Urinary incontinence - or passing urine unexpectedly - can be embarrassing. Many women experience it because of weak pelvic muscles - typically caused by pregnancy and child birth. It can also be caused by old age, obesity, and family history.
There are a number of treatment options available for stress urinary incontinence, including doing nothing (if your symptoms are not particularly troublesome), non-surgical treatment (pelvic floor exercises, medication, continence pessaries or absorbent products) and surgical treatments including synthetic tape procedures, natural or biological sling procedures, urethral bulking agents or Burch colposuspension.
Unexpected and uncontrolled urinating can be embarrassing and often distressing. Stress urinary incontinence (more commonly called stress incontinence) occurs when urine leaks from your bladder as you laugh, cough or lift a heavy object.
It occurs when the pelvic floor muscles and the urethral sphincter muscle that keep the bladder closed are weak (pelvic organ prolapse).
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 other surgical procedures have been developed to treat stress incontinence: tension-free vaginal tape (TVT) and trans-obturator tape (TOT). Both use medical tape to help support your urethra.
Another alternative is to have an injection of bulking agents into the urethra to help correct urinary incontinence. This procedure takes just 15 minutes and you can leave hospital as soon you have urinated normally.
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You will have a formal consultation with a healthcare professional. During this time you will be able to explain your medical history, symptoms and raise any concerns that you might have.
We will also discuss with you whether any further diagnostic tests, such as scans or blood tests, are needed. Any additional costs will be discussed before further tests are carried out.
During this appointment you and your consultant can discuss whether surgical treatment is the best option for you. Since July 11 2018, TVT and TOT operations have been paused while an independent review assesses the risks and benefits and to confirm that extra safety measures have been put in place. In the meantime, if you decide to go ahead with a TVT or TOT, a multi-disciplinary team of health professionals will consider your medical history, alternative treatment options and your own wishes to help ensure this is the most appropriate operation for you.
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Our dedicated team will also give you tailored advice to follow in the run up to your visit.
We understand that having any medical procedure, even one as relatively straightforward as this, can cause anxiety. Our experienced and dedicated medical staff will be there to reassure you throughout.
You will have discussed with your expert consultant at your initial appointment whether you’ll have a local, spinal or general anaesthetic for your TVT or TVT-O procedure.
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 operations take about half an hour.
Bulking agents are designed to "tighten" the urethra to treat urinary incontinence. The bulking agents, such as collagen, are injected into the urethra by the consultant. Your consultant will use a cystoscope (a thin optical tube) to inject the substances directly into your urethra.
You don’t need any anaesthetic or sedation, although the latter can be administered if you feel you need it. If you want to be sedated you should raise this during your initial meeting with 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.
If you have a bulking injection you’ll be able to leave hospital as soon as you pass urine normally. For most people, this will be the first time they urinate after the injection.
Similarly, most people who have a TVT or TVT-O are able to leave hospital on the same day. Because you’ll be feeling drowsy after the anaesthetic you’ll need a friend or relative to take you home.
After this, you will be taken to your room or comfortable area where you can rest and recuperate until we feel you’re ready to go home.
If you had TVT or TVT-O you will feel some tenderness and soreness around the sites of the cuts. We’ll give you pain relief medication while you are with us and advice on painkillers when you leave.
We will provide you with a supply of all the medicines your consultant feels you need to take home with you after you've left hospital, up to 14 days. This may be at an additional cost to some patients.
If you have a bulking injection you may experience a burning sensation when you urinate or have blood in your urine for a short time.
After a TVT or TVT-O operation you will probably need to take up to a week off work. You should avoid strenuous exercise and lifting for four to six weeks.
It’s likely that you’ll stop urinating unexpectedly immediately after each of these procedures.
Even once you’ve left hospital, we’re still here for you. If you have TVT or TVT-O your consultant is likely to want to see you after your treatment to see how you're doing. A follow up appointment will be made before you leave the hospital.
As with any medical treatment, complications following treatment can occur. The chance of complications depends on the exact type of operation you are having and other factors such as your general health. We will talk to you about the possible risks and complications of having this procedure and how they apply to you.
It is important to be aware that a number of complications associated with TVT or TOT procedures have been reported to the MHRA (Medicines and Healthcare products Regulatory Agency) and in some cases they have been of a particularly severe nature leading to further medical conditions. The most frequently reported adverse events have included chronic pain, sexual problems, mesh exposure and erosion and occasionally injury to nearby organs such as the bladder or bowel. The MHRA is still gathering information about the use and complications of these tapes and would encourage careful reporting of any adverse events.
If you would like to report an adverse event relating to tension-free vaginal tape please go to https://www.gov.uk/report-problem-medicine-medical-device
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