As far as medical treatments for urinary incontinence (UI) go, we’ve covered quite a few, from bladder sling surgery to pelvic floor therapy to kegel trainers, but hop in any internet forum about bladder leaks and you’ll hear the term ‘urethral bulking’. With a reported success rate of 60-70% according to the American Gynecologic Society (success meaning a reduction in leaks, but not complete cessation,) it’s gained a lot of interest in recent years. So, what is urethral bulking, and is it right for you? Let’s dive in.
Urethral Bulking: What is it?
Urethral bulking is a minimally invasive medical procedure usually used to treat stress urinary incontinence (SUI). Remember, SUI is the kind of bladder leak that happens when the bladder is under pressure, like when sneezing, exercising, or jumping on a trampoline.
With urethral bulking, a healthcare provider injects a bulking agent around the walls of the urethra to help it close more effectively and reduce those leaks. The goal of the procedure is to narrow the urethral opening and support the sphincter muscle that is not closing the urethra off as it should. That may be because of weakening of the muscle due to age, having a baby, or going through menopause.
What are the “Bulking Agents” used in urethral bulking?
Different materials are used, but all of them are made of soft, hypoallergenic beads floating in a dissolvable gel and designed to stay in the body without adverse effects. Among the options offered, Dr. Miranne says “In my experience, Bulkamid, which is a polyacrylamide hydrogel (mostly water), has offered better symptom improvement when compared with other urethral bulking agents we used in the past.”
Because the material is dissolvable, this is not a permanent fix and the effects typically wear off in a year or two. Attn: Grace Medical Advisor Dr. Barbara Frank notes “Apparently this idea and technique started in the 1900s! There is not a ton of long term data however it is very safe. The downside is that you need to go multiple times. Because it’s not permanent, your symptoms most likely will come back when the bulking agent wears off.”
Who is Urethral Bulking for?
Urethral bulking is a treatment for people with stress urinary incontinence. Injections may also be used for women who still leak after a bladder sling surgery. Says Attn: Grace Medical Director, Dr. Jeannine M. Miranne, “Urethral bulking agent injection with Bulkamid is a good intermediary option for women who have not responded to traditional conservative treatment of stress urinary incontinence (typically kegel exercises, pelvic floor physical therapy, disposable intravaginal devices like the Poise Impressa, or incontinence pessaries) who don’t have the time to recover from more definitive stress incontinence surgery like a sling procedure.”
A person may also opt for urethral bulking if they are not a good candidate for more invasive surgical interventions. It also is an option for women who plan to become pregnant in the future as it leaves no long-term foreign material that could interfere with pregnancy or delivery.
The Urethral Bulking Procedure
There are nuances in any healthcare setting that impact the exact process, but here’s the overall plan. Usually urethral bulking is performed in an outpatient setting like your doctor’s office with local anesthesia and no sedation.
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Preparation: Ahead of your procedure, your health care team may have some instructions for you regarding eating, drinking, and taking medications. The first step of the procedure itself is to prepare the treatment area. You lie on your back with your legs elevated in stirrups like having a gynecological exam. The whole external skin and genital area would be cleaned thoroughly.
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Anesthesia: If you’re not having general anesthesia, an injectable local numbing medical is administered to minimize discomfort.
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Cystoscopy: Once you’re numb (or asleep), a small camera (cystoscope) is inserted into the urethra so your healthcare provider can see the area to be injected.
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Injection of the Bulking Agent: The bulking agent is injected into the urethral walls at multiple locations to thicken the tissue and help with closure. When the healthcare provider is satisfied with the distribution of the agent, the procedure is over.
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Observation: You’ll have a quick recovery period to make sure no complications arise before heading home. Your health care team will want to be sure you can urinate before you leave. If you’ve had general anesthesia, you might have additional restrictions around recovery and going home.
The whole process is usually under 30 minutes, and you can go home the same day.
Recovery and Aftercare
Following the procedure, you could have a few days with some mild discomfort, minor bleeding, burning when peeing, or temporarily feel urgency when you have to pee. Aftercare guidelines, which may include:
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Avoiding strenuous activities
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Drinking plenty of fluids
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Monitoring for signs of infection
Most patients do normal activities within a couple of days. It can take a few days before you feel the full effect of the bulking agent.
Is Urethral Bulking Effective?
Data supports the efficacy of urethral bulking. Effectiveness of the procedure does decrease over time and repeat injections are often required to maintain results.
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Short-term success rates: The procedure reduces or eliminates stress incontinence leaks in 64%. to 85% of patients
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Patient satisfaction: Urethral bulking results in a high satisfaction rate of 69.9%.
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Comparisons with other treatments: While urethral bulking is less effective than surgical options like midurethral sling procedures, it is considered a compelling noninvasive alternative for people dealing with stress urinary incontinence.
What Are the Risks and Complications of Urethral Bulking?
While urethral bulking is generally safe, potential risks and side effects include:
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Temporary difficulty urinating
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Urinary tract infections (UTIs)
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Localized pain or swelling at the injection site
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Migration of the bulking agent (rare)
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Need for repeat treatments due to diminishing effects
Living with bladder leaks can be seriously frustrating; it’s why we’ve rebuilt urinary incontinence products for women that give you more coverage and confidence to go through the world, leaks and all. But if you’re exploring treatment options specifically for stress urinary incontinence, urethral bulking is likely one to look into. As with any potential treatment option, Dr. Frank points out, “It’s worth talking to a specialist urogynecologist or female urologist to see if you are a candidate and what option is best based on your type of leakage.” It’s minimally invasive and well-tolerated, and while it may not offer a permanent cure, it can help with symptom relief (and the chance to downgrade to a lighter pad for up to 2 years). Goodbye ultimates, hello moderates!
Disclaimer: This content is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This content is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice.