Christian Seipp MD PhD
Consultant Urological Surgeon
Getting you dry with involve a step-by-step approach: behavioural modifications such as changing what you drink, how to manage fluids throughout the day and how often you empty your bladder may help reducing your leakage.
The second step consists of pelvic floor rehabilitation in an attempt to strengthen your pelvic floor muscles. Physiotherapy (occasionally with bio-feedback and electrostimulation) will teach you how to improve the support structures that prevent your bladder from leaking.
If you have not perceived any benefit from physiotherapy, there are a number of surgical options to restore your bladder control. These include minimal invasive procedures such as the injection of bulking agents around the urethra to act like a cushion, thus adding "bulk" to the bladder outlet.
In other cases small tapes can be inserted underneath the urethra. These act almost like a hammock, supporting urethra and bladder neck and helping it close more tightly when the abdominal pressure is raised during coughing or exercising. The use of synthetic tapes (such as TVT/tension free vaginal tape or TOT/transobturator tape have become controversial due to potential longterm complications associated with mesh.
However, the same therapeutic effect can be achieved by using small strips of natural tissue usually taken from your tummy (autologous sling). Postoperative recovery is fast and the procedure is extremely successful with excellent longterm results.
Finally, there is open surgery, such as the colposuspension. The procedure can be carried out as open or keyhole surgery and recovery normally takes up to 6 weeks.
In very severe cases of urinary incontinence, devices such as an artificial urinary sphincter, can be implanted.