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Gynaecology

Stress Incontinence Surgery


IntroductionShow [+]Hide [-]

Stress incontinence is the term used to describe the leakage of urine when you cough or sneeze or when you walk or exercise. It is caused by a weak sphincter, (the muscle around the bladder outlet), or by poor support to the bladder outlet from the pelvic floor muscles and ligaments.

The first recommendation would be exercise for the pelvic floor muscles; you may have tried this already. If the leakage continues and remains a problem even after a period of time doing these exercises, then surgery may be required.

The operation will help support the neck of the bladder by creating a hammock of stitches or tissue taken from your own abdominal muscle. These are attached to tissues at the back of the pubic bone. This surgery has success rates of up to 85-90% at 10 years following the operation

Before your procedureShow [+]Hide [-]

Make sure that your family knows you will not be able to do any heavy housework or lifting for approximately two months. In the first four to six weeks after your operation you should avoid standing for long periods. The length of stay in hospital depends on your general health and recovery after the operation. You can expect to stay in hospital approximately seven days.

You will usually be admitted to hospital on the day before your operation. Please let the nursing staff know if you require a special diet. The ward doctor will see you following arrival and some blood samples will be taken. You may require a chest x-ray or an electrocardiogram. The nurse, consultant and anaesthetist will see you to discuss your operation and your after care.

The physiotherapist will visit to talk about the exercises you need to carry out after the operation. It is advisable NOT to carry out pelvic floor exercises immediately after the operation.

A pre-medication may be prescribed. This helps you feel relaxed before going to theatre.

Chest infections are more likely to occur if you are prone to these, or if you smoke. It is advisable to reduce or give up smoking at least four to six weeks before you come into hospital. Ask your GP for sources of help.

During your procedureShow [+]Hide [-]

You will usually also be given an antibiotic to help prevent infection and an injection of Heparin, to reduce the risk of thrombosis.

To ensure that your bowels are empty and to rest the bowel after the operation a small enema is usually given on the evening before to surgery.

After your procedureShow [+]Hide [-]

After the operation you will receive pain relief through a PCA (Patient Controlled Analgesia) for a couple of days until you can take tablets.  You will also have a catheter through the abdomen to drain urine from your bladder into a bag for the first few days after your operation and wound drains which reduce internal bruising, and are usually removed after 24 to 48 hours.

We will encourage you to do the breathing and leg exercises

To test how your bladder is working the nurse will measure the urine draining into the catheter. This will be taken out when appropriate.

Occasionally the residual urine remains high, and you may go home with the catheter in place.  The District Nurse will visit and you will be given a contact number at the hospital.

As well as the risks associated with any type of surgery, operations for stress incontinence have particular complications including:

  • A 10% risk of developing symptoms of urgency with the need to rush to the toilet and/or go more frequently following colposuspension.
  • A 10 –15% risk of developing posterior vaginal wall prolapse following colposuspension.
  • Sometimes, we will show you how to use a catheter to empty your bladder before you have surgery so that you can do this yourself. This is a simple safe procedure to carry out.
  • Sometimes there may be pelvic floor weakness.
  • There is a 10% of discomfort and leakage of urine during intercourse
  • Urine infections may occur after the surgery and can easily be treated with antibiotics.
  • Wound infections or bleeding under the wound (called a haematoma) may occur. These problems may lead to a small risk of wound hernias in the long-term.
  • A thrombosis is a blood clot that may happen after surgery when mobility is restricted. You will wear support stockings which help with circulation. Also, leg and breathing exercises will help. Some women may need injections of Heparin which helps prevent blood clots forming.
  • The risk of chest infections and thrombosis increases if you are overweight, so if possible try to lose any excess before admission

More InformationShow [+]Hide [-]

You may experience some frequency of passing urine. This should lessen with time. When you pass water try to empty your bladder completely. This will help reduce the risk of infection. You may have to alter your normal position slightly. If you have difficulty emptying try leaning forward or even standing up to do this.

Have a shower or shallow bath each day following your discharge.

Too much tea or coffee is not a good thing for the bladder. No more than 3-4 cups should be taken unless decaffeinated. Drink enough, but it is not necessary to drink more than 1.5 litres/3 pints in 24 hours.

Gradually increase your mobility during the six weeks following discharge. You should continue with the exercises given to you by the physiotherapist.

Avoid constipation by eating a high fibre diet including plenty of fresh fruit and vegetables, brown bread and so on

If you feel comfortable, you can start having sex again by about six weeks.

Please check your motor insurance policy. Some policies state a minimum time of six weeks before driving after an operation.

Start with gentle exercise six weeks after your operation. More vigorous exercise like aerobics, keep fit and competitive sport should be left until three months following surgery.

Take at least eight weeks off work. Sick notes will be issued by your GP. A certificate will be issued by the ward nursing staff for the time you are in hospital.

The staff on the ward will arrange an outpatient appointment. This may be for 3-6 months following the operation

If you have any problems when you get home, either contact your GP or you can contact the staff on Ward 40 for advice: Ward 40 Tel: 0191 2825640

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