Incontinence, a condition in which the bladder leaks, can have several different causes. Sometimes, it is just an occasional problem when you cough or laugh. But for those who have a more regular battle with this condition—and for whom less-invasive treatment options have not worked—surgery offers a more permanent option for dealing with incontinence.
The bladder can become weakened and start to sag, especially in women who have been pregnant and given birth to multiple children. The result can be a slight, involuntary discharge of urine. Over time and as the condition worsens, the leakage can become more frequent and greater in flow. Other causes of incontinence include medications, infections, physical exercise, physical movements (coughing or laughing hard) and mental or physical conditions, such as Alzheimer's disease and other forms of dementia.
Incontinence and Women
According to the National Institutes of Health (NIH), women are twice as likely as men to experience incontinence. And while older women have bladder control problems more frequently than their younger counterparts, it isn’t a condition of aging. Researchers say, though, that events related to reproduction--pregnancy, childbirth and menopause--play a role in why females experience the condition more frequently.
Surgery to address a bladder that has been weakened by pregnancy and childbirth is sometimes referred to as "tacking up the bladder." There are basically three types of surgery that accomplish this, according to the NIH: a traditional sling-type surgery, the midurethral sling surgery (a newer version) and retropubic surgery (also known as suspension surgery).
Traditional Sling Surgery
Performing the surgery through the vagina, surgeons attach tissue to one side of the pelvic bone, lift the bladder neck up by using the remaining tissue, then attach the other end of the tissue to the opposite pelvic bone. This “sling” then supports the bladder. The tissue used in this surgery can come from the individual being operated on, or the surgeon may choose to use a man-made type of tissue instead.
Midurethral Sling Surgery
Midurethral sling surgeries (there are basically two types) can be performed as an outpatient procedure. Additionally, the material used as the sling for this type of surgery does not come from the patient; it is a synthetic material.
After making tiny incisions behind the patient’s pubic bone (or on the sides of the vagina), the surgeon uses a special needle to thread the synthetic material (special tape) beneath the urethra, and to lift it and hold it in place. Once the doctor is satisfied the sling is as tight as it should be, the surgery is finished.
The Burch procedure is the most common type of retropubic surgery. It involves the surgeon making an incision inches beneath a woman’s navel, then threading sutures (surgical threads) to ligaments located within the patient's pelvic area. These threads are then used to secure the urethra’s sphincter, lifting it up accordingly. Often, this type of surgery is performed while a woman is undergoing a hysterectomy.