What is stress urinary incontinence?
Your pelvic floor muscles and urethral sphincter muscle help keep your bladder closed. If they are weak, your bladder may leak when you cough, laugh or lift a heavy object. This is called stress urinary incontinence, often known simply as “stress incontinence”.
Pelvic floor exercises with the help of a specialist physiotherapist or continence nurse may help to improve symptoms of stress incontinence. Traditionally, the only other treatment option was major pelvic floor surgery. However, in the last few years, two relatively simple and highly effective surgical procedures have been developed to treat stress incontinence.
Vaginal tape operations - TVT and TOT
A tension-free vaginal tape (TVT or TOT) may be used to support the urethra (the tube that carries urine from your bladder). This can help keep your bladder closed or support it so that it doesn’t leak under pressure.
In the TVT (tension-free vaginal tape) procedure the tape is inserted through a small cut within the vagina. The tape is then pulled through two tiny cuts on the skin, just above your pubic area. The tape acts as a sling to hold your urethra up. Your surgeon will snip the tapes, just under the skin, and close the cuts using dissolvable stitches. Your body makes scar tissue that grows into the tape and keeps it in place. This gives extra support for your urethra. The operation takes about half an hour.
A newer technique is called TVT-O (for obturator) or TOT (trans obturator tape). In the TOT procedure a similar cut in the vagina is made, but the tape ends pass out of the pelvis through a muscle called the obturator, to the skin surface via a small cut on each inner thigh.
Both TVT and TOT techniques gave similar results however your surgeon will be able to explain the differences between the two methods in more detail.
A TVT or TOT operation is usually done as a day case, but sometimes you may need to stay overnight in hospital. The procedure can be done using local, spinal or general anaesthesia. After a TVT or TOT operation you will probably need to take up to a week off work and avoid strenuous exercise and lifting for 4-6 weeks.
Periurethral bulking agents
Periurethral bulking agents are designed to "tighten" the urethra to treat urinary incontinence. Some patients can benefit from this procedure which does not involve any surgery. The bulking agents, such as collagen, are injected into the urethra by the consultant. The procedure usually takes about 15 minutes, with no sedation required. Patients can go home as soon as they show they can urinate normally.