In some women, the bladder can move out of its normal position, especially following childbirth. Surgeons have developed different techniques for supporting the bladder back to its normal position.
Surgery for SUI is designed to provide support or compression of the urethral sphincter mechanism (“urethral valve muscle”) to prevent stress urinary incontinence. Stress incontinence is a condition where urine leakage occurs with coughing, sneezing, running, or other physical movement. Sometimes, the urethral valve muscle is so weak that there is leakage with minor exertion such as walking. It is critical to differentiate stress incontinence from urge incontinence, the condition where there is “bladder overactivity”, or the bladder muscle has spasms, creating symptoms of urinating frequently and urgently and even urine leakage. Urgency symptoms are treated primarily with behavioral modification (avoid excessive fluids, caffeine, etc.), physical therapy and medications. One of our problems is that most women with stress incontinence have some urgency symptoms also, making the decision of how to treat (behavioral modification, physical therapy, medications or surgery) more difficult.
There are three types of surgery for SUI:
- The retropubic bladder suspension done through an abdominal incision, and the two vaginal sling procedures,
- The fascial sling,
- The midurethral sling.