What is incontinence surgery for?

Most incontinence surgery is for stress incontinence.

Stress incontinence occurs when urine leaks with activities like running, jumping, coughing, or sneezing.

That is stress incontinence.

Urge incontinence occurs when you have difficulty holding your pee when you really need to go.

Urge incontinence is mostly managed with procedures, rather than surgery, by biomedicine.

For both stress incontinence and urge incontinence surgeons generally recommend a conservative trial of therapy with manual medicine pelvic floor care and exercise.

What are the surgeries & procedures for stress incontinence?

• Colposuspension (colpo = cervix in Greek & vagina in Latin)
  • A cut is made in the lower tummy and the neck of the bladder is lifted and the vagina is also lifted up and sewn around the pubic bone to stabilize the bladder
  • This surgery can be open or laproscopic. Both require general anaesthesia
  • The surgery has about 50-70% success
  • The downside is women may have difficulty emptying the bladder, be more prone to infection, and experience discomfort with sex
• Sling Surgery
  • A cut is made in your lower tummy and your vagina
  • A piece of your rectus abdominus or thigh fascia (or tissue from another person or an animal or synthetic mesh) is removed to be used as the sling
  • The tissue or mesh (called “tape”)  is looped under the urethra like a hammock and stitched in place to hold it up
  • If you have the mesh sling, it is an outpatient procedure and you can go home the same day (this is preferred in the US)
  • If you have the traditional surgery using your tissue or someone else’s you will have to stay in the hospital for a couple days
  • If you get the mesh sling, about 5% of people respond to the mesh or experience mesh erosion, which is painful
  • After the surgery women may experience overactive bladder, difficulty peeing, incontinence, and urinary tract infections
• Urethral Bulking Agents
  • A tiny camera is inserted into the urethra
  • Bulking agents like silicone or collagen are inserted around the urethra to increase resistance
  • This procedure is less effective than the surgeries
  • Because this procedure only has modest results and has to be repeated, it is generally only recommended for people who cannot sustain surgery or people who want to have a baby

What are the surgeries and procedures for urge incontinence?

• Botulinum toxin A injections
  • Botox is injected into the sides of the bladder to relax it
  • This is also used for overactive bladder
  • The procedure has to be repeated several times a year
  • Because your bladder is somewhat paralyzed, it may be difficult to empty it, and you might need to catheterize yourself
• Sacral nerve stimulation
  • The sacral nerves 2-4 innervate the detrusor muscle
  • The detrusor muscle contracts during urination to push urine out of the bladder when you pee, and relax to allow the bladder to stretch and hold pee
  • The detrusor muscle is under autonomic control
  • A device is inserted into your buttock that gives electrical stimulation to the sacral nerves to stop them from over-firing so you don’t have the urge to pee as often
  • The electrical impulses can be painful, and also effective
  • It can also be used for urinary urgency-frequency, urinary retention, and fecal incontinence
• Posterior tibial nerve stimulation
  • The posterior tibial nerve originates from L4-S3
  • That means its innervation overlaps the innervation of the bladder (detrusor muscle)
  • To stimulate this nerve, a needle is inserted into the skin at the ankle and electrical current is passed through it
  • You will feel tingling and your foot will start moving
  • You will need 12, 30 minute sessions, one week apart
  • Posterior tibial nerve stimulation is only recommended if you have not responded to conservative care and medication
  • Posterior tibial nerve stimulation can also be used for over-active bladder
• Augmentation cystoplasty
  • This is an uncommon surgery that involves making the bladder larger using a piece of the intestine.
  • After the 6-8 hour surgery you will have to catheterize yourself to be able to pee
  • Because of the need for catheterization, there is increased risk of infection.
  • The surgery is successful in about 75% of cases
• Urinary Diversion
  • In this surgery the ureters (the tubes that carry urine from the kidneys to the bladder) are cut off from the bladder and diverted to the outside of your body so pee can be collected in a bag.
  • This surgery used only as a last resort

How can Dr. Caroline Peterson help me avoid surgery for incontinence?

My approach is informed by my training as a pelvic floor therapist, plus my understanding of how the standard biomedical procedures and surgeries work, and the neuro/vascular anatomy of the body.

The pelvic floor therapist approach tends to emphasize treatment of the end organ.

The end organ is the organ or system that is having problems.

This is very important, but possibly insufficient.

Pelvic Floor Therapy Component of Care for Incontinence

Dr. Caroline Peterson will care for the myofascial (muscle and connective tissue) component of bladder health by working inside of your pelvis to balance muscles and function. While working inside of the pelvis, she will also work with organ position and relationship, lymph, vascular, lymphatic, emotional, and energetic components that need support.

She will also prescribe exercises and daily habits to help to strengthen/stretch and recondition bladder function

Visceral/Vascular Component of Care for Incontinence

The bladder does not live in isolation.

The bladder lives in relationship to the kidneys, ureters, urethra, and all other organs and structures around it.

Dr. Caroline Peterson will assess and address any organ, vein, or other structure that is contributing to incontinence.

Physiologic Breathing Component of Care for Incontinence

Generally people who are incontinent are not activating their breathing mechanism properly.

When they breathe improperly the are creating a downward force with the breath (lift, and other movements) that jeopardizes bladder health.

Dr. Caroline Peterson will teach you how to use physiologic breathing with every breath and how to properly activate the diaphragms of your body (including the pelvic floor).

All the transverse planes of the body, including the pelvic floor diaphragm and the respiratory diaphragm, must be parallel and functioning properly to help the pelvic floor strengthen and normalize function. Breathing correctly is imperative for getting proper activation of the pelvic floor.

Chiropractic Adjustments Component of Care for Incontinence

Instead of using electrical insertions into your pelvis and leg to activate the nerves that stimulate the bladder, Dr. Caroline Peterson will use the chiropractic adjustment to activate those nerves so better information can go to the bladder and function can improve.

Craniosacral Therapy Component of Care for Incontinence

Dr. Caroline Peterson treats the pontine micturation center with craniosacral therapy to optimize the information the central nervous system gives to the bladder and urethra sphincter about emptying or not emptying.