You’ll normally get some information from your hospital about how to prepare for your Burch colposuspension. Be prepared for a hospital stay of up to about five days.
Your doctor may ask you to provide a sample of urine before the operation to check you don’t have a bladder infection. If you do, you’ll be offered antibiotics before, during and after your operation.
Burch colposuspension is usually done under general anaesthesia. This means you’ll be asleep during the procedure. It can also be done under a spinal anaesthetic – this means you’ll be awake but numb from the waist down. You’ll probably be asked not to eat or drink anything for about six hours before your operation. However, it's important to follow your anaesthetist's advice.
At the hospital your nurse may check your heart rate and blood pressure, and test your urine. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may need to have an injection of anticlotting medicine called heparin as well as, or instead of, wearing compression stockings.
Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you may have. This is your opportunity to ask questions so that you understand what will be happening. You don’t have to go ahead with the procedure if you decide you don’t want it. Once you understand the procedure and if you agree to have it, you’ll be asked to sign a consent form.
There are some other ways of managing stress incontinence which your GP may suggest before recommending surgery. These include losing excess weight to reduce the pressure on your bladder, and pelvic floor muscle training given by a specially trained healthcare professional. Medicines are sometimes offered, especially if you don’t want or can’t have surgery. These help contract the muscles around your urethra (the tube from your bladder).
The following are alternative procedures for stress incontinence.
- Tape procedures – your surgeon fits a synthetic tape under your urethra to keep the neck of your bladder closed. You may see these described as tension-free vaginal tape (TVT) or transobturator tape (TOT) procedures.
- Having your pelvic floor muscles electrically stimulated to strengthen them.
- Injections of substances, such as collagen, into your bladder neck to prevent leaks.
- Having an artificial urinary sphincter inserted – this is only an option if other treatments have failed.
Your doctor or surgeon will discuss which treatment options may be suitable for you.
Burch colposuspension can be done by open surgery or keyhole (laparoscopic) surgery.
If you have open surgery, your surgeon will make a cut in your lower abdomen (tummy) to allow them to reach your bladder. With keyhole surgery, your surgeon will make two or three small cuts in your lower abdomen and will insert a tube-like telescopic camera. This will send pictures to a monitor so they can see the area to be operated on. Your surgeon will pass specially designed surgical instruments through the other cuts.
Keyhole surgery isn't routinely used in the UK for this procedure. However, ask your doctor if it’s an option for you.
Your surgeon will lift the neck of your bladder by stitching the top of your vagina to the back of your pubic bone. This happens in both types of operation.
After your Burch colposuspension you’ll need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort for a while. You may be in hospital for up to five days.
If you’ve had open surgery, you may have a catheter to drain urine from your bladder into a bag. It will usually be removed after a day or two. Your nurse may ask you to measure how much urine you pass for a while after your catheter comes out. You may also be offered an ultrasound scan to check that your bladder is emptying completely. It’s possible you may need to have the catheter put back in if your bladder doesn’t empty properly without it.
You may also have fine tubes running out from your wound. These drain fluid into another bag and are usually removed after a day or two.
Your nurses will encourage you to get up and take a short walk around the ward on the day after your operation. Being active helps prevent blood clots in the veins of your legs.
You’ll be given sanitary towels to absorb any bleeding from your vagina.
It’s important to avoid getting constipated after your operation as straining will stretch and put pressure on your healing wound. Let the nursing staff know if you think you may be constipated so they can arrange treatment for you. You can also help yourself by drinking plenty of fluids and eating a diet rich in fibre. For more information, see our frequently asked questions.
Your nurse will give you some advice about caring for your wounds before you go home. You may also be given a date for a follow-up appointment.
You’ll need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours.
It usually takes about six to 12 weeks to make a full recovery from Burch colposuspension, but this varies between individuals. Ask your surgeon about when you can resume your usual activities and return to work. You shouldn’t drive for at least three weeks after your surgery. If you’re in any doubt about driving, contact your motor insurer so that you’re aware of their recommendations. It’s best not to have sex, and also to avoid heavy lifting, for at least six weeks after your operation. Because every person and every situation is different it's important to follow the advice your surgeon gives you personally.
If you need pain relief, you can take over-the-counter painkillers such as paracetamol. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.
The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure, they should usually disappear in about seven to 10 days. If you have surgical clips, these will be removed seven to 10 days later.
Contact the hospital or your GP if you develop any symptoms that may suggest you have an infection. These include:
- a burning sensation when you pass urine and/or bad-smelling urine
- your wound starting to hurt more, bleed or leak watery fluid
- increasing pain or pain that can't be controlled with painkillers
- a high temperature
You should also contact the hospital or your GP if you start to find it difficult to pass urine.
As with every procedure, there are some risks associated with Burch colposuspension. We haven’t included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to explain how these risks apply to you.
Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. Side-effects of Burch colposuspension include:
- some vaginal bleeding for up to a few weeks
Complications are when problems occur during or after the operation. The following are possible complications of Burch colposuspension.
- The operation not working – you may still have stress incontinence afterwards.
- Infection – if you get an infection you may need to take antibiotics.
- Difficulty passing urine or being unable to empty your bladder fully – if this happens you may need a temporary catheter.
- Overactive bladder – you may need to pass urine more often and urgently and may need medicines to help.
- Damage to your urethra or bladder – you may need further surgery to repair this.
- Pelvic organ prolapse – there’s a slight risk that your womb will slide down into your vagina and if this happens you may need further surgery.
- Pain or reduced sensation when you have sex.
What are pelvic floor muscles and how can they help with stress incontinence?
Pelvic floor muscles span the area between your legs, and support your bladder, uterus and bowel. If you have strong pelvic floor muscles, they give you more control over your bladder and help stop urine leaking accidentally.
Pelvic floor muscles form a sling passing from your coccyx (tip of your spine) at the back, to your pubic bone at the front. They support, and help to control, your bladder and bowel. Strengthening your pelvic floor muscles can help stop accidental leakage when you cough, laugh or make sudden movements. Strong pelvic floor muscles also make it less likely for your womb to slide down into your vagina (prolapse).
The following is a guide of how to do pelvic floor muscle exercises.
- Get into a comfortable position, either lying on your back or sitting upright in a chair.
- Imagine trying to stop yourself passing wind and urine. This should feel like a squeeze and lift inside.
- Squeeze and lift for 10 seconds as strongly as you can. Rest for 10 seconds and repeat 10 times. Follow with 10 fast squeezes.
- Do this three times every day. Breathe normally as you do the exercises.
Try to get into the habit of squeezing and lifting your pelvic floor muscles before you lift anything heavy. It can take weeks of regular pelvic floor exercises to improve your muscles. It’s best to keep doing them every day for the rest of your life and make them a part of your daily routine.
Ask a physiotherapist or surgeon about how these exercises might help you.
What can I do to improve my bowel movements after having Burch colposuspension?
Eat a diet rich in fibre, take regular exercise and have plenty to drink.
Mild constipation is common after surgery. But it's important to try and avoid this because straining when you go to the toilet can put pressure on your healing wound.
To help improve your bowel movement, make sure that your diet is rich in fibre. Fibre is essential for healthy bowel function. When fibre passes through your bowel, it absorbs a lot of water and increases the bulk of any waste matter.
To keep your bowel function regular, you should:
- eat plenty of fruit and vegetables every day
- base your meals around starchy foods like wholegrain bread, rice and pasta
- keep hydrated by drinking enough fluids
- go to the toilet when you first feel you need to – don’t put it off
- get some exercise each day – even if it’s just a walk
- avoid taking medicines that may cause constipation, such as codeine
If these measures don’t help, ask your GP for advice.
What are my treatment options if Burch colposuspension fails?
Burch colposuspension has a fairly good success rate but it doesn’t cure stress incontinence for all women. Your surgeon will discuss with you what your options are if you continue to have incontinence after your surgery.
About 80 to 95 women in 100 are cured or find that their symptoms are significantly improved after having Burch colposuspension. This means that some women will still have episodes of stress incontinence even after their surgery. If that happens your surgeon should ask you whether you wish to have a further surgical procedure or not. If you do, they’ll be able to give you advice on other treatment options available in your situation. These may include:
- surgery to have tension-free vaginal tape (TVT) or transobturator tape (TOT) fitted under the middle part of your urethra to provide support
- injections of a collagen-like substance into your bladder neck to prevent leaks – you’ll need to keep having these injections to stop the effects wearing off
- having an artificial urinary sphincter inserted – this will only be offered to you if your stress incontinence is severe and other treatments have failed
If you don’t want to have any more surgical procedures, your GP will be able to give you some advice about managing your symptoms. You’ll be able to change your mind and go back to see your surgeon if you decide later that you want to try further surgery.
For more information on these options, ask your doctor or surgeon for advice.
- Urinary incontinence in women. BMJ Best Practice. www.bestpractice.bmj.com, published 21 January 2015
- Burch colposuspension. Medscape. www.emedicine.medscape.com, published 28 January 2015
- Urinary incontinence – medication. Medscape. www.emedicine.medscape.com, published 21 July 2014
- Incontinence – urinary, in women. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published December 2014
- Constipation. NICE Clinical Knowledge Summaries. cks.nice.org.uk, published September 2014
- Urinary incontinence. National Institute for Health and Care Excellence (NICE), 2015. www.nice.org.uk
- Complications of urological surgery. OSH Post-operative complications (online). Oxford Medicine Online. www.oxfordmedicine.com, published date October 2011 (online version)
- OSH Operative surgery (online). Oxford Medicine Online. www.oxfordmedicine.com, published October 2011 (online version)
- Map of Medicine. Female urinary incontinence. International View. London: Map of Medicine; 2014 (Issue 2)
- Map of Medicine. Constipation in adults and the elderly. International View. London: Map of Medicine; 2014 (Issue 4)
- Colposuspension for stress incontinence. British Society of Urogynaecology. www.bsug.org.uk, published November 2014
- Bladder neck suspension. British Association of Urological Surgeons. www.baus.org.uk, published July 2014
- Surgical treatment for women with stress urinary incontinence – Burch colposuspension. European Association of Urology. www.patients.uroweb.org, published November 2014
- Personal training for your pelvic floor. Chartered Society of Physiotherapy and Royal College of Midwives. www.csp.org.uk, accessed 17 February 2015
- Lapitan M, Cody JD. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2012, Issue 6. doi:10.1002/14651858.CD002912.pub5
- Dietary fibre. British Nutrition Foundation. www.nutrition.org.uk, published 5 October 2012
- Opioid analgesics. Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 19 February 2015 (online version)
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