An artificial sphincter supports bladder health because it replaces the muscle that controls the flow of urine out of the bladder. When contracted, the opening is closed so that accidental leakage does not occur. Under normal conditions, this muscle stays contracted until you choose to relax it to urinate. The liquid will then flow through the urethra, and then out of the body.
Some people have problems with control over this muscle, which creates leakage issues that can be embarrassing. The use of an artificial sphincter can help to provide more control after the removal of the prostrate or radiation therapy in that region.
If your doctor recommends the use of an artificial sphincter, then it will operate in a manner that is different than the voluntary relaxing of the muscle. It is a device that works like your natural process, but it is made up of three parts: a cuff, pump, and balloon. You must squeeze the pump in your scrotum to urinate, allowing the urethra to stay open for about three minutes. Then the cuff closes automatically.
List of the Pros of an Artificial Sphincter
1. You can return to normal activities almost immediately.
Most men can return to doing most of their regular activities the day after they receive the surgery to implant their artificial sphincter. This advantage is possible even though a general anesthesia is used to place the device. You will need to wear a scrotal support for the first week after your surgery. If that support gets wet, then you’ll need to replace it. After 4-6 weeks after the surgery, you can typically return to strenuous activities like riding a bicycle, playing golf, and lifting objects over 10 pounds.
2. It is a highly successful treatment for incontinence.
Men receive this medical intervention more often than women because incontinence is a common problem after prostate removal or radiation therapy. It offers a success rate of 90% when installed correctly. Most men who have an artificial sphincter say that they are happy with it because the risks of leakage are minimal, especially during the day. Although there is a minor risk of failure at any time with this device, a majority of men can walk out of the hospital confident in what this technology provides.
3. This option isn’t the first treatment option for men or women.
The goal of an artificial sphincter is to provide leakage relief when other treatment options have failed. For women, there might be a need to have this procedure and device if other treatments for incontinence fail. Men receive this option more often because of how common prostate treatments are today, but only after other methods to stop urinary incontinence are attempted as part of a treatment plan. Some people may have this option when there is a spinal cord injury that prevents you from controlling when you urinate.
4. You are in control of the urinary process.
The artificial sphincter gives you the power to simulate what your muscles would do naturally with your bladder. It functions by having a cuff, pump, and balloon reservoir working together to cut off the flow of the urine. When you feel the pressure of a full bladder and have time to make it to the toilet, then you can manually release the pressure to the cuff that restricts the flow of urine.
The liquid in the cuff flows into the balloon, which then refills over time to restrict the urethra once again. If the leakage stops with placement, then you get to be in control of when and where you urinate.
5. It can stop periodic leakage from physical activities.
Some men and women have periodic incontinence because their natural sphincter is not as strong as it once was. An artificial sphincter can help to prevent leakage in this situation as well. If you have stress-based urinary incontinence, then you might experience small leaks when exercising, coughing, lifting an object, or walking. You’ll need to fast for up to 12 hours before your surgery to ensure the recovery goes well. A urine test is necessary to ensure that there isn’t an UTI present before placement of the device as well.
6. There are three placement options available for men and women.
If your doctor is recommending an artificial sphincter because no other treatment options are working for your incontinence, then there are three different placement options to consider. The most common placement for men is in the scrotum because the device activation is more natural in this area, and the body supports the cuff, balloon, and pump more naturally. Women typically have their device placed in the labia.
Men and women can also have the artificial sphincter placed in their lower belly if those options are not reasonable for some reason.
List of the Cons of an Artificial Sphincter
1. There are some risks associated with having this device.
Although the risks of having an artificial sphincter surgically implanted are considered uncommon, there are some complications that you’ll want to discuss with your doctor. Pain and bleeding are the usual complaints, which can usually be resolved through the use of medication and rest after the operation. Infections are possible and could result in the need to have the device removed.
There can also be operational problems with the artificial sphincter that can require another surgery to take it out, replace it, or repair the impacted area. About 23% of men who receive this treatment option will need to have a revision surgery to correct problems that can come up over time.
2. You might experience long-term problems with urinating.
Some men still have long-term problems urinating even when they have an artificial sphincter helping them to manage their bladder. This disadvantage can be permanent for some men as well. Your doctor might decide that a catheter is necessary to drain urine from your bladder if this disadvantage occurs. You might also need another surgery to correct the problem after you recover from the placement of the device.
Some men discover that they have an inability to hold urine until they can reach a toilet even with this device in place. There is also a small risk of developing blood clots in the legs after the surgery, which could then travel to the lungs. The device might make it challenging for the bladder to remove all of the liquid too.
3. It takes longer to return to sexual activity with an artificial sphincter.
If you and your doctor decide that an artificial sphincter is necessary for bladder control, then it can take some extra time to have you return to sexual activity. It usually takes at least six weeks for most men to recover enough from the surgery to ensure there is enough time for the wounds to heal. Your doctor will need to wait for 6-8 weeks after the procedure to turn the device on as well.
That means you’ll need a follow-up about 7-14 days after the surgery to ensure everything is healing as it should be. Then another appointment is necessary at 6-8 weeks post-op to turn on the artificial sphincter, teach you how to use it, and authorize more daily living activities.
4. You may not get to use the artificial sphincter at night.
Once you have the artificial sphincter installed and on, there are going to be times when you should still turn it off. Your doctor or caregiver will show you how to control that mechanism. You might be asked to stop using it at night because there will be less pressure on your urethra. Some men experience damage over time in this area when the bladder is stopped overnight, which requires more medical interventions, a catheter, or some other treatment to prevent urine leakage.
If this disadvantage applies to you, then your doctor will suggest that you wear a pad at night that can absorb urine leakage. You might need to adjust your lifestyle habits as well to reduce the amount of fluid you consume in the hours leading up to your bedtime routine.
5. Some women may not be able to use this device when pregnant.
Women can benefit from an artificial sphincter as well, but there are times when it may need to be turned off for them as well. This disadvantage applies most often at the end of a pregnancy because there is a need to decrease the pressure on the urethra. Turning the device off will also help to prevent cuff damage from the pressure that occurs internally due to the head of the unborn baby.
Your OB/GYN should discuss this element of your birthing plan with you. It typically occurs during the last trimester, but it could be necessary at any point of the pregnancy.
6. You may need to make some changes to your health and wellness routines.
When you have an artificial sphincter, then it is essential to keep a list of your current medicines available at all times. You’ll want to have a medical alert card, bracelet, or notification on your person in case an emergency intervention becomes necessary. If you are in the habit of taking vitamins or supplements to support your health, then make sure that you tell your doctor everything that you take. There may be some changes that become necessary to ensure that you can remain in good health.
7. This procedure requires you to take antibiotics afterward.
Your doctor will likely order a series of proactive antibiotics for you to take to prevent the development of an infection after the placement of your artificial sphincter. Always take this medication exactly as ordered to prevent bacteria buildups from occurring. You should never save this medicine or take leftover products that were given to you by someone else because the effectiveness of the drug declines over time. If you have sensitivities or allergies to one or more types of this medication, then you’ll be dealing with even more uncomfortable symptoms as you go through the recovery process.
8. You will likely need to take pain medication after the procedure.
Although some men and women can tough out the pain during their recovery, the placement of an artificial sphincter can create high levels of discomfort. It is not unusual to receive a prescription for pain medication that provides more relief than aspirin, Tylenol, or ibuprofen. These drugs can make you feel sleepy, cause dizziness, or make your stomach feel like you will be sick. If you need help getting out of bed during your recovery time because of the issues with pain that you experience, then it is helpful to have someone available who can provide you with the supports you need.
9. Most patients need a catheter after their surgery.
After the procedure to install the artificial sphincter, you can expect to have a Foley catheter placed in your urethra. This soft tube, which can be made of plastic if you have a rubber allergy, will drain urine from the bladder for you during the post-operative healing process. It is usually removed before you leave the hospital, but there can be times when it may need to stay in because of complications from the procedure.
If your bladder fails to empty because of the strength of the artificial sphincter, then a catheter could be a long-term need unless another surgery can fix the issue. Either way, you may be facing more down time than you expect.
Verdict of the Pros and Cons of an Artificial Sphincter
The typical artificial sphincter is made from silicone rubber, and it is useful in the treatment of urinary incontinence. As with any medical device, there are some specific pros and cons to consider if your doctor thinks this option is the best way to treat your condition. Hospitalization is required to recover from the procedure, but most people can leave the day after having their device implanted.
Men and women can both receive this device, but it is much more common for males to have one because of how common prostate issues are during the aging process. About 90% of men who have incontinence after prostate removal experience a successful result.