Stress and Urge Incontinence Treatment

What is urinary incontinence?

Urinary incontinence is a condition which can affect many women, especially following childbirth or in later life. There are several types of incontinence, including:

  • Stress incontinence – when urine leaks due to pressure from a physical movement, or exertion such as coughing, laughing or sneezing.
  • Urge incontinence – a person will notice a sudden and intense need to pass urine, which often cannot be prevented. People will this type of incontinence usually need to urinate frequently.
  • Mixed Incontinence – having both stress and urge incontinence

How is urinary incontinence managed?

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.

Many women also benefit from using incontinence products, like pads, absorbent pants, or handheld urinals. Sometimes, medicine may be prescribed to help manage symptoms.

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, medication or surgery may be the best option where all other means have been unsuccessful.

What are the surgical treatment options for urinary incontinence?

If other means of managing urinary incontinence symptoms have proven to be unsuccessful, you may be referred for surgical treatment. Several different types of surgical treatment procedures exist, all of which are minimally invasive. These include:

  • Mid-urethral tapes/slings using synthetic material or fashioned from a patient’s own tissue
  • Injection of bulking agent into the neck of the bladder
  • Botox treatment to the bladder
  • Colposuspension

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 Sling procedure

What is the Mid-urethral Sling procedure?

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 to reduce leaking urine. The procedure usually lasts between 15 and 30 minutes and is carried out under general anaesthetic.

Why choose a Mid-urethral Sling procedure?

Tape procedures have a high success rate (85-90%) and can last for over 15 years based on current evidence. This procedure is recommended by the National Institute for Clinical Excellence (NICE). It is considered one of the gold standard procedures for the 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 also a minimally invasive technique with only small incisions and therefore causes very little or no visible scarring afterwards.

What are the risks involved in mid-urethral sling procedures?

All procedures to restore continence can have an effect on the urinary flow, but this is usually barely noticeable, and only around 3-5% of women do not empty their bladder successfully after the procedure. In almost all 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.

Currently, although recommended as a gold standard first line procedure to treat stress incontinence, synthetic mid-urethral slings are paused in their use in the U.K. This means that we do not offer this procedure at the current time.

It is expected that we will be able to offer this procedure in due course pending a national review, but until this time we still offer the procedure using a sling fashioned from a patient’s own tissue, called the Autologous Fascial Sling.  

This is inserted in a similar fashion to the mid urethal tape but requires a slightly larger incision over the patient’s abdomen to allow a sling to be fashioned from the muscle sheath.

 

Urethral Bulking Agents

What is the Urethral Bulking Agents procedure?

This procedure involves injecting a substance into the urethral walls, around the bladder neck. The procedure aims 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 in 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.

What are the risks involved in Urethral Bulking Agents procedures?

Some risks may include:

  • Burning or bleeding when passing urine, though this usually stops shortly after treatment
  • Difficulty emptying the bladder
  • Urethral pain
  • Urinary tract infection

Colposuspension

What is the Colposuspension procedure?

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 abdomen, lifting up vagina which in turn lifts 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. Longer recovery times and resulting 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 may be recommended by a subspecialist urogynaecologist if a previous continence operation has failed.

What are the risks involved in Colposuspension procedures?

Colposuspension has the same risks as the mid-urethral tape, as well as some additional risks associated with it being a more significant 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.

View our patient resources page to download more information regarding procedures for incontinence.

Before deciding to proceed with an incontinence operation all our patients are provided with an information detailing the different options that are currently available and the evidence for their success as well as the risks and benefits of each procedure so that you can make an informed decision.

 

Botox to the Bladder

When is Botox to the bladder used?

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 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.

What are the risks of Botox to the bladder?

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

  • Urinary tract infection
  • Difficulties emptying the bladder

London Women’s Centre’s 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 women’s health 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 is 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.

To see book a confidential consultation with London Women’s Centre’s subspecialist urogynaecologist, contact the clinic on 07990 781826.

See A Consultant