Urine is produced in the kidneys and passes to the bladder. As the bladder fills, it expands and the muscles around it stay relaxed. A ‘sphincter’ muscle keeps the opening at the bottom of the bladder tightly closed. The thick, spongy walls of the urethra help form a watertight seal when compressed by the sphincter.
The sphincter, bladder, bladder neck and urethra must be in the proper position to work effectively. They are held in place by the pelvic muscles and other support structures. When you urinate the bladder contracts and the sphincter relaxes. This forces urine out of the bladder, through the urethra and out of the body.
SUI is caused by weakened or damaged pelvic muscles. Pregnancy, childbirth and repetitive straining or damage to your muscles can lead to permanent weakening. Loss of oestrogen at menopause may also play a role, since oestrogen helps keep the pelvic muscles strong.
Two factors working alone or in combination, can lead to stress urinary incontinence:
Too much mobility of the bladder neck and urethra means that they have dropped down from their normal positions. With this condition, the sudden added pressure from a cough, sneeze or lifting can be enough to cause leaking.
Intrinsic sphincter deficiency is a sphincter that does not close the urethra completely. The sphincter is a muscle, and like other muscles it can become weak or be damaged by such things as trauma, radiation or surgery.
Loss of the female hormone oestrogen at menopause can also play a part by causing thinning of the urethra’s inner walls, which can result in an ineffective seal.
A urethral support sling is a narrow strip of material placed in your body to create support for your bladder neck and urethra.
The sling acts as a hammock that cradles the bladder neck and urethra, so your bladder is well supported and your urethra has a solid point to rest on and press against, allowing the sphincter muscle to close more effectively.
SPARC sling placement requires two very small incisions in the lower abdomen above the pubic bone and one in the vagina. The sling will be placed through the incision into the vagina. Using two needles passed through the incision in your vagina, the sling will be guided into position behind the urethra. The two ends of the sling will be placed under the skin in your abdomen and will not be visible.
It is important to ensure that you do not have any urinary tract infections prior to the procedure so you will be asked to perform a urine test 5-7 days pre-operatively. If this test does confirm an infection the procedure will have to be postponed, the infection treated with antibiotics and then a specimen rechecked 10 days after the antibiotics. If the second specimen is clear another date for the operation will be offered.