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Burch colposuspension

Published by Bupa's health information team, July 2008.

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

Burch colposuspension is a treatment for stress incontinence. The top of the vagina is lifted and fixed with permanent stitches into the space behind your pubic bone. This provides better support to the bladder neck so that it stays closed under pressure.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About stress incontinence
Alternatives to Burch colposuspension
Preparing for your operation
About the operation
What to expect afterwards
Recovering from Burch colposuspension
What are the risks?
Further information
Questions and answers
Related topics
Sources

About stress incontinence

Stress incontinence is when urine leaks under sudden pressure on the bladder, such as when you cough, laugh or lift something. This happens because the pelvic floor muscles and urethral sphincter are weak and unable to stop urine from leaking under pressure.

Burch colposuspension operation is done to lift the entrance of the bladder (or bladder neck) so that it's better supported and able to stop urine from leaking under pressure.

Illustration showing the position of the bladder and surrounding structures
The position of the bladder and surrounding structures

Alternatives to Burch colposuspension

Strengthening the pelvic floor muscles and making life-style changes, such as changing your diet, doing more exercise and managing fluid intake, may help improve stress incontinence.

Alternative surgical options include having a tension-free vaginal tape (TVT) fitted. A synthetic tape is placed under the middle part of your urethra (the tube through which urine passes out of the body) through your vagina. This helps to keep the bladder-neck closed.

Your surgeon will discuss your options with you.

Preparing for your operation

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you will be asked to stop as smoking increases your risk of getting a chest and wound infection, which can slow your recovery.

Burch colposuspension usually requires a hospital stay of about three to five days. 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.

Your surgeon will explain the procedure and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your nurse will prepare you for theatre. You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs.

About the operation

The top of the vagina is lifted and fixed with permanent stitches into the space behind your pubic bone. The stitches are attached to the cartilage behind the pubic bone.

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

Laparoscopic (keyhole) surgery - two or three small cuts are made in your lower abdomen. A tube-like telescopic camera is used to view the area and the procedure is done using specially designed surgical instruments. The cuts are closed with dissolvable stitches.
Open surgery - a large cut is made in your lower abdomen to carry out the procedure. The cut is closed with dissolvable stitches.

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.

Fine plastic tubes may be left in your wound for up to 48 hours afterwards. These allow blood and fluids to drain into a bag.

You will need to wear a sanitary towel to absorb any vaginal bleeding, which is usually similar to a light period.

You may have a catheter to drain urine from your bladder into a bag. It is either passed into the urethra or is put directly into the bladder just above the cut in your lower abdomen. The catheter is usually taken out during the first day or two. Immediately after the catheter is removed, you may feel some discomfort on passing urine but this usually improves after 24 hours. Please tell your nurse or surgeon if you have any difficulty in passing urine or problems with bladder control.

Your nurse will give you advice about getting out of bed, bathing, diet and gentle exercises.

A physiotherapist will explain some exercises that you can do to help speed up your recovery.

The dressings covering your wound are usually removed on the second day. You will then be able to take a shower or bath. Dissolvable stitches will disappear on their own in seven to 10 days.

You may find that you don't open your bowels for a few days after the operation. However, try not to strain when you go to the toilet as this can stretch the healing wound.

Your surgeon will visit you before you go home to assess your progress and answer any questions that you have. 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

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.

You shouldn't drive until you are confident that you could perform an emergency stop without discomfort. If you are in any doubt about driving, please contact your motor insurer so that you are aware of their recommendations, and always follow your surgeon's advice.

You should take things gently for a day or two after returning home. You must not do any heavy lifting or strenuous exercise until you have made a full recovery. This can take up to two months.

Follow your surgeon's advice about getting back to your usual activities. You will usually be advised to wait at least six weeks before having sexual intercourse. You should continue to use your usual form of contraception unless advised otherwise.

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

burning sensation on passing 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

These are the unwanted but mostly temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic. You will feel some discomfort and have some vaginal bleeding for a few days.

After keyhole surgery, you will also have some pain in the abdomen and in the tips of your shoulders. The pain in your shoulders is known as referred pain and is due to irritation of the diaphragm above the stomach by the gas. This usually improves within 48 hours.

Complications

This is when problems occur during or after the operation. Most women are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). A blood transfusion may be required to replace the lost blood.

Specific complications of Burch colposuspension are uncommon but can include:

infection - you may need antibiotics
difficulty in passing urine or an inability to empty the bladder fully - you may need a catheter for a short while
overactive bladder - you may need to pass urine more often and urgently for the first few weeks
damage to the ureter or bladder - this may require further surgery to repair the damage and remove any scar tissue
pelvic organ prolapse - there is a slight risk that your womb will slide down into your vagina and you may need further surgery to repair this

There's a chance your surgeon may need to convert your keyhole 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.

Further information

The Cystitis and Overactive Bladder Foundation
01908 569169
www.cobfoundation.org
The Continence Foundation
0845 345 0165
www.continence-foundation.org.uk