Are you thinking about surgery for bladder incontinence?  Surgery for bladder leaking is common and women remain satisfied with the results about 80% of the time.  But when does a physician think it is time for surgery?  And how will you know if you are ready for a bladder incontinence surgery? 

When does the surgeon think you are ready for incontinence surgery?

Urinary incontinence is a quality of life issue.  As physicians, we treat incontinence when it bothers you.  This level of bother is different for different women.  Some women are very bothered by small amounts of leakage while others are only bothered when it is severe.  I think you are ready for bladder incontinence surgery when you meet the following criteria:

• It bothers you enough and you feel like you have exhausted other treatment options
• You have completed your family and do not want to be pregnant again
• I have seen you leak in the office (yes, I know, everyone hates this part)
• There is no unexplained blood in your urine (even microscopic blood)
• Your bladder empties well

When to perform surgery depends on these factors and your treatment goals. The next step it to ensure you have exhausted the non-surgical treatment options .

What should you try before considering surgery?

• Losing weight–  Research tells us that losing 5-10% of your body weight (if you are overweight) can lead to a >70% improvement in urinary incontinence.  This is a great place to start as losing weight also has so many other health benefits for you! In addition, incontinence surgeries are more successful in normal-weight women so even if this is not the complete answer for you, your surgical results will be better.
• Tracking your symptoms– Keep a voiding diary for 24 hours.  This is when you write down what you are drinking and when you are leaking.  See if you can determine a pattern.  Do you only leak if you drink 18 ounces of water before working out?  Or maybe you only leak if you have coffee before your walk?  See if there are any behaviors you could change that might help your bladder behave better.
• Exercising– Exercise in general has been shown to improve leaking.  We don’t really know if this is because of weight loss or indirect core strengthening but this is also a good thing to try with lots of other health benefits.
• Strengthening your pelvic floor– Strengthening your pelvic floor helps leaking.  The impact of pelvic floor muscle exercises continues to be effective as we age.  Studies have shown that working on your pelvic floor with a physical therapist results in curing your leakage in about 60% of women.  That does not mean that you can’t do them on your own.  You can do them on your own, with a pelvic trainer, with weights or with a PT.  Whatever will make you stick to it is what you should pick. And having a strong pelvic floor will improve your surgical results!
• Trying a pessary– A pessary might not appeal to you but they can be great.  If nothing else, they can keep you from leaking while you consider your other options!

Final thoughts

There are lots of little things you can try on your own to make sure you are really ready for a surgery. And if you want more information, come to the office to discuss surgery. Some women need surgical information long before they are actually ready to have surgery. This is part of their process. It is your journey and you get to pick the stops to get you ready for your bladder incontinence surgery!

Malek JM et al. Short-, Mid-, and Long-term Incontinence Outcomesin Women undergoing Mid-urethral Sling Procedures: A Retrospective Cohort Study. Int Urogyne J 2020. 10.1007/s00192-020-04393-3.doi: 10.1007/s00192-020-04393-3

Wing RR et al. Effect of weight loss on urinary incontinence in overweight and obese women: Results at 12 and 18 months.  J Urolo 2010:184(3) ;1005-10.

Lucasz ES et al. Urinary Incontinence in Women: A Review. JAMA 2017;318(16):1592-1604.

Dumoulin C et al. Conservative Management for Female Urinary Incontinence and Pelvic Organ Prolapse Review 2013: Summary of the 5^th International Consultation on Incontinence. Neurourol & Urodynam 2016;35:15-20.