It is important to be aware of possible risks from incontinence surgery, and talk through your options thoroughly with a healthcare professional. Risks can include an increased chance of:
Sling procedures are a common form of stress incontinence surgery, especially for females. The procedure involves a strip (or ‘tape’) of tissue being placed under the urethra to provide support and to prevent leakage. The tapes can be made from different materials, and attached to the body in different ways. The procedure usually takes place in a hospital or outpatient clinic without the need for general anaesthetic. Most patients recover within a couple of weeks.
Sling procedures can also be an option for male incontinence, although this is a newer form of treatment and studies are still underway to prove its effectiveness across a wide patient group.
As always, it is important that you thoroughly discuss this treatment option with a healthcare professional. This is because differing opinions exist around the use of sling procedures, with some arguing that they are not very effective and may cause unwanted side effects. To date, no clear conclusion has been drawn on either side of the debate.
Bladder neck suspension is another surgery often used to treat stress urinary incontinence. There are a number of ways to perform the procedure, some of which are less invasive than others. The idea is to lift up the bladder and stop it from sagging, which can provide long-term relief for many patients. During the consultation with the surgeon, he/she will advise whether you should have it performed laparoscopically (leaving smaller scars), or as a “retropubic suspension”, “Burch procedure” or “coloposuspension”.
Transurethral resection of the prostate (TURP) is a surgery for those with benign prostatic hyperplasia (BPH), and involves cutting away a small part of the prostrate. Patients with BPH often suffer from incontinence, particularly urge incontinence, and a TURP procedure can help treat this. Overall, it is thought that the benefits of surgery outweigh any side effects, but a thorough discussion with a healthcare professional should of course take place before deciding on this treatment.
Artificial urinary sphincter is a treatment for males with prostate cancer who have had to undergo a radical prostatectomy. The prostatectomy itself can often result in incontinence, since it can damage the urinary sphincter. To treat this, an artificial urinary sphincter (a fluid-filled ring) is placed under the urethra to keep it shut. A valve is then also inserted under the skin which you press when you need to go to the bathroom: it deflates the ring and allows for a flow of urine.
Adjustable continence therapy for men is another treatment for males with prostate cancer who have had to undergo a radical proctectomy. It is designed to help with stress incontinence, by placing a balloon-like implant under the neck of the bladder to lift it up. This procedure is not as invasive as other surgeries, and the inflatable balloon can be controlled through a device implanted under the skin. These procedures have a high success rate.
Sphincteroplasty is a surgery to repair a damaged sphincter. The damaged part is removed and the sphincter is then sewn back together again. To strengthen the area, sometimes a piece of muscle is removed from the thigh and placed around the sphincter. If necessary, an inflatable ring (known as an artificial anal sphincter) can be inserted, which is deflated using a pump when you need to do a bowel movement. This pump is placed under the skin of the major labia in females, and under the skin of the scrotum in males.
Rectal prolapse surgery is used to lift a fallen rectum back into place. The surgeon then stiches the rectum into the correct position, and if necessary, repairs the damaged muscles that created the original problem.
Haemorrhoidectomy is a surgery used to remove haemorrhoids that are preventing the anal sphincter from properly closing. The surgeon will use a laser, electricity (cautery pencil) or a surgical knife (scalpel) when performing the procedure.
Colostomy is a surgery for severe cases of incontinence, which is used when other treatments have not been successful. In this sense, it is considered a more serious and drastic option that should only be undertaken after a thorough consultation. The surgeon will close off the rectum, diverting the stools to an external colostomy bag.
Most surgeries normally take place in an hospital or outpatient clinic. Depending on the health system in your country, you will probably be given a consultation by a surgeon who can recommend the best treatment for your profile.
Make sure that you ask about any possible side effects of surgery so that you can decide on the option you are most comfortable with. For females, it is especially important to consult your healthcare professional if you are pregnant or planning on getting pregnant, as certain surgeries for incontinence may be “undone” with childbirth.
European Guidelines on Urinary Incontinence [Internet]. 2018 [cited 18 August 2020]. Available from:https://wfip.org/european-guidelines-on-urinary-incontinence/.
Bladder Control Problems (Urinary Incontinence) [Internet]. 2018 [cited 18 August 2020]. Available from: https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems/treatment.
Stress Incontinence in Women: Should I have surgery? [Internet]. 2020[cited 16 June 2020]. Available from: https://myhealth.alberta.ca/health/pages/conditions.aspx?Hwid=aa137467.