Incontinence & OAB Overview

Stress incontinence and overactive bladder (OAB) are the main causes of incontinence. Stress incontinence, which is more common in women, causes urine to leak when you laugh or cough. Overactive bladder, also called urge incontinence, is caused by urinary muscle spasms that cause an urgency to urinate. Incontinence can also be caused by multiple pregnancies, being overweight, and genetic weaknesses.

Surgery

There are several different kinds of surgeries to correct stress incontinence, which results when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra and/or bladder into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.

Surgery is usually not done for urge incontinence.

The decision to have surgery must always be based on an accurate diagnosis, consideration of other treatment possibilities, and realistic expectations for the surgery.
Surgery Choices

• Tension-free vaginal tape (TVT) surgery. TVT surgery is commonly used for stress incontinence. During this surgery, a meshlike tape is positioned under the urethra like a sling or a hammock to support it and return it to its normal position. The surgeon inserts the tape through small incisions in your vagina and pubic hair line. TVT surgery takes approximately 30 minutes and is usually done under local anesthesia. This surgery can also be done to correct incontinence that has come back after having another type of incontinence surgery. Another surgery called transobturator tape (TOT) surgery is like TVT surgery.
• Retropubic suspension. The Marshall-Marchetti-Krantz (MMK) and Burch colposuspension procedures are the most common types of retropubic suspension. Retropubic surgeries provide lift to the sagging bladder neck and urethra by attaching their supporting tissues to the pubic bone or tough ligaments. These surgeries require hospitalization.
• Urethral sling. The surgeon fashions a piece of muscle, ligament, or tendon tissue or synthetic material into a sling that lifts the urethra back into a normal position. This involves abdominal surgery, so hospitalization is required.

Visit www.acog.org for more information.

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