What is urethral bulking?

Urethral bulking to treat urinary incontinence involves injecting material (such as collagen) around the urethra. This may be done to build up the thickness of the wall of the urethra so it seals tightly when you hold back urine.

Most bulking materials are injected around the urethra just outside the muscle of the urethra at the bladder outlet. Injecting the bulking material may be done through the urethra or, in women, through the vagina. Needle placement is guided by the use of a cystoscope inserted into the urethra.

Urethral bulking procedures are usually done under local anesthesia or with sedation. But they may require a general or regional anesthesia. Using local anesthesia or sedation allows the person to stand up after an injection to find out if continence has been achieved. If continence has not been restored, another injection may be done.

This treatment may help, but the effect may wear off over time. It is common to need more treatments.

The surgery is used mostly for women and sometimes for men.

Activity

• Rest when you feel tired.
• You can do your normal activities when it feels okay to do so.
• Many people are able to return to work the day after the procedure.
• Allow the area to heal. Don't move quickly or lift anything heavy for 2 weeks or until your doctor says it's okay.
• You can shower after the procedure, but avoid taking a hot bath for a few days. Soaking in hot water too soon may soften the bulking agent and affect how well it works.

Diet

• Drink plenty of fluids. If you have kidney, heart, or liver disease and have to limit fluids, talk with your doctor before you increase the amount of fluids you drink.
• You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt.
• If your bowel movements are not regular right after the procedure, try to avoid constipation and straining. Drink plenty of water. Your doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

• If needed, ask your doctor if you can take an over-the-counter pain medicine.
• If you stopped taking aspirin or some other blood thinner, your doctor will tell you when to start taking it again.
• Your doctor will tell you if and when you can restart your medicines. You will also get instructions about taking any new medicines.

Other instructions

• If you got medicine to relax you during your procedure:
  • Do not drive or operate machinery until the medicine wears off and you can think clearly. Your doctor may tell you not to drive or operate machinery until the day after your procedure.
  • Do not sign legal documents or make major decisions until the medicine wears off and you can think clearly. The anesthesia can make it hard for you to fully understand what you are agreeing to.
• Avoid putting anything inside your vagina for 2 weeks or until your doctor says it's okay. This includes having sex and using tampons.

Urethral bulking may work for some women. But fewer than 4 out of 10 women have long-term benefits.

There are some risks related to urethral bulking. For example, you may have trouble urinating after the procedure. This often goes away after a few days. Some other risks include pain at the injection site, injury to the urethra, and migration of the bulking material.

Most urethral bulking injections can be done in a doctor's office or surgery center. You may need to take it easy for a few days afterward and will need to avoid heavy lifting and strenuous activities for 4 to 6 weeks.

Urethral bulking was done to help treat your urinary leakage problem. Your doctor injected a gel-like substance around your urethra. This thickens the wall of the urethra so it seals more tightly when you hold back urine.

You may be sore in the area and feel some burning when you urinate. It's common to have a little blood in your urine. These symptoms should start to get better within a day or two.

Some people may need more than one treatment for it to work well.

Urethral bulking may be done to treat:

• Stress incontinence in women. There are different types of surgery used to treat stress incontinence. Talk to your doctor about what is best for you.
• Mild stress incontinence in men that results from prostate surgery.