Surgery for bladder leakage or bowel leakage has dramatically changed from what was done twenty years ago. Like many fields in medicine and surgery, techniques and principles evolve, and technology improves with time. Today, the best results in completely or nearly completely resolving incontinence of both the bladder and bowels comes from technology that is so non-invasive, it doesn’t really require “surgery” at all. But more on that in a minute.
Surgery for Incontinence
If you’re researching surgery for incontinence, it must first be clarified whether it’s for the bladder or the bowels. For bowel incontinence, surgery plays much less of a role than it once did. Occasionally, sphincters require surgical reconstruction with a procedure known as sphincteroplasty, in which the surgeon wraps and tightens the sphincters and then builds up the soft tissue, suturing closed the tissues and skin. As you can imagine, this is pretty painful. The recovery can be quite long, and often the muscles don’t work as well as we would hope. Other kinds of surgery can sometimes involve repairing a prolapse (protruding outward) of the rectum or removing hemorrhoid tissue. Each of these can, in certain cases, contribute to improving the control and reducing the leakage.
Surgery for bladder incontinence may consist of a sling procedure in which a prosthetic material is inserted and wrapped under the neck of the bladder. Procedures which repair prolapsing of the bladder or uterus or vagina can sometimes improve continence and reduce leakage. These procedures can be done with small incisions and a laparoscopic or robotic minimally invasive technique, in most cases. And while not exactly surgery, injection of Botox into the detrusor muscle can result in some temporary relaxation of the muscle, allowing the bladder to fill with more volume and hopefully leak less. But its effectiveness does not last.
A Better Approach
Less invasive and more effective than these approaches is newer neuromodulation technology together with plain old exercising of the sphincters and pelvic floor muscles. Called sacral nerve modulation, this technique results in 90% success and involves some local anesthetic over the tailbone area, a bandage, and a small implant that delivers gentle current to restore the natural muscles and sphincters.
It’s usually good advice to seek an opinion from experts who have experience with a wide variety of procedures and are also familiar with the advances in technology. These days, the very best results for incontinence often don’t require actual surgery at all.