Previously colposuspension was the most commonly performed procedure in the treatment of stress incontinence. This involved making incisions in the abdomen to allow access to move the bladder and uterus back into their correct positions before using carefully placed stitches to strengthen the pelvic floor.
In more recent years the urethral tape suspension procedure became increasingly popular and this involved placing a tape through the top of the vagina which helped to hold the organs in place. Recent research into the use of these tapes, often referred to as "bladder slings" has led to this type of procedure being temporarily suspended as a method of treatment.
With the main surgical options to repair the pelvic floor no longer being offered, a lot of focus has been moved into less intrusive methods of treatment such as performing a vaginal repair if necessary and at the same time inserting some carefully positioned sutures to help hold the bladder in place. Other options such as physiotherapy, medication and vaginal support pessaries can also be considered.
Urine is produced in the kidneys and passes through tubes called the ureters, into the bladder. As the bladder fills, it expands and the muscles around it, called the detrusor muscles, stay relaxed. The urethra is a tube that runs from the neck of the bladder to the outside of your body and it has a valve, called a urinary sphincter that keeps the opening at the bottom of the bladder tightly closed. The thick, spongy walls of the urethra help to form a watertight seal when compressed by the sphincter.
When you need to empty your bladder the detrusor muscles contract to help force the urine out of your body and the sphincter opens to allow the urine to pass through.
The sphincter, bladder, bladder neck and urethra must be in the correct position in order to work properly. They are held in the correct position by the pelvic muscles and other support structures. If the pelvic floor muscles are not strong enough to support a full bladder it will allow the sphincter to open and for urine to leak out. Therefore, with the added pressure of coughing, sneezing or lifting for example, leakage may occur.