Incontinence Sling – A Less Invasive Procedure for Stress Incontinence

Incontinence is a medical condition usually referring to the loss of urinary continence, the ability of a person to control the flow of urine. This condition is a symptom of an underlying problem in the urinary or the genital system that affects thousands of people everywhere each year.  More people suffer from stress incontinence than from any other types of urinary incontinence and more women experience this at some point in their lives.

With stress incontinence, urine loss happens when greater pressure is applied by the abdominal muscles on the bladder during movements such as coughing, sneezing or lifting. Along with weak pelvic floor muscles and loose urethral sphincter, control over urine flow is lost. There are different reasons for the occurrence of stress incontinence in women. More common of which are:

  • Pregnancy and childbirth.  Women of child-bearing age are more susceptible to losing muscle tone on the pelvic floor due to the baby’s weight and straining during childbirth. Trauma to the tissues during medically assisted deliveries contribute to the loss of muscle strength
  • Menstruation causes the pelvic floor muscles to relax to allow blood to flow freely.  When this happens, urine may leak at the same time menstrual blood does
  • Premenopausal and post-menopausal syndrome contributes to the changes in the bladder muscles and the underlying tissues and organs. Lowered Oestrogen hormones reduces strength of the bladder walls and elasticity of the urethral sphincter leading to leaks and dribbles

Studies have shown that light stress incontinence can be treated with a pelvic floor workout called the Kegel exercise. This set of exercises aims to strengthen the muscles cradling the bladder, uterus and the bowels.  In more severe cases, Kegels may not be enough to correct the problem. In some instances, a combination of different treatments may be needed.

Although surgery may be considered to correct a physical injury as in the case of a torn tissue, this is a procedure not without disadvantages.  More women prefer the less invasive procedure of the incontinence sling where incision is minimal and can be done as an out-patient in a doctor’s clinic. Recovery period is fast with laparoscopic procedure and cure rate is as high as 85%-95%.

A sling procedure is the insertion of a fine ribbon mesh made of synthetic material or from the person’s own tissue and wrapped around the urethra. The tape’s end is sutured into the pubic bone to form a “hammock” and ease the pressure coming from the drooping bladder. The doctor makes tiny incisions in the lower abdomen for the insertions and navigation is done through an endoscope.

It is best to discuss the options with your doctor and know the risks involved. Depending on the attending physician’s advice and the patient’s preferred sling procedure, there are currently three most common procedures favoured by many patients and surgeons alike for its higher success rate:

  • Trans Vaginal Tape (TVT) is a tension-free sling made of polypropylene material that is inserted underneath the urethra through two tiny incisions to provide support and improve control over urine flow. This is a fairly safe procedure and cure rate is about 85%. However, there are rare cases of  secondary complications due to accidental bladder perforation  during surgery
  • Trans Obturator Tape (TOT) eliminates the retro pubic needle entry to avoid unnecessary complications. The mesh tape is inserted underneath the urethra through the three small incisions in the groin area
  • The Mini-Sling is a more advanced sling procedure developed in the US that was designed to reduce the risk factors reported in the other two procedures. Insertion of the mesh tape into the internal obturator muscle is through a single vaginal incision

For post-menopausal urinary incontinence, a sling procedure may be the best option to treat stress incontinence along with the other treatments for a more successful regimen. Incontinence sling has been developed to help women live a more productive life and help manage the inconvenience of having a “leaky” bladder.  Consult your doctor and be informed.

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