Burch Colposuspension

Burch Colposuspension is an established surgical procedure designed to treat stress urinary incontinence (SUI). SUI is the involuntary leakage of urine during activities that increase abdominal pressure, such as coughing, sneezing, laughing, or exercising.

The surgery supports the neck of the bladder (urethrovesical junction) by lifting and stitching the vaginal tissues to a strong, fixed ligament in the pelvis. This provides a supportive “hammock” that prevents the urethra from dropping down and leaking under pressure.

Your gynaecologist may recommend this procedure if:

Conservative treatments (like pelvic floor physiotherapy) have not worked.
You have significant SUI, often with some bladder neck mobility.
You are undergoing another abdominal pelvic surgery (like a hysterectomy) and need treatment for SUI simultaneously.

Preparing for Surgery

Pre-operative Assessment:

Full Urodynamic Testing: This series of tests assesses how your bladder and urethra are functioning to confirm SUI is the main issue.
Cystoscopy: A camera may be used to look inside your bladder.
Discussion: Your surgeon will explain the procedure, its success rates, potential risks, and how it compares to other options like a mid-urethral sling.

Before Surgery:

Medications: You will get instructions on which medications (especially blood thinners) to stop and when.
Fasting: No food or drink (fasting) for 6-8 hours before your surgery.
Support: Arrange for help at home for 1-2 weeks after surgery, especially if you have young children. You will not be able to drive or lift heavy items.
Healthy Bladder: Treat any existing urine infection before surgery.

During the Procedure

Anaesthesia: The surgery is performed under general anaesthesia (you are asleep).
Approach: It is typically done through a low horizontal (“bikini line”) abdominal incision, though it can sometimes be performed laparoscopically (keyhole).
Duration: The operation usually takes 1 to 2 hours.
The Procedure: The surgeon makes an incision and gently moves the bladder aside. Stitches (sutures) are placed in the vaginal wall tissue on either side of the bladder neck and attached firmly to the strong pelvic ligaments. This elevates the bladder neck into a higher, supported position.
Catheter: A urinary catheter will be placed during surgery to drain your bladder. It usually remains for 1-3 days afterwards.
Hospital Stay: You can expect to stay in the hospital for 2-4 days.

Recovery After Surgery

In Hospital & First 2 Weeks:

Pain: You will have pain from the abdominal incision, managed with pain medication. Deep breathing and moving carefully are important.
Catheter & Voiding: Once the catheter is removed, nurses will monitor your ability to empty your bladder completely. Temporary difficulty voiding is common.
Wound Care: Keep the abdominal incision clean and dry. You will be advised on showering and checking for signs of infection.
Activity: Avoid all heavy lifting (nothing heavier than a kettle), strenuous exercise, and prolonged standing for at least 6 weeks. Walking is encouraged.

First 6 Weeks:

Driving: Do not drive until you can perform an emergency stop comfortably and are off strong painkillers (usually 4-6 weeks).
Work: Return depends on your job. Sedentary work may be possible after 4-6 weeks; physical jobs may require 8-12 weeks off.
Sexual Intercourse: Must be avoided until you are fully healed, typically at your 6-week post-operative check-up and after your doctor gives the all-clear.

Long-Term Considerations

Success Rates: The Burch procedure has a high long-term success rate (70-90% cure/improvement over 5+ years).
Follow-up: You will have a follow-up appointment at 6 weeks to check your wound and discuss your recovery and symptoms.
Bladder Function: You may experience temporary urgency or frequency. Pelvic floor physiotherapy after recovery can help optimise long-term results.
Future Pregnancy & Childbirth: A successful Burch colposuspension can be affected by a future vaginal delivery. A Caesarean section may be recommended for subsequent pregnancies to protect the repair. Discuss future fertility plans with your surgeon.

Risks and Potential Complications

As with any major surgery, potential risks include:

General Surgical Risks: Reaction to anaesthesia, bleeding, infection, blood clots (DVT/PE).
Bladder or Urethra Injury: Rare but may require further repair.
Voiding Difficulties: Some women struggle to empty their bladder fully after surgery, which may require longer-term intermittent self-catheterisation (rarely permanent).
Development of Overactive Bladder (OAB) Symptoms: New or worsened urgency and frequency.
Failure/Recurrence: Incontinence may return over time, or the surgery may not fully correct it.
Other Rare Risks: Injury to nearby structures, fistula formation, or pain during intercourse.

Frequently Asked Questions (FAQs)

Q: How is this different from a TVT or sling operation?
A: The Burch supports the bladder neck via an abdominal approach, while a sling supports the mid-urethra via a vaginal or small abdominal incision. The Burch is often preferred in complex cases or when performing concurrent abdominal surgery.

Q: Will the surgery affect my sex life?
A: The goal is to improve quality of life, including sexual activity, by eliminating fear of leakage. Some women report improved sensation. There is a small risk of pain during intercourse post-surgery.

Q: Are there non-surgical alternatives?
A: Yes. First-line treatments are always pelvic floor muscle training (physiotherapy) and lifestyle changes. Other options include continence pessaries or urethral bulking injections.

Q: Is the surgery permanent?
A: It is designed to be a long-term solution, but results can be influenced by factors like ageing, future pregnancies, chronic coughing, or significant weight gain.

eGynaecologist Advice

You must seek urgent gynaecological review if you develop chest pain, shortness of breath, or calf swelling after surgery, while you are recovering from surgical procedure.
You should seek gynaecological consultation if you have heavy vaginal bleeding or increased pain/swelling at the wound site or develop signs of infection including fever, chills, or foul-smelling discharge or if you are unable to pass urine.