While conservative treatments such as lifestyle changes, physical therapy, and medications can be effective for some who lives with incontinence, they may not provide sufficient relief for others. In these cases, incontinence surgery can be a viable option.

This guide will explore everything you need to know about incontinence surgery, including the different types, candidacy, procedures and recovery, and potential risks.

It’s important to note that incontinence surgery will most often be considered only after more conservative treatments have failed to provide any results.

These conservative treatments can include:

• Lifestyle modifications (dietary changes, weight management, etc.)
• Pelvic floor exercises
• Medications
• Bladder training

Other factors that can make someone a candidate for incontinence surgery include:

• Desire for Long-Term Relief
  Surgical options are often preferred by individuals who are seeking a long-term solution for their incontinence. Of course, all information, risks and benefits need to be discussed with their doctor before surgery is agreed upon.
  
  
• Adequate Health
  It's essential that the person with incontinence is in good overall health and can tolerate the surgical procedure, as any surgery carries risks, some of which could be exacerbated by poor health.
  
  
• Accurate Incontinence Diagnosis
  A proper diagnosis of the type and cause of incontinence is crucial in helping determine the most suitable type of incontinence surgery.
  

There are a number of different forms of surgery tailored to not only the type of incontinence, but other factors such as gender and incontinence severity.

For Urinary Incontinence:

1. Tension-Free Vaginal Tape (TVT) or Transobturator Tape (TOT)
These minimally invasive procedures involve the placement of a synthetic tape to support the urethra. They are commonly used to treat stress incontinence. Stress incontinence occurs when a physical activity, like coughing, sneezing, laughing and/or heavy lifting puts pressure on your bladder which can cause urine leaks. Weak or strained pelvic floor muscles can also contribute to stress incontinence.

2. Sling Procedures
These involve creating a supportive sling around the urethra using the patient's tissue or a synthetic material. Sling procedures can treat various types of urinary incontinence, including stress and urge incontinence. Urge incontinence occurs when a person feels a sudden and strong urge to pass urine. They may feel their bladder is fuller than it actually is.

3. Bladder Neck Suspension
This surgery involves repositioning and supporting the bladder neck to reduce incontinence, typically for stress incontinence in women. The bladder and urethra are lifted and secured to nearby structures such as the pelvic bone.

4. Artificial Urinary Sphincter (AUS)
An AUS is an implantable device that mimics the function of the urinary sphincter. It is primarily used for severe urinary incontinence when other surgical options are ineffective.

For Faecal Incontinence:

1. Sphincteroplasty
This procedure repairs a damaged or weakened anal sphincter muscle, which is often the underlying cause of faecal incontinence. This surgery can be performed in both men and women, however, one study notes that the outcome can be more successful for men compared to women who have given birth to more than one child [1].

2. Sacral Nerve Stimulation (SNS)
SNS involves implanting a device that sends electrical impulses to the sacral nerves, helping to regulate bowel function. It is effective for certain cases of faecal incontinence, such as those with faecal urgency. According to the Continence Foundation of Australia, almost all patients considering SNS have already exhaused conservative treatments with no significant outcome. Both men and women can be considered for SNS, however, it’s currently more commonly used to treat women.

3. Colostomy
In severe cases where other treatments have failed, a colostomy may be considered. This involves diverting the colon to an opening in the abdominal wall, allowing stool to be collected in an external bag. There are different types of colostomies which your surgeon will discuss with you before undergoing the procedure.

Like any surgical procedure, incontinence surgery carries potential risks and complications. These can include:

• • Infection - There is a risk of surgical site infection, which can be managed with antibiotics.
  • Bleeding - Some bleeding is common after surgery but is typically manageable.
  • Pain - Pain or discomfort at the surgical site may occur but is usually temporary.
  • Urinary Retention - Difficulty emptying the bladder can occur post-surgery but is often temporary and can be managed with catheterization.
  • Mesh Complications - For procedures involving synthetic mesh, there is a risk of mesh erosion, contraction, or other complications.
  • Overcorrection or Undercorrection - Surgical outcomes may vary, with the potential for the procedure to be less effective or more effective than desired.

Incontinence surgery can really be a life-changing option for those who have struggled with urinary or faecal incontinence and have found little relief from other more conservative treatments.

It is crucial to consult with a urologist or colorectal surgeon to assess your candidacy for surgery, thoroughly discuss your options, and understand the potential risks and benefits.

As we mentioned earlier, patients should explore non-invasive and less invasive treatments to manage incontinence effectively before opting for surgery. Additionally, maintaining a healthy lifestyle, including exercise, a balanced diet, and proper hydration, can play a crucial role in managing and preventing incontinence.

Remember that the decision to undergo incontinence surgery should be well-informed and carefully considered.