The urinary tract is consists of:

• The kidneys, where urine is made
• The bladder, where urine is stored
• The ureters, the tubes that carry urine from the kidneys to the bladder
• The urethra, the tube that carries urine from the bladder to the outside of the body

Urinary incontinence occurs when one is unable to control the leakage of urine. There are two important muscle groups that help hold urine in the bladder.

• The urethral sphincter, a ring of muscle at the bottom of the urethra
• The pelvic floor muscles, a group of muscles that support the bladder.

When the urethral sphincter and pelvic floor muscles weaken, the bladder can drop. When the bladder drops, it can lead to the development of urinary incontinence. Stress urinary incontinence happens when certain activities put pressure on the bladder, causing urine to leak. These activities include:

• Sneezing
• Coughing
• Laughing
• Exercising
• Other activities that put pressure on the bladder

Stress incontinence is the most common type of urinary incontinence, especially among women.

A sling operation is when a strip of man-made material or human tissue is surgically inserted to support the bladder and urethra. The sling acts as a hammock for the bladder. It helps keep the bladder and urethra in their correct position.

• A catheter is inserted to drain urine from the bladder. The catheter is typically left in place for a brief period after surgery.
• The surgeon will make one incision in the abdomen and one small incision in the vagina.
• A sling is inserted through the vagina. The sling is placed behind the spot where the urethra connects to the bladder.
• The sling is then tightened and anchored into place through the incision in the abdomen.

There are different risk factors for female stress urinary incontinence. Some of the more common causes include:

• Childbirth
• Age and menopause
• Obesity
• Strenuous physical exercise
• Certain medications
• A urethral muscle defect

Although not as common, men can also develop stress urinary incontinence from trauma or after having certain types of surgery or radiation.

It is not unusual for there to be more than one cause of incontinence. Before any treatment is done, urinary incontinence requires a thorough evaluation to make sure all causes are identified. Therefore, contact your healthcare provider if you have urinary incontinence that has not been controlled with conservative treatments. He or she will ask about your symptoms and do a physical examination. The examination will include your pelvic area (internal examination) to check the shape and position of your bladder. Your provider may also recommend:

• Laboratory tests
• A urinalysis
• Diagnostic tests to evaluate your urinary system
• You keep a voiding diary

Depending on the circumstances, you may be referred to an urologist or urogynecologist (a doctor who specializes in the urinary tract of women). There are several different forms of treatment for stress urinary incontinence. Non-surgical treatments can often be very successful. These include:

• Muscle-strengthening exercises (Kegel exercises)
• Vaginal cones, which are weights held in the vagina to strengthen pelvic floor muscles
• Biofeedback is the use of two sensors (one in the vagina or rectum and one on the abdomen) and a monitor that lets a person known when the correct muscles are squeezed
• Electrical stimulation is the placement of a small probe in the vagina to deliver a mild electrical shock and cause a contraction of the pelvic floor muscles
• Bladder training to teach your bladder how to hold more urine
• Dietary changes, which include limiting or eliminating certain foods or beverages that irritate the bladder (i.e., those that contain caffeine and alcohol).
• Losing excess pounds

Some medications may be recommended to help with stress urinary incontinence. However, they are not approved by the US Food and Drug Administration (FDA) for that use. Talk with your healthcare provider for more information.

• There are several different devices and surgeries to treat stress urinary incontinence that has not responded to treatments that are more conservative.
• This care path includes information and costs for the surgical insertion of a bladder sling to support the bladder and urethra.

Your healthcare provider may recommend surgery if your symptoms have not been controlled with less invasive treatments. Prior to the surgery, tell your healthcare provider about any medications you are taking (including over-the-counter medications and supplements). Ask about specific instructions you should follow before the procedure. These may include:

• Medications you should not take before the procedure, such as blood thinners or aspirin
• Regular medications you should continue to take on the day of your procedure
• How many hours you should stop eating and drinking before the procedure
• Any activity or dietary restrictions you should follow after the procedure

If you are a smoker, you should quit smoking. Smoking can interfere with your recovery.

During surgery, which is typically performed as an outpatient, you will most likely receive general anesthesia to keep you comfortable and pain free.

• With general anesthesia, you are put into a deep sleep and are unable to see, hear or feel anything.
• Do not forget to make arrangements for transportation to and from the facility.
• Pain medication and help at home may be needed while you recover.

What should I ask my healthcare provider before having a sling operation?

• What is my diagnosis and reason for the surgery? What non-surgical alternatives are available to me?
• What are the chances my symptoms will come back after surgery?
• Is there any other preparation for the surgery? (If so, get clear instructions on what you need to do.) What kind of sedation will I have? What are the possible side effects?
• What are the possible complications to surgery?
• How will I feel after the surgery? Will I have to modify my activity?
• How many of these procedures have you done? How many of your patients have had their symptoms continue or return after surgery?
• How many of your patients have had prolonged hospital stays because of complications?
• Do you use mesh products? If so, have the mesh products that you use been subject to investigation by the FDA?

After your surgery, you should know what you had done, what medication was given, and what symptoms you should report to your healthcare provider. You should also understand all home care instructions (including medications and side effects) and follow-up plans. Your surgeon should also let your primary care physician know the details of your surgery and treatment plan.

Source UHC.com

Also known as:

Stress Incontinence Repair - Sling Operation

Sling Operation

Incontinence

Hysterectomy