What is it?
You have been leaking urine if you strain, or cough, or run. This is called stress incontinence, meaning the stress of physical activity, not emotional stress. The problem lies in the floor of the pelvis. This is a sheet of special muscle stretching across the inside of the pelvis. You can feel it tighten when you try to hold the urine in. The uterus and the bladder both lie above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the floor. If the pelvic floor weakens, the uterus and bladder drop down. The control of the urine is weakened. The operation strengthens the pelvic floor to lift the uterus and bladder back up again. It is called a colposuspension, from the Greek name for the vagina - colpos.
Diagram © Copyright EMIS and PIP 2005
The operation
You will have a general anaesthetic, and will be completely asleep. The skin is usually opened with a cut across of the tummy. This will be a "bikini" incision , just above the hair line. Sometimes an up and down incision is used. Sometimes any nearby incisions from other operations are used instead. Ask the surgeon about this before your operation. Under the skin, the bladder is freed up. The pelvic floor is tightened up with special stitches. The wound and the skin are then closed.
Any alternatives
If you leave things as they are, the leaking will steadily get worse. Exercises to strengthen the pelvic floor have not worked. Electric implants to make the pelvic floor stronger are experimental. Overall, your best plan is to have the operation.
Before the operation
Stop smoking and get your weight down if you are overweight. (See Healthy Living). If you know that you have problems with your blood pressure, your heart, or your lungs, ask your family doctor to check that these are under control. Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT). Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation. Bring all your tablets and medicines with you to hospital. On the ward, you may be checked for past illnesses and may have special tests to make sure that you are well prepared so that you can have the operation as safely as possible. Many hospitals now run special preadmission clinics, where you visit for an hour or two, a few weeks or so before the operation for these checks.
After - in hospital
You will have a small/thin plastic tube (a drip) in an arm vein. This gives you salt and sugar and water, and sometimes blood, for a day or so from a plastic bag on a stand. You will have a dressing plaster on your wound. There will be a plastic drain tube nearby, coming through the skin to drain any blood from the operation. Your bladder will have a fine plastic tube or catheter to drain out the urine into a plastic bag at your bedside. Usually it is brought out through the skin of your tummy. The wound is a little painful. Usually pain killers are given by injection. You may have a button switch (PCA Patient Controlled Analgesic) on your wrist to press when you have pain. This gives you a small dose of a pain-relieving drug into a vein. Later you will only need tablets.
By the end of four days you should have little pain. The skin will be closed with stitches or clips or paper dressings. You will be told about arrangements for taking out the stitches etc. You can bathe or shower but try to keep the area of the wound dry for seven days. After a few days the bladder catheter will be closed to allow the bladder to fill with urine. If you are able to pass urine and empty your bladder naturally the bladder catheter can be removed. Any drain is usually removed the day after the operation. You should plan to leave hospital about seven days after your operation. The nurses will talk to you about your home arrangements, to fix the best time for you to leave hospital. You will be given an appointment to visit the Out- Patient Department for a check up about six weeks after you leave hospital.
After - at home
You are likely to feel tired and need rest two or three times a day for three to four weeks. You will gradually improve so that by the time 3 months have passed you will be able to return completely to your usual level of activity. You can drive as soon as you can make an emergency stop without discomfort in the wound, generally after three weeks. You may have sex before your six week check, as long as you feel comfortable. You should be able to go back to a light job after about six weeks. Leave a very heavy job for 12 weeks.
Possible complications
As with any operation under general anaesthetic there is a very small risk of complications related to your heart or you lungs. The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Most colposuspensions are without complication. The chances of minor complications are about 2%. The medical and nursing staff will look out for any problems. If you think that all is not well, please ask the nurses or doctors. Occasionally the bladder is slow to start working again. This may need a few more days in hospital. Wound infection is sometimes seen. This settles down with antibiotics after a week or two.
More serious complications happen very rarely and can include severe bleeding or damage to your womb, bladder, bowel and vessels and may require another operation to fix them.
There is about a 5% chance that in the future you will develop either an irritable bladder (feeling the urge to pass urine more frequently than usual) or have difficulty passing urine. In this case you will be taught how to use a urine catheter on your own to help you empty your bladder whenever you have difficulty passing urine.
The overall success rate of the colposuspension is about 85% and these women enjoy a very good quality of life. If the first operation is not successful you might need to have another operation in the future.
General advice
We hope these notes will help you through your operation. They are a general guide. They do not cover everything. Also, all hospitals and surgeons vary a little. If you have any queries or problems, please ask the doctors or nurses.
