Surgery for Incontinence Problems

Urinary incontinence is the uncontrollable loss of urine. Three main types of incontinence exist--stress incontinence, which occurs when urine is lost when putting the bladder under stress (as occurs when coughing); urge incontinence, which occurs when the bladder leaks large amounts of urine infrequently; or overactive bladder, which causes frequent, urgent needs to urinate. When the condition affects a patient's quality of life, many look for treatment, including urinary incontinence surgery.

Sling Procedures

• The Mayo Clinic indicates that sling procedures are the most common types of surgery used for stress incontinence. This procedure uses a strip of tissue from the patient's body or a synthetic material to create a sling around the neck of the bladder and the urethra. This provides the support necessary to hold the urethra closed when under pressure, such as when you cough or laugh. In female patients, conventional slings are inserted through a vaginal incision and adjusted using an abdominal incision. Doctors place the sling in male patients using an incision between the scrotum and rectum.

Suspension Procedures

• A bladder neck suspension adds support to the urethra and bladder neck. It involves an incision in the abdomen through which the physician stitches the tissue around the bladder neck to a ligament near the public bone. This keeps the bladder neck and urethra from sagging, thus aiding with urinary control. Some women have incontinence because the bladder or urethra has dropped, and this is fixed using a retropubic suspension. This procedure involves stitching the pelvic fascia to the wall of the vagina to keep the bladder in its place. Like the sling procedure, suspensions work best for stress incontinence.

Sacral Nerve Stimulation

• A sacral nerve stimulation device controls incontinence caused by overactive bladder syndrome. In this surgery, the physician places a sacral nerve stimulation device inside the buttock. This works much like a pacemaker, delivering continuous electrical impulses into the nerves responsible for the urge to urinate. The procedure is performed on an outpatient basis under local anesthesia, but may not work for all patients. For this reason, many doctors recommend using the stimulator externally prior to surgery to make sure it will work.

Bladder Augmentation

• Bladder augmentation treats incontinence caused by overactive bladder by making the bladder larger. The complex surgery begins with an abdominal incision to reach the bladder. A strip of tissue from the stomach or intestine is harvested and used to increase the bladder's size. This surgery requires a lengthy hospital stay, as patients cannot leave until they are able to eat, drink and void properly. Some patients must use a catheter even after having this procedure because of nerve damage.

Considerations

• While incontinence is an uncomfortable and sometimes embarrassing problem, patients should carefully consider their options before choosing surgery because of the risks involved. Other treatment options should be pursued prior to opting for surgery. Women interested in incontinence surgery should wait until they are done having children, as the childbirth process can damage any fixes put in place by the surgeon. Finally, patients with mixed incontinence may still need medication or physical therapy for their condition, as surgery can only treat one type of incontinence, not several.

Risks

• Incontinence surgery caries several risks. Damage to the organs around the bladder is possible. Sometimes the patient's body rejects the sling or transmitter inserted during surgery. Other potential side effects include abdominal or pelvic pain, bleeding and blood loss, infection, development of overactive bladder syndrome, urinary tract infections or pain during intercourse. Some patients experience urinary retention, which is the inability to completely empty the bladder, after incontinence surgery.