What is Burch Procedure for Stress Incontinence
Burch Procedure for Stress Incontinence is surgery to treat the loss of bladder control (stress incontinence) in women. Women with stress incontinence often have urine loss while straining, coughing, sneezing, laughing, or doing physical activity.
Urinary incontinence may occur because of the bladder and urethra changing position through the course of normal aging or childbirth.
The goal of the Burch procedure is to improve bladder function by providing more support for the urethra and bladder and by restoring them to their normal position. During this procedure, stitches (sutures) are placed in the tissue around your urethra and bladder to help support the bladder neck.
Tell a health care provider about:
- Any allergies you have.
- All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
- Any problems you or family members have had with anesthetic medicines.
- Any blood disorders you have.
- Any surgeries you have had.
- Any medical conditions you have.
- Whether you are pregnant or may be pregnant.
What are the risks?
Generally, this is a safe procedure. However, problems may occur, including:
- Bleeding.
- Infection.
- Injury to the bladder, urethra, or surrounding organs.
- Allergic reactions to medicines.
- Leaking of urine again or trouble urinating.
- Increased need to urinate.
- Blood clots.
What happens before the procedure?
Staying hydrated
Follow instructions from your health care provider about hydration, which may include:
- Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.
Eating and drinking restrictions
Follow instructions from your health care provider about eating and drinking, which may include:
- 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
- 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
- 6 hours before the procedure – stop drinking milk or drinks that contain milk.
- 2 hours before the procedure – stop drinking clear liquids.
Medicines
- Ask
your health care provider about:
- Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
- Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood.Do nottake these medicines before your procedure if your health care provider instructs you not to.
- You may be given antibiotic medicine to help prevent infection.
General instructions
- You
may have tests before the day of surgery, such as:
- Blood tests.
- X-ray exams.
- Ultrasound.
- Bladder and urinating tests (urodynamic testing).
- Cystoscopy. This is a test to look into your bladder using a small metal scope with a light.
- Electrocardiogram (ECG).
- Ask your health care provider how your surgical site will be marked or identified.
- Do notuse any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes, for 4–6 weeks before surgery. These can slow the healing process and can lead to breathing problems during and after surgery. If you need help quitting, ask your health care provider.
- Plan to have someone take you home from the hospital or clinic.
What happens during the procedure?
- To
lower your risk of infection:
- Your health care team will wash or sanitize their hands.
- Your skin will be washed with soap.
- Hair may be removed from the surgical area.
- An IV tube will be inserted into one of your veins.
- You
will be given one of the following:
- A medicine to make you fall asleep (general anesthetic).
- A medicine that is injected into your spine to numb the area below and slightly above the injection site (spinal anesthetic).
- The
surgeon may use either a laparoscopic or open technique for this surgery:
- In the laparoscopic technique, the surgery will be done through small incisions in the abdomen and groin area. A thin, lighted tube with a tiny camera on the end (laparoscope) will be inserted into one of the incisions. The tools needed for the procedure will be put through the other incisions. This technique allows for a faster recovery time.
- In the open technique, the surgery will be done through one large incision in the abdomen.
- In either technique, the bladder will be filled with a saline solution, and the surgeon will then lift the wall of the vagina where the urethra is located. The tissue around the urethra will be stitched (sutured) to tissue near the pubic bone. This will help the bladder remain stable during activities that might cause leakage, such as coughing or sneezing.
- The incision or incisions will be closed with stitches and will be covered with a bandage (dressing).
What happens after the procedure?
- Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines you were given have worn off.
- You may have a thin, flexible tube (catheter) in your bladder to drain urine. This may stay in place until your bladder is working properly on its own. In some cases, you may still have a catheter in place when you go home.
- You may have gauze or dressings in the vagina. These will be removed in 1–2 days.
Burch Procedure for Stress Incontinence, Care After
What can I expect after the procedure?
After the procedure, it is common to have:
- Some pain in the abdomen.
- Soreness at the incision site.
- Difficulty urinating. You may have to use a catheter until you can urinate on your own.
Follow these instructions at home:
Activity
- Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
- Do notexercise or lift anything that is heavier than 10 lb (4.5 kg) until your health care provider says that it is safe.
- Do nothave sexual intercourse until your health care provider says it is okay.
Incision care
- Follow
instructions from your health care provider about how to take care of your
incision. Make sure you:
- Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
- Change your dressing as told by your health care provider.
- Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do notremove adhesive strips completely unless your health care provider tells you to do that.
Check your incision area every day for signs of infection. Check for:
- More redness, swelling, or pain.
- More fluid or blood.
- Warmth.
- Pus or a bad smell.
Catheter care
- If
you have a catheter in place, follow instructions from your health care
provider for care. Instructions may include the following:
- If the catheter is connected to a bedside bag, make sure that the bag is always below the level of your bladder. Do notlay it on the floor. If you cannot connect the bag to the side of your bed, a small stool or chair can be placed near the bed for you to hang the bag on.
- If the catheter is connected to a leg bag or belly bag, make sure that you do notlie down with the bag attached to your leg or belly. If you do, this may allow urine to flow back into your bladder from the bag.
- If you were given intermittent catheters, use them as told by your health care provider.
General instructions
- Do nottake baths, swim, or use a hot tub until your health care provider approves. You may take showers.
- Take over-the-counter and prescription medicines only as told by your health care provider.
- Do notdrive until your health care provider approves.
- Do notdrink alcohol until your health care provider says it is okay.
- Resume your usual diet as told by your health care provider.
- Try to maintain a healthy weight.
- Be careful about drinking too much fluid. Talk with your health care provider about how much you can drink.
- Plan to urinate regularly.
- Keep all follow-up visits as told by your health care provider. This is important.
Contact a health care provider if:
- You have abnormal discharge from your vagina.
- You have more redness, swelling, or pain around your incision.
- You have more fluid or blood coming from your incision.
- Your incision feels warm to the touch.
- You have pus or a bad smell coming from your incision.
- You have a fever or chills.
- You have trouble with your catheter or the intermittent catheterization.
- Your incision breaks open (edges not staying together) after stitches have been removed.
- You have increasing pain in the shoulders.
- You have persistent nausea or vomiting.
- You have pain when urinating or you have small amounts of blood in your urine.
- You have consistent pain or pressure in your pelvis or abdomen that will not go away.
Get help right away if:
- You develop a rash.
- You have difficulty breathing or have shortness of breath.
- You feel dizzy when standing or you faint.
- You cannot urinate.
- You have chest pain.
