Are there any complications with surgery for incontinence?

• There are always general risks involved with having an operation, including anaesthetic problems, bleeding, infection, and clots in the legs (DVT) that can travel to the lungs (pulmonary embolus). Antibiotics are given during surgery and continued after your operation to reduce the risk of infection. Medication (e.g. Fragmin or Clexane) to thin your blood is given during surgery and while you remain in hospital to reduce your risk of developing blood clots.  There maybe some pain after surgery but this generally settles after a few days or weeks. It is rare for women to experience long-term pain following surgery for stress incontinence.
•  It is very uncommon to experience serious bleeding or need a blood transfusion or further surgery to control bleeding. Rarely, damage can occur to nearby organs and structures such as bowel, bladder, ureter and nerves and may require further surgery. Dr Carey always performs cystoscopy (using a telescope to look inside the bladder) during surgery to make sure there is no bladder or ureter injury.
• About 5 women in 100 will have difficulty passing urine and may need a catheter after the surgery until normal bladder emptying is established. Very rarely difficulty passing urine due to obstruction of to the urethra may persist. Further surgery may be required to relieve urethral obstruction. For women who have had a Pubo-vaginal, TVT or TOT sling, dividing or adjusting the sling may be needed and for women who have had a Burch colposuspension, replacing or removing the suspension sutures may be required.
• For women who have over-active bladder (urine frequency, urgency and urge incontinence) as well as stress incontinence, about half will experience improvement in their overactive bladder symptoms after surgery, However, about 5 in 100 women will develop new overactive bladder symptoms after surgery.
• For women who have TVT or TOT slings, there is a small risk that part of the mesh may become exposed in the vagina, bladder or urethra. If this occurs further surgery will be required. TOT or TVT sling may cause chronic persistent pain and may need to be completely removed.
• The main complication from bladder Botox is inability to empty your bladder after surgery. This problem occurs in 6 in 100 cases and gradually settles as the Botox wears off. Some women may need to pass an in-out catheter to empty their bladder a few times a day.
• The main complications from sacral neuromodulation (SNM) are abnormal stimulation if movement of the sacral lead occurs and mechanical/electrical problems with the device. These problems usually require revision surgery.
• Dr Carey’s strong preference is to perform surgery for urinary incontinence WITHOUT using mesh mid-urethral slings such as TVT and TOT slings. Urinary incontinence can be successfully treated but surgeries that do not use synthetic mesh.

Recovery time and instructions following surgery for incontinence

Depending on the type of surgery, women only need to stay in hospital for the day or for more complex surgery one to three nights. Bladder Botox, transurethral Bulkamid and SNM are day surgery operations. Burch colposuspension and Pubo-vaginal sling require overnight stays.

It is important to rest after the operation and allow the area to heal.

Generally it is recommended to…..

• Restrict your level of physical activity for two weeks.
• From two to four weeks do light activity only.
• Avoid heavy lifting (nothing heavier than 5 kg) for six weeks, including shopping bags, washing baskets and children.
• Abstain from sexual intercourse for six weeks.
• Avoid playing sport and impact exercises such as jogging or jumping for six weeks.

You may……

• Drive a car after two weeks; however, check this with your car insurance provider. CAREFUL HERE

Pain relief

• If you experience pain after leaving hospital you can take over the counter pain control medication (e.g. Paracetamol, Ibuprofen, Diclofenac).
• Ensure you take some time each day to rest.

Maintain good bowel habits

• Try to drink approximately 1.5 litres of fluids each day.
• Maintain a healthy diet.
• Use Metamucil, Movicol or similar preparations (available at the supermarket chemist) if required to maintain regular bowel function. It is important to keep your bowel motions soft.

The recovery after bladder Botox and transurethral Bulkamid is rapid. Generally, patients can return to normal activities 2 to 3 days after these two operations.

If you also underwent vaginal prolapse surgery as well as surgery for incontinence there may be some light pink vaginal discharge after surgery but be minimal and last a maximum of three weeks. Occasionally, some women experience a sudden moderate dark blood loss, one or two weeks after surgery. This occurs from discharge of a blood collection under the vaginal wall and should be self limiting.

Any stitches that you still have, when you go home will dissolve between 10 and 21 days.  These do not need to be removed.

Dr Carey will be happy to answer any questions you may have and can give more specific advice. Before deciding to have surgery, you should read carefully all the information about your operation and consider obtaining a second opinion.

If you experience complications after you leave hospital, contact Dr Carey or the nursing staff on 1 West at the Epworth Freemasons Hospital for advice. In an emergency you may attend the Royal Women’s Hospital, Parkville or Epworth Hospital, Richmond emergency department or attend your closest hospital emergency department.