Surgery or other procedures may be recommended if non-surgical treatments for urinary incontinence have not worked.
If you're a woman and plan to have children, this will affect your decision. The physical strain of pregnancy and childbirth can cause surgical treatments to fail. You may wish to wait until you no longer want to have any more children before having surgery.
Surgery and procedures for stress incontinence
The following procedures can be used to treat stress incontinence.
Colposuspension involves making an incision in your lower tummy (abdomen). The surgeon will lift up the neck of your bladder, and stitch it in this lifted position.
This can help prevent involuntary leaks in women with stress incontinence.
Colposuspension offers effective long-term treatment for stress incontinence.
Problems that can happen after colposuspension include:
- difficulty emptying the bladder when going to the toilet
- recurrent urinary tract infections (UTIs)
- discomfort during sex
Sling procedures involve making an incision in your lower tummy and vagina. A sling of tissue is placed around the neck of the bladder to support it. This will prevent accidental leaks.
The sling's tissue can be:
- taken from another part of your body (autologous sling)
- donated from another person (allograft sling)
- taken from an animal (xenograft sling), such as cow or pig tissue
The surgeon will often use an autologous sling. This is made using part of the layer of tissue that covers the abdominal muscles (rectus fascia).
These slings are generally preferred. This is because more is known about their long-term safety and effectiveness.
Problems that can happen following a sling procedure include:
- difficulty emptying the bladder when peeing
- some women may develop urge incontinence
Urethral bulking agents
A urethral bulking agent can be injected into the walls of the urethra.
This increases the size of the urethral walls and allows the urethra to stay closed with more force.
This is less invasive than other surgical treatments for stress incontinence in women. It does not normally need any incisions. The substances are injected through a cystoscope inserted into the urethra.
This procedure is generally less effective than the other options available. The effectiveness of the bulking agents will also reduce with time. You may need repeated injections.
After the injections you may have a slight burning sensation or bleeding when you pee. This usually only lasts for a short period of time.
Artificial urinary sphincter
The urinary sphincter muscle prevents pee flowing from the bladder into your urethra.
Your doctor may suggest fitting an artificial urinary sphincter to relieve your incontinence. This tends to be used more often as a treatment for men with stress incontinence. It is rarely used for women.
The procedure to fit an artificial urinary sphincter often causes short-term bleeding. It can also cause a burning sensation when you pee.
In the long term, some devices can stop working. You may need more surgery to remove it.
Vaginal mesh surgery is where a strip of synthetic mesh is inserted behind the urethra to support it. The urethra is the tube that carries pee out of your body.
Vaginal mesh surgery for stress incontinence is sometimes called tape surgery. The mesh stays in the body permanently.
The HSE has temporarily stopped the use of mesh for urinary stress incontinence and pelvic organ prolapse surgeries in hospitals. This is in cases where it is clinically appropriate and safe to do so. The pause will remain in place until new recommendations are implemented.
Surgery and procedures for urge incontinence
These include botox injections and nerve stimulation treatments.
Botulinum toxin A injections
Botulinum toxin A (botox) can be injected into the sides of your bladder. This is used to treat urge incontinence and overactive bladder syndrome.
This medicine can sometimes help relieve these problems by relaxing your bladder. The effect can last for several months and the injections can be repeated if they help.
Botox is not currently licensed to treat urge incontinence or overactive bladder syndrome. The long-term effects of this treatment are not yet known.
Sacral nerve stimulation
The sacral nerves are located at the bottom of your back. They carry signals from your brain to some of the muscles used when you go to the toilet, such as the detrusor muscle. This muscle surrounds the bladder.
Your incontinence may be a result of your detrusor muscles contracting too often.
A device is inserted near one of your sacral nerves, usually in one of your buttocks. An electrical current is sent from this device into the sacral nerve.
This improves the way signals are sent between your brain and your detrusor muscles. This will reduce your urges to urinate.
Sacral nerve stimulation can be painful and uncomfortable. But some people report a huge improvement in their symptoms.
Posterior tibial nerve stimulation
Your posterior tibial nerve runs down your leg to your ankle. It contains nerve fibres that start from the same place as nerves that run to your bladder and pelvic floor.
It's thought that stimulating the tibial nerve will affect these other nerves. This will help control bladder symptoms, such as the urge to pee.
During the procedure, a needle is inserted through the skin of your ankle.
A mild electric current is sent through it, causing:
- a tingling feeling
- your foot to move
You may need 12 sessions of stimulation, each lasting around half an hour, 1 week apart.
This treatment can give relief from overactive bladder syndrome and urge incontinence. But there is not enough evidence to recommend this as a routine treatment.
Pee can be collected without it flowing into your bladder. The tubes from your kidneys to your bladder can be redirected to the outside of your body. This is called urinary diversion.
It is only used if other treatments are not working or are not suitable.
It can cause complications, such as a bladder infection. You may need further surgery to correct any problems if they happen.
Catheterisation for overflow incontinence
This is where a catheter is used to empty your bladder.
Clean intermittent catheterisation
Clean intermittent catheterisation (CIC) is used to empty the bladder at regular intervals. It can reduce overflow incontinence, also known as chronic urinary retention.
A nurse will teach you how to place a catheter through your urethra and into the bladder. Your pee flows out of your bladder, through the catheter and into the toilet.
Using a catheter can feel a bit painful or uncomfortable at first. But any discomfort should reduce over time.
How often you need to carry out this technique will depend on your circumstances. For example, you may only need CIC once a day, or you may need to use the technique several times a day.
Regular use of a catheter increases the risk of urinary tract infections (UTIs).
This is a catheter inserted in the same way as for CIC, but left in place. A bag is attached to the end of the catheter to collect pee.
Content supplied by the NHS and adapted for Ireland by the HSE