Suspension procedures to treat stress incontinence

A bladder neck suspension reinforces the urethra and bladder neck so that they won't sag and provides something for the urethra to compress against to help prevent leakage.

To perform the procedure, your surgeon makes an incision in your lower abdomen or performs the surgery through small incisions using thin instruments and a video camera (laparoscopic surgery).

Your surgeon secures stitches (sutures) in the tissue near the bladder neck.

For bladder neck suspension performed abdominally, you'll need general or spinal anesthesia. Recovery takes several weeks, and you might need to use a urinary catheter until you can urinate normally. Recovery time is likely to be shorter with laparoscopic surgery.

Nerve stimulation to treat overactive bladder

Certain procedures to treat overactive bladder involve stimulation — using small, electrical impulses — of the nerves that signal the need to urinate.

  • Sacral nerve stimulation. Your surgeon implants a small, pacemaker-like device under your skin, usually in your buttock. Attached to the device (stimulator) is a thin, electrode-tipped wire that carries electrical impulses to the sacral nerve. These painless electrical impulses block messages of needing to urinate sent by an overactive bladder to your brain.

    You can try sacral nerve stimulation by having the wire placed under your skin in a minor surgical procedure and wearing the stimulator externally. Later, you can have the stimulator implanted if it substantially improves your symptoms.

    Surgery to implant the stimulator is an outpatient procedure done in an operating room under local anesthesia and mild sedation. Your doctor can adjust the level of stimulation with a hand-held programmer, and you also have a control to use for adjustments.

  • Tibial nerve stimulation. In this procedure, a needle placed through the skin near your ankle sends electrical stimulation from a nerve in your leg (tibial nerve) to your spine, where it connects with the nerves that control the bladder.

    Tibial nerve stimulation takes place over 12 weekly sessions, each lasting about 30 minutes. Based on your response to the treatment, your doctor might recommend follow-up sessions at regular intervals to maintain the results.

One step at a time

Finding an effective remedy for urinary incontinence might take time, with several steps along the way. If a conservative treatment isn't working for you, ask your doctor if there might be another solution to your problem.

Feb. 18, 2017 See more In-depth