mild to moderate pain for the first several days following their procedure. Most women report that this pain is well controlled with either ibuprofen or
Tylenol or in some instances, pain medication which will be given to you following the procedure. If these medicines are not sufficiently improving your discomfort, contact your physician for further evaluation.