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Colposuspension


Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
Next review due May 2023

Colposuspension is an operation to treat stress incontinence in women. Stress incontinence is when you accidentally pass urine because you’re doing something that puts extra stress on your abdomen and bladder. The extra stress can be due to activities such as laughing, coughing, sneezing, exercising or jumping.

Your doctor might suggest having a colposuspension when you’ve tried other treatments and they haven’t worked.

Image showing the organs of the female pelvis

About colposuspension

Stress incontinence can be caused by changes to muscles and ligaments that hold up your bladder and stop you leaking urine. These are your pelvic floor muscles and the ring of muscle (sphincter) that holds your bladder closed.

In colposuspension, your surgeon lifts the neck of your bladder into the correct position and holds it in place with stitches. This helps to prevent urine from leaking.

Consideration for colposuspension

There are some things to consider before deciding whether or not colposuspension is the right treatment for you.

Colposuspension works well as a long-term treatment for stress incontinence in most women. In the first year after the operation, it’s successful for between eight and nine out of 10 women. After five years, around seven in every 10 women will continue to be dry. If the operation works well, it can improve your quality of life.

However, colposuspension doesn’t always work and you may still have stress incontinence after your operation. It can take six weeks or sometimes longer to fully recover from the procedure. There’s also a risk that you’ll have some problems during or after the operation. See our sections on side-effects and complications for more information.

Ask your surgeon to explain the benefits and risks of the procedure, and how they might affect you in your particular circumstances.

What are the alternatives to colposuspension?

Before suggesting a colposuspension, your doctor is likely to suggest trying other options such as the following.

  • Incontinence pads can be helpful if your symptoms are not too bothersome.
  • Lifestyle changes, such as losing weight if you’re overweight, and drinking less fluid including caffeinated drinks, can help.
  • Pelvic floor exercises or training can be helpful. We describe these in our FAQ on pelvic floor exercises. You may be offered the help of a physiotherapist or a continence advisor.
  • Biofeedback is where a doctor uses an electronic device to tell you how well you're doing pelvic floor exercises, by giving you feedback as you do them.
  • If you can’t tighten your pelvic floor muscles, you can use a device that uses a small electric current to stimulate and help strengthen them.
  • You might be offered a medicine called duloxetine if you can’t have surgery or don’t want to have an operation.

There are also other procedures (operations) for stress incontinence.

  • A sling procedure is where your surgeon will use a piece of your own tissue as a sling to support your urethra.
  • A tape procedure is where you have a ribbon-like plastic mesh put under your urethra as a support.
  • A substance such as silicone can be injected to bulk up the area around your urethra to help it to stay closed.
  • Having an artificial sphincter put in is an option used only if other treatments haven’t worked.

Your doctor or surgeon will discuss which treatment options may be suitable for you. They can also tell you more about the pros and cons of these different options.

Procedures using mesh

The NHS has decided to put a temporary ban on procedures using vaginal mesh until certain conditions to ensure safety are met. But some people may still have the procedure. This is only likely if the benefits of the procedure will outweigh the risk. If you have the procedure, it’s really important to discuss with your surgeon, and be fully aware of, the risks involved. This is so that you can make an informed decision on whether or not you want to go ahead.

If you’ve had the procedure and haven’t experienced any complications, try not to worry – it’s likely that everything is fine. If you think you may be having problems, speak to your GP or your surgeon.

Preparing for colposuspension

You’ll probably be invited to the hospital for a health check a few weeks before your operation, and you’ll be given information about how to prepare. For example, if you smoke, you’ll be asked to stop. This is because smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

If you’re taking any regular medicines, you should be told if you need to continue taking these or stop before your operation. If you’re not sure, ask. Before you go into hospital, your urine may be tested to check for infection.

Prepare to be in hospital for three or four nights.

You’ll probably have a general anaesthetic. This means you’ll be asleep during the procedure. Colposuspension can also be done under local anaesthesia using a spinal anaesthetic. This means you’ll be awake but feel numb from the waist down. It’s very important to follow any instructions the hospital gives you about not eating or drinking before your anaesthetic.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. You may also need to have an injection of an anticlotting medicine.

Your nurse or surgeon will discuss with you what will happen before, during and after the operation, including any pain you might have. If you’re unsure about anything, ask. Being fully informed will help you feel more at ease and will allow you to give your consent for the procedure to go ahead. You may be asked to do this by signing a consent form.

What happens during colposuspension?

You can have colposuspension as open surgery or keyhole (laparoscopic) surgery. Most women will have open surgery because laparoscopic surgery isn’t available in all hospitals.

If you have open surgery, your surgeon will make a cut in your lower abdomen (tummy) to allow them to reach your bladder. The cut is usually quite low down and is sometimes called a bikini line cut because of where it is.

Your surgeon will lift the neck of your bladder by stitching the top of your vagina to the tissues at the back of your pubic bone. Your surgeon may then put a small camera inside your bladder to check that the stitches are in the right place, and there are no injuries to your bladder.

What to expect afterwards

You’ll need to rest until the effects of the anaesthetic have passed. There are medicines available to ease any pain or discomfort you may have. Let your nurse know if you’re in pain.

If you’ve had open surgery, you may have a tube (catheter) inside your bladder when you wake up. This drains urine from your bladder into a bag. You may have an ultrasound scan to check that your bladder is emptying properly. If you have problems passing urine when your catheter has been removed, you may have another one put in. Or, the nurses may show you how to do self-catheterisation. This is when you put in and then take out a disposable catheter each time you need to empty your bladder. If you need to do this, it will usually only be for a few days.

You may have tubes running from your wound into a bag or bottle for the first day or so. These drain any blood or fluid.

Your nurse will encourage you to get out of bed and move around as soon as possible. This helps to prevent other problems later, such as blood clots in your legs or lungs.

You’re likely to have some bleeding from your vagina. You can use sanitary pads until the bleeding stops.

It’s important that you don’t get constipated, because straining to open your bowels after the operation can put pressure on your healing wound. For more information about avoiding constipation, see our FAQ.

Before you go home, your nurse will tell you how to look after your wound. You may also be given a date for a follow-up appointment. You’ll need to arrange for someone to drive you home. You may need some help at home for a few weeks until you fully recover.

Recovering from colposuspension

You’ll probably start to get back to your usual activities after about four weeks, though everyone is different, and it can take some women longer than this. You may recover more quickly if you’ve had keyhole surgery rather than open surgery.

It’s best not to have sex, do strenuous exercise or lift anything heavy, for six to eight weeks after your operation. Ask your surgeon about when you can get back to your usual activities and return to work.

You shouldn’t drive until any pain in your wound or from your operation has completely gone. Ask your surgeon for advice about when it should be safe for you to drive. If you’re in any doubt about driving, contact your motor insurer and the Driver and Vehicle Licensing Agency (DVLA) for more information.

Your wound may be uncomfortable for up to six weeks after the operation. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Contact the hospital or your GP if you develop any of the following symptoms when you’re at home:

  • problems passing urine, such as not being able to go to the toilet, a burning sensation when you pass urine or needing to get to the toilet quickly (urgency)
  • signs of a wound infection such as redness, pain, and fluid or pus leaking from your wound
  • a raised temperature
  • increasing pain or pain that can't be controlled with painkillers

Side-effects of colposuspension

Side-effects are the unwanted but mostly temporary effects you may get after having the procedure. All medical procedures come with some risk. Side-effects of colposuspension include:

  • pain and discomfort
  • some vaginal bleeding
  • problems passing urine so you may need to use self-catheterisation (see our aftercare section for more information)

Complications of colposuspension

Complications are when problems occur during or after the operation.

Most women recover well after a colposuspension procedure, with few problems. However, it isn’t successful for every woman, so you may find that it doesn’t work and you still have stress incontinence afterwards.

Other possible complications include:

  • infection, which could be in the wound, inside your pelvis or a urinary infection
  • bleeding
  • problems passing urine – if this happens you may need a catheter, which may be indwelling (left inside your body for some time) or intermittent (temporary and removable by yourself)
  • an overactive bladder – you may need to pass urine more often and urgently
  • damage to your urethra or bladder – you may need another operation to fix this
  • pelvic organ prolapse – this is where part of your womb moves downwards to make a bulge in the wall of your vagina
  • painful sex
  • the stitches through your vagina also catching the bladder. This isn’t particularly harmful, but over the years stones might form on these stitches, causing pain

Your surgeon will be able to talk to you about the risks of getting complications in your particular circumstances.

Frequently asked questions

  • Pelvic floor exercises help to tone and strengthen your pelvic floor muscles. These are the muscles in the lower part of your abdomen (tummy) that support your bladder, uterus and bowel.

    Regular exercises for your pelvic floor muscles can help stop accidental leaks when you cough, laugh or make sudden movements. However, it’s important to make sure you’re exercising the right muscles in the right way. This is how to do pelvic floor 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 – you should feel a squeeze and lift inside.
    • Squeeze and lift for 10 seconds as strongly as you can. Repeat 10 times. Follow with 10 fast squeezes.
    • Do the exercises three times a day. Breathe normally as you do the exercises.

    Getting the exercises right and making them work takes practice. You should find that they start to work well in about three to five months. Once the exercises are working well, keep doing them once a day.

    Losing any excess weight you have may help pelvic floor exercises be more successful. But if you’ve had colposuspension surgery, you should avoid drastic weight change afterwards because this could affect the delicate adjustments your surgeon made.

    If you have difficulty with pelvic floor exercises or are uncertain about how to do them, ask to see a specialist continence nurse or physiotherapist.

  • After colposuspension, it’s important not to get constipated. This is because straining to go to the toilet can put pressure on your healing wound. You can help to prevent constipation by doing the following.

    • Eat more high fibre foods. Fibre bulks up stools (faeces) and makes them move through your gut more quickly. It also makes the stools softer and easier to pass. Foods that are high in fibre include fruit, beans and pulses, wholemeal pasta and bread, cereals such as high-fibre breakfast cereals, and vegetables.
    • Have plenty to drink. You should be drinking about eight glasses of fluid a day.
    • Be active. Once you’re recovering from your operation, gradually building up your activity could help relieve constipation, as well as being good for your health in general.

    If these measures don’t help, talk to your pharmacist or contact your GP for advice.

  • Colposuspension works very well for most women, but it doesn’t work for everyone. Some women find that after their operation, they still have stress incontinence. If this happens, your surgeon will talk to you about your options. These might include an operation to put in a ‘sling’ of your own tissue, or an artificial sphincter to hold your bladder closed. Or you may be offered an injection of silicone into the tube that takes urine from your bladder (urethra) to prevent leaks. Your surgeon may arrange pressure tests, called video-urodynamics, to find out exactly what needs further attention.

    If you don’t want to have any more surgical procedures, your doctor 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.



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Related information

    • The British Association of Urological Surgeons (BAUS)
      baus.org.uk
    • Urinary incontinence in women. BMJ Best practice. bestpractice.bmj.com, last reviewed February 2020
    • Burch colposuspension. Medscape. emedicine.medscape.com, updated April 2018
    • Urinary incontinence. Medscape. emedicine.medscape.com, updated September 2019
    • Constipation. Medscape. emedicine.medscape.com, updated July 2019
    • Urinary incontinence. Patient. patient.info, last edited May 2019
    • Constipation in adults. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised June 2019
    • Urinary incontinence and pelvic organ prolapse in women: management. National Institute for Health and Care Excellence (NICE), 2019. www.nice.org.uk
    • Lapitan MCM, Cody JD, Mashayekhi A. Open retropubic colposuspension for urinary incontinence in women. Cochrane Database of Systematic Reviews 2017, Issue 7. doi:10.1002/14651858.CD002912.pub7
    • Colposuspension for stress urinary incontinence (SUI). The British Association of Urological Surgeons (BAUS), 2018. www.baus.org.uk
    • Colposuspension for stress urinary incontinence. British Society of Urogynaecology, 2018. bsug.org.uk
    • Government announces strict rules for the use of vaginal mesh. GOV.UK. www.gov.uk, published July 2018
    • Pelvic floor muscle exercises (for women). Pelvic, Obstetric and Gynaecological Physiotherapy. Chartered Society of Physiotherapy. pogp.csp.org.uk, published December 2018
    • Dietary fibre. British Nutrition Foundation. www.nutrition.org.uk, last reviewed January 2018
    • Personal communication, Professor Raj Persad, Consultant Urological Surgeon, May 2020

  • Reviewed by Dr Kristina Routh, Freelance Health Editor, Bupa Health Content Team, May 2020
    Expert reviewer, Professor Raj Persad, Consultant Urological Surgeon
    Next review due May 2023

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