Book Now
Quick Exit

Incontinence

Bladder leakage refers to the involuntary loss of urine. 1 in 3 women will experience bladder leakage, it is extremely common but never normal. There are two main types of urinary incontinence, Stress incontinence and urgency incontinence. Stress incontinence is when a person loses urine while coughing, laughing, or sneezing. Urgency incontinence is when urine is lost with the sudden need to urinate. Sometimes the entire bladder can empty before getting to the toilet. Many people suffer from both types. We call that mixed urinary incontinence. Any type of incontinence can disrupt an individual’s everyday routine and cause them to feel less confident when participating in social activities.

Urge incontinence, can be treated with behaviour modification, medication, acupuncture, tens treatment, Botox injections into the bladder, or implantation of a nerve stimulator. 

A variety of medications might help you have more normal urination. These include medications that encourage nerve activity, medications for bladder relaxation, and other options. Other treatment choices include bladder catheters or having one of a few different surgical options. Some lifestyle changes might also help. You can learn exercises that build strength in the muscles of the pelvic floor and pay attention to your urination patterns.

The first line treatment of stress urinary incontinence (SUI) is pelvic floor muscle exercises, this is best done in conjunction with a pelvic floor physio and has an improvement rate of up to 75%. Other options include Incontinence pessaries, intra-urethral bulking agents, and surgery. 

Surgery is often considered for women with stress incontinence who fail to respond to conservative therapy. The Australian commission of health and safety have a document that can help you make a decision on what type of surgery you would feel more comfortable with. 

https://www.safetyandquality.gov.au/publications-and-resources/resource-library/treatment-options-stress-urinary-incontinence-sui

Despite the senate enquire into mesh implants for incontinence and prolapse the Australian commission of health and safety still recommends the use of mesh slings in the management of SUI. If you want to read the senate enquiry into mesh implants the link is attached here.

https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/MeshImplants/~/media/Committees/clac_ctte/MeshImplants/report.pdf

A screen shot of a diagram

Description automatically generated

Burch Colposuspension (Mesh free)

There are various surgical options for women with stress urinary incontinence who have not responded to physiotherapy or medications. A Burch colposuspension is an operation that has been used for more than 50 years with good long-term success rates of 80-85%. This surgery avoids the use of mesh (non-mesh or mesh free incontinence surgery). Dr Carswell usually performs this by laparoscopy (keyhole) surgery

Diagram of a person's uterus- burch colposuspension surgery for urinary incontinence

Pubo-vaginal Sling (Mesh free)

The Pubo-vaginal sling is an operation that has been used for many years with good long-term success rates of 80-85%. This surgery avoids the use of mesh (non-mesh or mesh free incontinence surgery). The surgery is performed through an incision in the lower abdominal wall and a small incision in the vagina. The sling is taken from the rectus sheath in the lower abdominal wall and placed under and around the urethra through the small vaginal incision. 

The illustration below demonstrates the sling in position supporting the urethra.

Pubo-vaginal sling surgery for incontinence

Mid-urethral Sling (Mesh surgery)

The most widely used operation for stress incontinence is the mid-urethral sling procedure, often referred to as the tension-free vaginal tape or TVT operation. The mid-urethral sling procedure is a minimally invasive surgical operation that involves the placement of synthetic mesh tape to support the urethra and prevent stress incontinence.  The Mid-urethral slings have good long-term success rates of 80-85%. These operations can be performed in combination with other procedures such as surgery for prolapse. The two types of mid-urethral slings most commonly used are the retropubic sling (TVT) and trans-obturator sling (TOT). The Urogynaecology Association of Australia recommends the retropubic sling over the trans obturator sling for a variety of reasons (eg longer lasting effectiveness)

Women can comfortably have the operation with local, regional or general anaesthesia. A small incision is made in the vagina just below the urethra. If you have a retropubic TVT, two tiny incisions will also be made just above your pubic bone. This operation takes approximately 20 minutes to perform. Most women return home within 24 hours of the operation.

A diagram of a person's body

Description automatically generated

Trans-urethral Bulking Injection

In this procedure, a long acting or permanent filler substance (Bulkamid) is injected into the muscular wall of the urethra under direct vision (urethroscopy). This injection bulks up the lining of the urethra which results in less, or no, urine leakage. Although the cure rate is less after this procedure when compared to the sling or Burch procedures, it is much less invasive, does not require incisions, has a low complication rate and can be performed as a day procedure. About seven out of 10 women who have a Bulkamid injection report significant reduction in urinary incontinence and some women report being completely dry after this surgery.  If urinary incontinence returns the same procedure may be repeated (“top-up” injection) or an alterative treatment may be chosen.

Trans-urethral bulking injections are usually recommended for women who are not medically fit and for whom more invasive surgery or anaesthetic is not recommended. It is also used for women have a very scarred and rigid urethra (usually from previous surgery). This surgery may be recommended for women who continue to leak after other incontinence surgery.