In some people, stress incontinence does not sufficiently improve with the other treatments and that is when you may wish to consider surgery. Every person is different, and a surgeon will be able to discuss with you what exactly is causing your problem, and how surgery may help. Whatever your particular condition, it is important to really think through the pros and cons of having surgery.
If your doctor or nurse refers you to see a surgeon, then this is an ideal time to ask lots of questions. Ask your doctor as many questions as you want, and never be afraid to go back or telephone to get more information or a clearer explanation. Before meeting the surgeon it may help to note down your questions on a piece of paper, so you don’t forget what you wanted to ask. Make sure you write down the answers you are given; it’s easy to come out of a consultation and forget what has been said.
At any stage of the process if you are not clear about anything the doctor or surgeon says, ask them to explain again, a bit slower this time. The surgeon can also explain why they consider one operation particularly suitable for you.
In the past, Colposuspension was the most commonly performed operation for the treatment of stress urinary incontinence. This is a major operation that requires a general anaesthetic. The abdomen is opened and the bladder neck is lifted upwards by stitching the lower part of the front of the vagina to a ligament behind the pubic bone. This lift helps to prevent leakage by improving pressure transmission and compression of the neck of the bladder.
No surgical operation can guarantee success in treating incontinence. The Colposuspension has a success rate of between 50% and 70%. That means that over half the women having the operation will be cured or greatly improved. The remainder may still suffer from incontinence.
There are two versions of the operation:-
Open Colposuspension, which gives better long-term success rates, but involves making a large cut in the abdomen so post-operative healing times are longer.
Laproscopic Colposuspension, which involves making a smaller cut to do the operation; sometimes called keyhole surgery. After this operation, most people recover and get back to work more quickly than with Open Colposuspension, but its success rate is less good. This operation can cause extra problems – problems with emptying the bladder (some people need to use catheters after the operation), irritable bladder and urgency, and pain during sexual intercourse
Sometimes it is not possible to do a Colposuspension, because of previous surgery. There are other similar operations that can be performed in these cases: the aim is still to provide extra support to the bladder neck and reduce the risk of leaking. Sometimes, for example, a ‘sling’ is placed under the bladder neck.
If you would like more information about any of these procedures, please make an appointment with your GP who can discuss your options with you.