Are there other causes of incontinence?
Another common cause of urinary incontinence is a problem with the detrusor muscle of the bladder. To pass urine the detrusor muscle contracts increasing pressure within the bladder, the bladder neck opens and urine passes down the urethra. If your detrusor muscle is unstable it will contract at other times, causing incontinence. A cough or sneeze may make your detrusor muscle contract. This condition is called detrusor instability. Surgery to lift up your bladder neck will not help for this.
We use a special test called urodynamics to find out the cause of your incontinence. Sometimes the test shows that true stress incontinence and detrusor instability are both present. Surgery may not be the best treatment in this situation but sometimes it can help.
There are other causes for incontinence. We will need to rule these out before you decide to have surgery.
The aim of the operation is to lift your bladder neck into the correct position, just above your pelvic floor. This should give increased pressure to your bladder neck and upper urethra during a cough or other stress and prevent the leak of urine.
You should no longer have problems with leaking urine. If the incontinence has disrupted your life, the operation should help things return to normal.
Are there any alternatives?
If your bladder neck has only dropped a little, you may be able to correct it with exercises to strengthen your pelvic floor muscles.
After the menopause, hormone replacement therapy (HRT) may improve the pelvic floor muscles enough to correct the problem and avoid the need for surgery.
Other surgical techniques can provide the same or a similar effect to a Burch colposuspension. The Burch colposuspension is considered to be reliable in most cases, with a success rate of about 85% (17 in 20). Other new procedures include a keyhole Burch colposuspension, stitching in a special tape called a tension-free vaginal tape (TVT) or injecting a strengthening chemical around the urethra, called a para-urethral collagen injection. These new techniques have yet to prove themselves fully but are developing all the time. Discuss all the options with your gynaecologist.
What if you do nothing?
If you do nothing your incontinence will probably continue and become steadily worse. However, the success of the operation is not guaranteed and it fails in about 15% (3 in 20) of cases. In most of these failures the incontinence is no better. In rare cases, the incontinence becomes worse.
Author: Dr David Hutchon M.R.C.O.G, F.R.C.O.G. Consultant Gynaecologist.
© Dumas Ltd 2006