Stress incontinence affects about 15 million women in the United States. It occurs when urine leaks out of the bladder due to sudden pressure on the abdomen. This can happen when you cough, sneeze, jump, laugh, or make another quick motion. You may be able to treat your stress incontinence with lifestyle changes and medications. Some women need surgery to regain bladder control.
One common procedure to help treat stress incontinence is transvaginal taping (TVT) bladder tack. This is an inpatient operation that uses a small piece of mesh to help support your urethra, the tube that carries urine from the bladder out of the body. The goal is to close the urethra and the bladder neck, which connects the bladder to the urethra. This will help keep urine from escaping uncontrollably.
Your doctor will likely schedule the TVT procedure in the morning. They’ll advise you to have no food or water past midnight before the operation. If you take medications, especially blood thinners, ask your doctor when you should stop taking them before the procedure. You’ll spend the night in the hospital, so bring anything you might need and plan to have a ride home the next day.
TVT usually takes less than an hour, but it requires overnight observation in the hospital. For the procedure, your doctor will make an incision inside the vagina, below the urethra. They will also make two more small incisions in the abdomen near the pubic hairline. The surgeon will then guide a small strip of polypropylene mesh tape through the incision in the vagina and place it under the urethra. This secures the ends of the tape to the two abdominal incisions to hold the urethra firmly in place.
The surgery requires local anesthetic, as well as general anesthesia or intravenous sedation. The two abdominal incisions shouldn’t need stitches. Your doctor will probably use Steri-Strips instead.
Pain medications can help reduce your discomfort. You’ll also have a catheter in your bladder overnight. Using ultrasound, your healthcare team will check how well your bladder is emptying. If there’s a problem after you leave the hospital, you may need to use a catheter at home for a few days until your system recovers. Self-catheterization could last up to a month or more if your bladder isn’t emptying properly.
You can eat regular foods after the operation, and resume most regular activities in a week or two. You should wait about a month before doing any heavy lifting. You should also wait a month before having sexual intercourse. The same is true for using a tampon. Be sure to ask your doctor or nurse about tampon use and any other hygiene concerns in the weeks following your surgery to help reduce the risk of infection.
Risks and complications
As with any type of surgery, TVT comes with a slight risk of bleeding and infection, and a small chance of complications from the anesthesia. If you’ve had general anesthesia and become nauseated or had other side effects, tell your doctor before the procedure. TVT also carries a small risk of accidental damage to your bladder or bowel.
The change to your urethra’s position could lead to urinary retention, which means your bladder won’t empty properly. If this goes on for weeks or months, be sure to tell your doctor.
Before you’re discharged from the hospital, ask what changes to expect in your urinary habits. Talk to your healthcare team about any possible side effects and what you should do about them.
If surgery seems too drastic to help control your stress incontinence, discuss other treatments with your doctor. There are interventions that don’t involve surgery. Your doctor can inject synthetic bulking materials into the tissue around the urethra to help keep it closed. This helps reduce urine leakage.
To prevent incontinence during activities that might trigger leakage, such as sports, you can place a plug, or urethral insert, in the urethra. This will temporarily block the flow of urine. After the activity remove the plug so you can urinate.
Medications may also provide some symptom control. Anticholinergics, which treat overactive bladder, may be an option. You can also try a topical estrogen cream, which can improve the health of the tissues in and around the urethra. Talk to your doctor before starting any type of treatment.
TVT is usually successful at treating stress incontinence with few side effects or complications. If urinary retention isn’t a problem after the surgery, you should experience few, if any, symptoms of incontinence.
Remember that incontinence has many factors. In some cases, aging leads to a bladder that can’t retain urine as well as it once did. A hysterectomy can weaken the pelvic floor muscles, which can lead to incontinence. It’s also a symptom of chronic diseases like multiple sclerosis and Parkinson’s disease.
Though urinary incontinence for any reason may be challenging to discuss with your doctor, it’s too important to ignore. TVT or other approaches can often treat incontinence.
Incontinence can also lead to recurring urinary tract infections. So talk with your doctor about whether you might be a good candidate for TVT bladder tack.
Managing urinary incontinence
If you deal with urinary incontinence frequently, there are some simple steps you can take to reduce those episodes, such as:
- double voiding: This technique is helpful if your bladder doesn’t empty as well as it should. Try urinating, waiting a few minutes, and then try urinating again.
- scheduled bathroom trips: You may want to schedule bathroom visits every few hours instead of waiting until you feel the urge to go.
- Kegels: Strengthening your pelvic floor muscles with Kegel exercises may also lead to better urine control. For example, tighten the muscles you use to urinate for five seconds and then relax. Do this 10 times in a row. Work up to 10 repetitions of 10 seconds each. Eventually do three sets of 10 repetitions.
You also want to avoid skin irritation caused by incontinence. Use a washcloth to clean and let your skin air dry. Cocoa butter or petroleum jelly can also help protect your skin from the effects of urine.