woman contemplating bladder sling surgery
Incontinence

What The Mesh: Contemplating Bladder Sling Surgery

Let’s talk about sling. No, I’m not talking about Sling TV or a sling shot. I’m talking about bladder sling surgery. When the occasional spritz and drip has become too much to handle, sometimes doctors will suggest bladder sling surgery. But when is too much? And hasn’t there been a lot of controversy about this kind of surgery? I won’t leave you slinging (hanging, get it?), so keep reading to learn more.

(A quick note before we dive in: the FDA banned the use of transvaginal mesh for repairing pelvic prolapse as of April 16, 2019. However, bladder sling surgery is a bit different and is the main focus of this article).

Let’s Cover The Basics

Before diving into what bladder sling surgery is all about, it’s important to cover the basics, such as why would someone need sling surgery in the first place. Well my friends, here’s why: stress incontinence. As you probably already know, stress incontinence is an unintentional loss of urine (aka incontinence) that happens when stress is placed on the bladder and knocks the bladder sphincter door open. Everyday physical activities like sneezing, coughing, and laughing are just a few things that than can lead to a spontaneous leak. When everything is working fine, the bladder expands and the urinary sphincter remains shut until you sit on a toilet and relax, which causes it to open. This keeps us from leaking all the time.

However, when the bladder and pelvic floor starts to weaken, then sometimes we get to leaking. In many cases, a slight diet change and some pelvic floor exercises can tighten up the pelvic floor and lessen the leaks. Absorbent products, like pads and disposable underwear, can also keep you dry and keep leaks in their place. But if your condition is severe or really bothersome, your doctor will probably recommend bladder sling surgery.

But Wait, Why Do The Pipes Burst?

When you’ve got weak pelvic floor muscles, any force to the sphincter can force the urethra open and you’ll accidentally leak. The pelvic muscles and urinary sphincter can lose their strength because of several reasons:

  • Recent or past childbirth: sometimes delivery damages nerves and tissue. Ladies, this is why it’s so important to practice those Kegel exercises when you’re well and recovered.
  • Body weight: your bladder experiences more physical stress the heavier you are relative to your height and frame, which means a higher chance of developing stress incontinence.
  • A previous pelvic surgery.
  • Dietary habits. Spicy foods, wine, and other bladder irritants may make you happy, but your bladder doesn’t feel the same way.

Is Bladder Sling Surgery A Good Idea For You?

Get a Doctor’s Diagnosis

If you think you may have stress incontinence, check in with your doctor before taking any other steps. Different types of incontinence will require different surgical procedures and you may need to see a specialist to determine what’s right for you. If you have overactive bladder or urge incontinence, for example, surgery won’t help. Doctors recommend bladder sling surgery for women dealing with severe stress incontinence. Essentially, the idea is to place a sling underneath the urethra in order to support and lift the urethra and neck of the bladder. This sling provides a form of elevation to alleviate any unnecessary stress and prevent bladder leaks.

When’s A Good Time For Bladder Sling Surgery?

Still plan on making babies? If yes, then you might want to hold off on bladder sling surgery until you close up the baby shop. While a study showed that 10 out of 12 women who delivered an infant after application of a midurethral sling remained continent, it is still not encouraged. It’s best to postpone bladder leak surgery until after your last pregnancy. If you’re approaching menopause and have experienced a few leaks here and there (which is common), then consider talking to a doctor about your options, including surgery.

Sorry, No Lifetime Warranty

Although the surgical implant itself has an 85%-90% success rate of treating stress incontinence, the effects do not always last. Symptoms can return over time. Typically after five years or so. If that happens, and you have surgery again, know that the effectiveness drops for each additional surgery.

Understand The Risks

The obvious benefit of surgery is to stop leaks, but all types of surgery carry some form of risk. The most common complications include:

  • Having a hard time peeing or, in some rare cases, an inability to pee
  • Having to urinate too often
  • UTIs
  • Painful sex and and difficulty making your O face
  • Vaginal discharges and bleeding
  • The possibility of pelvic prolapse, which will require more surgery
  • The rare possibility that the mesh could break down

Medical providers can treat most of these issues. Remember, risks and symptoms that arise are as unique as the individual. Surgery only corrects the problem it’s designed to treat so if you have a mixture of reasons for your incontinence, surgery may not fully remove the problem. Only you and your doctor can make the best decision for you.

Types of Bladder Surgery

My Surgery Ain’t Your Surgery

There are two types of sling surgeries for women, mid-urethral bladder sling surgery and traditional bladder sling surgery. And then there are transvaginal mesh implants which sometimes all get lumped together.

Tension Free, Mid-Urethral Sling:

  • This method applies a thin strip of mesh to your urethra in one of several ways:
    • Retropubic method: this involves the surgeon making a small cut just under the urethra and above the pubic bone. After that, they’ll insert a needle to place the sling and stitch or glue it in.
    • The transobturator method: a mouthful, right? This is basically the same thing as the tension-free vaginal tape, but instead, they’ll make a cut on each side of the labia and place the sling under the urethra.
    • The single-incision mini method: surgeons make a single small cut inside the vagina and put the sling through it.

Traditional Sling:

  • Also known as the conventional approach. This method is where the surgeon makes an incision in your vagina and places the sling under the neck of your bladder.
  • This procedure sometimes requires a larger incision than the tension-free sling, so it will require longer recovery time in the hospital.

Transvaginal meshes:

On April 16 2019, the FDA banned the use of transvaginal mesh. Before that, transvaginal mesh was used to treat pelvic organ prolapse and sometimes stress urinary incontinence as well. This kind of surgery uses a lot more material than sling surgeries and involves a net-like implant being inserted through the vagina to provide support to the bladder neck or urethra.

The Road to Recovery

You’re probably wondering how soon you can go home after a bladder sling surgery. While some people are discharged the same day, it’s generally recommended that you stay overnight. You may need a catheter after surgery to assist in draining urine from the bladder. Vaginal bleeding that looks similar to your period is also common. The full recovery time after surgery can last from a few weeks to a few months, depending on the surgery. During this time, you should sit back, relax, and avoid anything that may strain your bladder until you’re healed.

What’s All The Controversy About

Regardless of the type, we all know that surgery can be risky business. However, transvaginal meshes have been getting a lot more attention over the last few years. In fact, research has shown that surgical meshes for transvaginal repair can cause complications like mesh erosion, pain, infection, pain during sex, or more urinary problems. Some even say the mesh moved through their vaginal wall and into other organs. Without a doubt, that’s a little scary. And that’s why the FDA recently banned the use of transvaginal mesh. In the UK, mesh implants are considered a last resort and restrictions have been put into place due to safety concerns.

But What About Bladder Sling Surgeries?

Although the sling has less severe and less frequent complications, research has shown that it can cause a sneaky side effect in other parts of your life: your sex life. A study analyzing sexual function in women, post operation, has shown that out of 200,000 women, 14% to 20% experience worsening sexual function after the procedures. The issue is that the incision is inside or near the vagina, so the placement of the sling can compromise its neural integrity. In other words, it’ll be a little more challenging to make your O-face.

It’s Best To Be Informed

We’re not saying that you shouldn’t consider bladder sling surgery but you should be informed. There’s risks with every surgery, so it’s always in your best case to do as much research as possible and discuss your options with your doctor.

Does surgery feel a bit too drastic for now? Absorbent products can be a great alternative. And Lily Bird has you covered with pads and underwear for night time dribble dilemmas delivered right to your door. Start your trial today.

By Jessica Thomas, MPH