Recovery after continence surgery

Retropubic midurethral sling or Burch colposuspension

This page provides recovery guidance following your continence surgery at Urogynaecology Specialists. Your surgeon will advise you of any specific instructions for your procedure. Please contact our rooms if you have any questions.

About your surgery

You have had surgery to treat stress urinary incontinence (leakage with coughing, sneezing, exercise, or activity). The two operations covered by this guide are:

• Retropubic midurethral sling (TVT or similar) — a small strip of mesh tape is placed under the urethra through two or three small incisions. It works by providing a supportive hammock that prevents leakage during activity.
• Burch colposuspension — the tissues around the urethra and bladder neck are lifted and stitched to a strong ligament behind the pubic bone. This is performed laparoscopically (keyhole surgery).

Both procedures aim to restore the support of the urethra and bladder neck. Results are generally excellent, but it is important to follow the recovery guidelines carefully — particularly regarding exercise — to allow the repair to heal correctly.

Immediately after surgery

A catheter (a small tube draining urine from the bladder) will be in place when you wake from the anaesthetic. A voiding trial is performed before you are discharged — this means the catheter is removed and you will be asked to pass urine so your team can check that your bladder is emptying well.

Some women have difficulty emptying the bladder fully in the first days to weeks after this surgery. If the voiding trial is not successful, you may go home with a catheter in place or be taught how to perform intermittent self-catheterisation. Your team will give you specific instructions and support if this is needed. Difficulty emptying the bladder after this surgery is usually temporary.

Activity guidelines

Recovery is typically 4–6 weeks. It is very important to avoid high-impact exercise for 12 weeks — the sling or sutures can move significantly in the first 6 weeks if put under strain, which can affect the outcome of surgery.

Pain relief

Most patients experience mild to moderate discomfort around the wounds and in the lower abdomen or pelvis. Over-the-counter paracetamol taken regularly (every 6 hours) is usually sufficient. Your surgeon may also prescribe a short course of something stronger if needed.

Make sure you take time to rest each day. In the first 2 weeks it is helpful to lie down for 1–2 hours in the middle of the day.

Bladder symptoms after surgery

It is common for bladder symptoms to change after continence surgery. Understanding what is normal can help reduce anxiety during your recovery.

Leakage

Some temporary leakage can occur during the early weeks of recovery, particularly while the tissues are still healing and swollen. This does not necessarily mean the surgery has failed — the final result is usually not apparent until 3 months after surgery when healing is complete.

Urgency

Some women notice new or worsened urgency (a sudden strong urge to pass urine) after continence surgery. This is known as de novo urgency and affects a small proportion of women. In most cases it settles over the weeks following surgery. If it persists, it can usually be treated effectively with bladder training or medication.

Difficulty emptying

As described above, some difficulty emptying the bladder fully is common after this surgery and is usually temporary. If you feel you are not emptying well, or if you are unable to pass urine for more than 4–6 hours and are uncomfortable, please contact our rooms urgently or call the after-hours number.

Urine flow

Your urine stream may feel slower or slightly different from before surgery — this is expected and usually settles. Some change in flow is normal and does not indicate a problem.

Bowel care

Constipation is common after surgery and straining should be avoided as it puts pressure on the repair.

• Drink 1.5–2 litres of fluid daily
• Eat a bowel-friendly diet — kiwi fruit, pears, prunes, leafy vegetables, and wholegrains all help
• Use Movicol or a similar product from the chemist if your bowels are not moving regularly

Wounds

For a midurethral sling, you will have two small wounds just at the pubic bone. These are closed with dissolving sutures and you can shower normally from day one.

For a Burch colposuspension, you will have 3–4 small keyhole wounds on the abdomen. These are covered with waterproof dressings that can be removed after 10–14 days. Underneath there is usually skin glue and dissolving sutures — leave these in place and they will drop away on their own.

Keep wounds clean and dry. Showering is fine from day one — avoid baths and swimming for 6 weeks.

Vaginal symptoms

A small amount of vaginal spotting is normal in the first few days. You do not need to use tampons — pads are recommended for the first 6 weeks. Offensive or heavy discharge is not expected and you should contact your team if this occurs.

Post-operative appointments

Your surgeon will usually see you at approximately 4 weeks after surgery. This appointment is important as your surgeon will assess your bladder function, check your wounds, and clear you to drive and return to work. A further review at 3–6 months is often arranged to assess the long-term result of the surgery.

Our specialist nurse

Our specialist nurse Lucy will usually contact you in the 1–2 weeks after your surgery to check on your recovery. Lucy can also answer any post-operative care questions you may have.

Lucy works one day per week in most weeks. For non-urgent nursing questions you are welcome to email the rooms and she will try to get back to you when she is next working. Please don’t email urgent clinical concerns.

When to seek help

Please contact our rooms or present to your nearest emergency department if you experience any of the following:

• Inability to pass urine for more than 4–6 hours
• Burning or stinging when passing urine that is worsening rather than settling
• Heavy vaginal bleeding
• Offensive vaginal discharge
• Increasing abdominal or pelvic pain or new vomiting/severe nausea
• Fever, chills, or vomiting
• Signs of wound infection (redness, swelling, or discharge from a wound)
• Calf pain, swelling or redness (possible blood clot)
• Chest pain or shortness of breath

How to contact us