Treatment for Bladder Problems & Incontinence
Your GP will first suggest making lifestyle changes to improve symptoms, including weight loss and cutting down on alcohol and caffeine. Pelvic floor exercises are also recommended to strengthen pelvic floor muscles, which often weaken following childbirth or as a natural result of ageing.
If these measures fail, you may be referred for bladder training, guided by a specialist who can help teach you ways to train yourself to wait longer to pass urine.
In some cases, surgery may be the best option where all other means have been unsuccessful.
Minimally-invasive surgical procedures include:
- Mid-urethral Tapes
- Injection of bulking agent into the neck of the bladder
- Botox treatment to the bladder
More major procedures include Colposuspension, which is carried out in a small minority of patients.
We also use a minor surgical procedure to investigate the bladder when symptoms are not easily explained or resistant to treatment. This is called cystoscopy and involves looking inside the bladder using a small, thin camera.
Mid-urethral tapes can be used as a treatment option for those with stress incontinence, which is brought on by physical activity such as sneezing, lifting or coughing.
This is a minimally-invasive procedure in which tape is inserted through a small incision inside the vagina and threaded behind the urethra, holding it up in the correct position so as to reduce leaking urine. The procedure usually lasts between 15 and 30 minutes and is carried out under general anaesthetic.
Tape procedures have a high success rate (80-85%) and can last for over 15 years based on current evidence.
All procedures to restore continence can have an effect on the urinary flow, this is usually barely noticeable, but 3-5% of women do not empty their bladder successfully after the procedure. In almost all of these cases, the problem is reversible depending on the cause.
A woman might experience the feeling of needing to pass urine more frequently after any surgery to correct incontinence, but this usually settles with time, during the post-operative recovery period. Occasionally a woman might require treatment with medication to calm the bladder down.
Why choose a Mid-urethral Tape?
This procedure is recommended by the National Institute for Clinical Excellence (NICE). It is considered one of the gold standard procedures for treatment of stress urinary incontinence and has a long record of evidence in the highest quality scientific studies of excellent success rates with minimal risks.
It is a minimally invasive technique with only small incisions and therefore causes very little or no visible scarring afterwards.
Urethral Bulking Agents
This procedure involves injecting a substance into the urethral walls, around the bladder neck. The aim of the procedure is to increase the size of the urethral walls to allow the urethra to stay closed more strongly.
Bulking procedures are recommended for women with stress incontinence or those who have difficulties emptying the bladder. It can also be used in more complex cases, such as for women who have had previous continence operations.
This is a short procedure, carried out under general anaesthetic and one which requires no incisions or stitches to be made. Women can typically go home the same day.
However, it does not have the same success rate or long-lasting effects as a mid-urethral tape or colposuspension, so it is usually recommended as a second line treatment option. Bulking agents will wear off over time, so repeated injections are often necessary.
- Burning or bleeding when passing urine, though this usually passes shortly after treatment
- Difficulty emptying the bladder
- Urethral pain
- Urinary tract infection
The colposuspension is an older procedure for urinary incontinence. It has a good success rate and is carried out by making an incision in the tummy, listing up the neck of the bladder and then stitching it in its new, lifted position.
This is a more invasive operation which requires a 45-60 minute procedure and a hospital stay of 3-4 nights. A longer recovery time is and scarring, much like a caesarean section scar, means this procedure is less common in modern times. A more popular treatment option now is the newer mid-urethral tape procedures which have a shorter operating time, fast recovery and minimal scarring
However, colposuspension is used by a subspecialist urogynaecologist if a previous continence operation has failed.
Colposuspension has the same risks as the mid-urethral tape, as well as some additional risks associated with it being a more major procedure, including difficulty emptying the bladder fully, recurring UTIs and painful sex.
There are no risks associated with vaginal healing because the procedure is not carried out through the vagina.
Click here to download more information regarding procedures for incontinence
Botox to the Bladder
If medication has failed to control an ‘unstable’ bladder, then you may be offered Botox treatment. During such a procedure, Botulinum toxin A (Botox) is injected into the sides of the bladder in order to stop urge incontinence or overactive bladder syndrome.
This is a short procedure that requires no incisions or stitches. It involves injecting Botox into the bladder wall via a camera called a cystoscope. You will be able to go home the same day after passing urine.
The effects of botox often last for 3-12 months and treatment can be repeated if found to have helped.
- Urinary tract infection
- Difficulties emptying the bladder
- The long-term effects of this treatment are not yet known
Our approach to treatment
We believe in a multi-disciplinary approach to managing women with incontinence and pelvic floor problems. This means working with nurses and physiotherapists as well as doctors from other disciplines to provide women with a comprehensive care package for their bladder treatment.
We also believe women should be given choices for managing their condition and offer conservative treatment, physiotherapy, medication and surgery as treatment options.
Urinary symptoms can be investigated using a bladder diary, urodynamics tests (a function test for the bladder), cystoscopy (a camera test to see the appearance of the bladder and urethra), as well as an ultrasound scan of the bladder and pelvic floor.
Why see a Subspecialist Urogynaecologist?
An accredited subspecialist urogynaecologist has been trained to manage women with urinary problems, to the highest level of expertise. They work at centres where patients with complex problems are referred from other units, such as women who have previously been operated on or treated for urinary incontinence or prolapse, but without success.
They also deal with women who have more than one type of incontinence or have incontinence as well as other pelvic floor problems, such as prolapse of the vagina and uterus. Subspecialists are usually involved with the training of surgeons and research and development of new techniques. This is, therefore, the highest level of care that you can receive.