Urinary Incontinence Surgery

What is urinary incontinence?

Urinary incontinence simply means leaking urine.  Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.

What other symptoms occur with urinary incontinence?

It is common for other symptoms to occur along with urinary incontinence:

  • Urgency—Having a strong urge to urinate
  • Frequency—Urinating (also called voiding) more often than what is usual for you
  • Nocturia—Waking from sleep to urinate
  • Dysuria—Painful urination
  • Nocturnal enuresis—Leaking urine while sleeping

What are the types of urinary incontinence?

Urinary incontinence in women can be divided into three main types:

  1. Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Leaks also can happen when a woman walks, runs, or exercises.
  2. Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop.  Women with this type of urinary incontinence may leak urine on the way to the bathroom.  If you have an “overactive bladder” (OAB), it means that you have symptoms of urgency and frequency that may or may not include incontinence.
  3. Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.

How is urinary incontinence diagnosed?

The first two steps in assessing urinary incontinence usually are a medical history and physical exam:

  1. Medical history—Your gynecologist or other health care professional will ask you to explain your signs and symptoms in detail.  You may be asked to fill out a bladder diary for a few days.
  2. Physical exam—A pelvic exam may be done to see if you have pelvic organ prolapse and to look for other anatomical problems.  A “cough test” may be done during the exam. During a cough test, you are asked to cough and bear down with a full bladder to see if urine leaks.  A pad test may be done, in which you wear a pad that absorbs leaked urine.  The pad is weighed for the amount of leakage.  A test to measure the support of the urethra may be done.

Sometimes, imaging tests and bladder function tests are done if more information is needed.

What medications are available to help treat urinary incontinence?

Many medications are available to help reduce the symptoms of urgency urinary incontinence and OAB:

  • Drugs that control muscle spasms or unwanted bladder contractions can help prevent leakage from urgency urinary incontinence and relieve the symptoms of urgency and frequency.
  • Mirabegron is a drug that relaxes the bladder muscle and allows the bladder to store more urine.  This drug is used to treat urgency urinary incontinence and relieve the symptoms of urgency and frequency.
  • Injection of a drug called onabotulinumtoxinA into the muscle of the bladder helps stop unwanted bladder muscle contractions.  The effects last for about 3–9 months.

Is there a surgical procedure to treat urinary incontinence?

There are different types of surgical procedures for different types of incontinence.  You and your doctor may discuss many factors before choosing the surgery that is right for you, including the risks and benefits of each type.

What types of surgery are available to treat SUI?

Surgery to correct SUI includes the following procedures:

  • Slings—Different types of slings, such as those made from your own tissue or synthetic materials, can be used to lift or provide support for the urethra.  The synthetic midurethral sling is the most common type of sling used to correct SUI. This sling is a narrow strap made of synthetic mesh that is placed under the urethra.
  • Colposuspension—Stitches are placed on either the side of the bladder neck and attached to nearby supporting structures to lift up the urethra and hold it in place.
  • If surgery is not an option for you or has not worked for your SUI, urethral bulking may help. A synthetic substance is injected into the tissues around the urethra.  The substance acts to “plump up” and narrow the opening of the urethra, which may decrease leakage. 

What procedures are available to treat urgency urinary incontinence?

  • Sacral neuromodulation—This is a technique in which a thin wire is placed under the skin of the low back and close to the nerve that controls the bladder.  The wire is attached to a battery device placed under the skin nearby.  The device sends a mild electrical signal along the wire to improve bladder function.
  • Percutaneous tibial nerve stimulation (PTNS)—PTNS is a procedure that is similar to acupuncture.  In PTNS, a slender needle is inserted near a nerve in the ankle and connected to a special machine.  A signal is sent through the needle to the nerve, which sends the signal to the pelvic floor.  PTNS usually involves weekly 30-minute office sessions for a few months.

Interested in learning more?

For more information or to schedule an appointment, please call us at 318.443.7222.