Bladder problems and urinary incontinence – treatment and definitions

A mid-urethral sling procedure is a minimally invasive surgery primarily used to treat stress incontinence.

In this procedure, a small sling is placed under the urethra, the tube that carries urine from the bladder out of the body. This sling functions like a hammock, supporting the urethra and keeping it closed, especially during coughing or sneezing, thereby preventing leaks.

The procedure is usually performed under general anaesthesia and lasts approximately 30 minutes. Most women can return home the same day, although a full recovery typically takes 6 weeks.

Currently, although recommended as the gold standard first-line procedure for treating stress incontinence, synthetic mid-urethral slings are being paused in their use in the U.K. This means that we are currently unable to offer this procedure. It is expected that we will be able to provide this procedure in due course, pending a national review.

However, until this time, we still offer the procedure using a sling fashioned from a patient’s tissue, called the autologous fascial sling.

This is inserted similarly to the mid-urethral tape but requires a horizontal abdominal incision to allow a sling to be obtained from the muscle sheath.

This procedure leaves a scar on the abdomen and requires a one-night stay in the hospital.

This procedure involves injecting a substance into the urethral walls around the bladder neck. The procedure aims to enlarge the urethral walls, allowing the urethra to remain closed more securely.

Bulking procedures are often recommended for women experiencing stress incontinence or those having trouble with bladder emptying. It’s also applicable to more complex scenarios, such as women who’ve undergone prior continence operations.

This is a relatively quick procedure performed under general anaesthesia, requiring no surgical incisions or stitches.

Urethral bulking agent treatment has a lower success rate and durability than mid-urethral tape or colposuspension. However, it has a reduced risk of complications, such as voiding problems and urgency, and does not require patients to learn self-catheterisation. For this reason, it is the most popular first procedure women choose. As bulking agents tend to wear off over time, repeated injections may be necessary to maintain the effect.

BoNT to the bladder is a treatment for urge urinary incontinence, involving injecting BoNT into the bladder muscle. This is usually chosen when medication has failed to produce the desired reduction in patients’ symptoms. This procedure can help relax the bladder, increase its storage capacity, and reduce urinary incontinence episodes.

This procedure is brief and non-invasive, involving no cuts or stitches. BoNT is administered into the bladder wall through a cystoscope camera device. You’re set to return home the same day after passing urine.

While the long-term effects of this treatment are still somewhat unknown, some known risks may include:

• Urinary tract infection
• Difficulties emptying the bladder (10%)

For this reason, women choosing to undertake BoNT treatment for the bladder need to learn to self-catheterise in advance of the procedure.

The impact of BoNT typically endures between 3-12 months, and the treatment can be repeated if proven beneficial.

Stress incontinence is when urine leaks due to physical exertion, such as coughing, laughing, or sneezing. It often happens when the muscles that support the bladder and regulate the release of urine, namely the pelvic floor muscles and the urethral sphincter, weaken and are unable to function effectively. This is typically treated with pelvic floor muscle strengthening and, if this is not successful, with a surgical procedure.

Urge incontinence is characterised by a sudden and overwhelming need to urinate, which can be challenging to control. This type of incontinence is typically caused by an overactive bladder muscle, leading to involuntary contractions that make it hard to hold urine until reaching a restroom. This is typically treated with lifestyle measures, bladder retraining and, if this fails, medication or BoNT.

Yes, stress incontinence can worsen over time, especially if the underlying causes are not addressed. Factors such as ageing, obesity, and childbirth can weaken the pelvic floor muscles and cause the condition to deteriorate. High-impact exercises and heavy lifting can also exacerbate symptoms. Therefore, seeking medical advice and treatment as soon as possible is crucial for managing the condition effectively.

Stress and urinary incontinence are quite common, especially among women. Approximately 1 in 3 women will experience some form of urinary incontinence in their lifetime, and stress incontinence is the most common type.