Burch colposuspension

Published by Bupa's Health Information Team, September 2010.

This factsheet is for women who are having Burch colposuspension, or who would like information about it.

Burch colposuspension is a treatment for women with stress incontinence. The front wall of the vagina is lifted and fixed with permanent stitches onto a ligament behind the pubic bone. This provides better support for the bladder neck so that it stays closed under pressure.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About Burch colposuspension

Burch colposuspension is a procedure used to treat stress incontinence.

Stress incontinence is when you accidentally leak urine after sudden pressure on your bladder, such as when you cough, laugh or lift something heavy. This happens because your pelvic floor muscles and urethral sphincter are weak and unable to stop urine from leaking. Your pelvic floor muscles form a sling passing from your coccyx (tip of your spine) at the back to your pubic bone at the front, supporting your bladder, uterus and bowel. Your urethral sphincter is the band of muscles that goes around your urethra and acts like a valve to stop urine leaking out. It usually contracts to stop you passing urine when you cough, sneeze or strain in any way.

Burch colposuspension aims to give you more control over your bladder by re-positioning your bladder neck with supporting stitches and lifting your vagina and bladder neck upwards. Around 85 to 90 out of 100 women say their continence improved for the first year after the operation, and 70 out of 100 say it improved for the first five years.

What are the alternatives to Burch colposuspension?

Your doctor or surgeon will discuss any alternatives that may be suitable for you. These may include the following.

• Having a tension-free vaginal tape (TVT) or transobturator tape (TOT) fitted under your urethra (the tube through which urine passes out of your body) through your vagina to keep your bladder neck closed.
• Having injections of substances such as collagen into your bladder neck to prevent leaks.
• Having your pelvic floor muscles electrically stimulated to strengthen them.
• Taking a medicine that stimulates a specific part of your nervous system to prevent leaks.
• Having an artificial urinary sphincter inserted - this is only an option if other treatments have failed.

Preparing for Burch colposuspension

Your surgeon will explain how to prepare for your operation. You will need to stay in hospital for about one week.

The operation is done under general anaesthesia. This means you will be asleep during the procedure.

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.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during Burch colposuspension

Your surgeon will lift your bladder neck by stitching the top of your vagina to the ligament behind your pubic bone. Your surgeon will do this using one of two different techniques.

• Open surgery - the operation is performed through a large cut in your lower abdomen (tummy).
• Laparoscopic (keyhole) surgery - two or three small cuts are made in your lower abdomen. Your surgeon uses a tube-like telescopic camera to help him or her operate through the cuts. This technique isn't routinely used in the UK.

The operation usually takes one to two hours depending on the technique used.

What to expect afterwards

You will need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will usually have a catheter to drain urine from your bladder into a bag. It is either passed into your urethra or put directly into your bladder through a small cut in your abdomen. The catheter will usually be removed after a day.

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.

You will need to wear a sanitary towel to absorb any vaginal bleeding.

You may be constipated for a few days. It's important to try and avoid this because straining when you go to the toilet is uncomfortable and puts pressure on your healing wound. Let the nursing staff know if you think you may be constipated.

You will usually be discharged from hospital after 24 to 48 hours. Before you're discharged, your wound should be re-dressed, and after this no further dressings should be necessary. If you have dissolvable stitches, they will disappear within seven to 10 days. Alternatively, you may have surgical clips which will be removed seven to 10 days later. Your nurse will give you some advice about caring for your healing wounds before you go home. You may be given a date for a follow-up appointment.

You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.

Recovering from Burch colposuspension

It usually takes about six weeks to make a full recovery from Burch colposuspension, but this varies between individuals, so it's important to follow your surgeon's advice.

Take over-the-counter painkillers such as paracetamol or ibuprofen if you need pain relief. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Don't do any strenuous exercise or drive for four to six weeks.

You will usually need to take at least six weeks off work.

If you develop any of the following symptoms contact the hospital or your GP as you may have developed an infection:

• a burning sensation on passing urine and/or foul-smelling urine
• increasing pain or pain that can't be controlled with painkillers
• high temperature

What are the risks?

Burch colposuspension is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. They include:

• discomfort
• some vaginal bleeding for a few days
• pain in your abdomen and in the tips of your shoulders after keyhole surgery, improving over 48 hours

Complications

Complications are when problems occur during or after the operation. Most women aren't affected.

Specific complications of Burch colposuspension are uncommon but can include:

• infection - if you develop 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 for the first few weeks
• damage to your ureter or bladder - you may need further surgery
• 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
• painful sex - this can happen as the shape of your vagina may change

If you're having keyhole surgery, there's a chance your surgeon may need to convert the procedure to open surgery.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.