My embarrassing bladder was fixed by a “fishing line” implant
No laughing matter: Isabel suffered stress incontinence for ten years
A 25-minute operation likened by surgeons to ‘tightening a leaky pipe’ could end the misery of women suffering an embarrassing yet common condition.
Stress incontinence – involuntary leaking from the bladder when coughing, laughing, sneezing or exercising – is thought to affect a third of women who have had children. Most suffer in silence because they are too ashamed to discuss their symptoms.
The operation, called tension-free vaginal tape (TVT), involves inserting a mesh strip made from a woven plastic material similar to fishing wire under the middle of the urethra, the tube that carries urine from the bladder. This effectively tightens up the ‘pipe’.
Studies show that more than 90 per cent of women who have had the procedure are pleased with the result. However, a recent news report revealing that the mesh can disintegrate and tiny fragments can become embedded elsewhere in the body has sparked concern.
This, according to Clive Spence-Jones, consultant gynaecologist and obstetrician at The London Clinic, is due to the TVT operation being confused with another procedure for pelvic organ prolapse, known as POP surgery.
Both operations use mesh but with POP surgery, much larger amounts of the material are implanted in a different position. A third of patients experience complications, which include the mesh being rejected by the body, leading to it moving and parts of it being pushed out through the internal membranes, which can be painful. In contrast, the TVT operation is highly successful with few complications.
‘It is a very different operation from POP surgery,’ says Mr Spence-Jones, who also sees patients at the Whittington Hospital in North London. ‘The operation for prolapse is complex but the TVT operation is simple, involves only a regional or light general anaesthetic. It rarely causes difficulties.’
Most cases of stress incontinence are due to a weakening of the pelvic-floor muscles, the group of muscles that wrap around the underside of the bladder. Usually, these muscles relax only when there is a need to pass water, but pregnancy and childbirth can affect their structure.
About five million British women are thought to suffer and 99 per cent of cases are pregnancy-related.
Isabel Boyer, 50, a mother of three from Kensington, West London, endured the condition for almost ten years before having the TVT operation six years ago.
The TVT operation works by supporting the middle of the urethra with the tape
‘I’m fit and energetic but after giving birth to my third child, I noticed that if I was about to cough or sneeze in the street, I’d have to stop walking and cross my legs,’ she says. ‘It was embarrassing. I like jogging but I couldn’t run downhill because it caused me to leak. At my aerobics class, when it came to doing the jumping jacks exercise, I simply had to jog lightly on the spot.’
Isabel first tried pelvic-floor exercises to strengthen the muscles but found that they were impractical.
‘I was given small weights to insert but it was impossible as a mother with three children to have enough time to do the exercises properly,’ she says. ‘Then I had electro-stimulation – a probe was inserted that passed an electric current into the muscle to make it contract. After three months, it was obvious it was not working, so I had the surgery.’
The TVT operation works by supporting the middle of the urethra with the tape.
‘An inch-long incision is made within the body underneath the urethra while two more incisions are made just at the level of the pubic hairline,’ says Mr Spence-Jones.
‘The tape is carried on needles that are passed upwards from the vagina so the tape supports the middle part of the urethra. This creates a kink of about five to ten degrees, enough to stop accidental leakage.
‘One in ten women will have incontinence problems again within a decade, but a second operation to fine-tune the implant usually solves it. In neither the TVT or POP operation does the mesh migrate to other parts of the body.’
Most women return to normal activities in two weeks. For Isabel, life has changed for the better. ‘I was delicate for a few days but after that it wasn’t painful. A little while later, friends asked me if I’d climb Mt Kilimanjaro with them. I made the trip and was absolutely fine.’