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Below are some of the most common questions patients have regarding
Urogynecology is a subspecialty of Obstetrics and Gynecology that focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and other bladder problems. After completing a residency in Obstetrics and Gynecology, Urogynecologists complete fellowship training where they spend several years focusing only on these disorders.
How common is urinary incontinence among women? Many women incorrectly assume that urine leakage is normal. While the problem of urine leakage is very common, it should never be considered normal. The most commonly quoted study estimates that 11 million American women currently suffer from leakage of urine. However, this estimate may be low. A study of 2800 postmenopausal women (average age 67) funded by the National Institute on Aging found that fifty-six percent of women experienced urinary incontinence at least weekly.
What causes urinary incontinence? Urinary incontinence is a symptom, not a disease. This means that there are many possible causes of urinary incontinence. The key to treatment is identifying the specific type(s) of incontinence that a woman has through a careful medical interview and focused physical exam. It may also be necessary to perform a special test called urodynamics to diagnose the problem. Urodynamics are necessary if a woman is considering surgery to correct incontinence. The two most common types of urinary incontinence are stress incontinence and urge incontinence.
A Urodynamic Study is actually a SERIES of tests designed to thoroughly evaluate bladder and urethral function. In order to understand every detail of your bladder problem, these tests record very precise scientific data on your bladder's ability to store and empty urine. These studies are conducted to evaluate leaking urine, difficulty emptying the bladder, frequent urination, recurrent infections, blood in the urine and loss of bladder support. Depending on your situation and our diagnostic needs, you may have one or more of these individual tests that comprise a Urodynamic Study:
What treatment options are available? Stress incontinence may be effectively treated with pelvic floor exercises, devices that "block" the loss of urine, or surgery. Urge incontinence is commonly treated with medications, biofeedback, or electrical stimulation to the nerves that control the bladder. There is even a new treatment for urge incontinence that involves placement of an electrical stimulator under the skin (similar to a pacemaker). The most important thing to remember is that there is a wide variety of non-surgical and surgical treatment options available for all types of urinary incontinence.
I've heard that surgery doesn't work for very long. Is that true? When it comes to treating stress incontinence, not all surgical procedures are created equal. Over the years, literally hundreds of variations of anti-incontinence surgery have been described in medical journals, and some of them don't work very well. Fortunately, research studies have identified two basic kinds of surgical procedures that seem to be the "best": the retropubic urethropexy and the suburethral sling. There is no surgery for incontinence that has a 100% cure rate, but either the retropubic urethropexy or suburethral sling should permanently cure 75-95% of women with stress incontinence. A relatively new type of suburethral sling called "tension Free Vaginal Tape" (aka TVT) that became available in 1998 has rapidly replaced most other surgeries for stress incontinence. Nearly 1 million TVT slings have been placed worldwide, and many surgeons now consider the TVT-type sling to be the 'gold-standard' treatment for the problem. The TVT procedure can be performed on an outpatient basis. Our doctors have performed thousands of TVT Slings and prefer these in treating stress incontinence.
How can I prevent this problem? We don't fully understand all the factors that cause urinary incontinence, so it is difficult to recommend ways to prevent the problem. Pelvic muscle exercises (PME) - also known as Kegel exercises - are probably the best way to prevent stress incontinence. Another easy thing to try on your own is to avoid eating or drinking things known to irritate the bladder.
The word prolapse simply means displacement from the normal position. When this word is used to describe the female organs, it usually means bulging, sagging or falling. It can occur quickly, but usually happens over the course of many years. There are various types of prolapse, which can occur individually or together.
What symptoms are caused by my prolapse? The symptoms depend on which type of prolapse you have. Since prolapse usually occurs slowly over time, the symptoms can be hard to recognize. Most women don't seek treatment until they actually feel something protruding outside of their vagina. The very first signs can be subtle - such as pain during intercourse or an inability to keep a tampon inside the vagina. As the prolapse gets worse, some women complain of a bulging or heavy sensation in the vagina that worsens by the end of the day or during bowel movements. Some women with severe prolapse even have to push stool out of the rectum by placing their fingers into the vagina during bowel movements.
Why did this happen to me? Did I do something to cause this problem? The simple answer to this question is NO. There are many factors that seem to contribute to the development of prolapse, and almost none of them are things you can control. Genetics definitely plays a major role. Vaginal deliveries can predispose certain women to develop prolapse, but we haven't learned how to identify these women BEFORE they have children. Other conditions that seem to go along with the development of prolapse are severe obesity, pelvic tumors and chronic constipation. Repetitive heavy lifting, especially lifting from the floor, may contribute to prolapse as well.
Do I need to have surgery for my prolapse? Only a trained physician can help you answer this question. There are two non-surgical choices - do nothing about it or wear a pessary. A pessary is worn in the vagina like a diaphragm. Pessaries come in many different shapes and sizes all designed to support the prolapsed pelvic organs. Many women are completely satisfied using a pessary for years - avoiding surgery all together. Other women prefer surgery. Again, if you have prolapse be sure to get an examination and discuss this with your doctor.
If I choose to use a pessary, won't that give me an infection? The ideal way to use a pessary is to insert it each day as part of your morning routine, and take it out for cleaning each night. When this is not possible, women come to the office about four to six times a year for an exam and pessary cleaning. Even when a pessary is worn almost continuously, vaginal infections are rare although vaginal discharge is common.
What will happen if I just ignore this problem? Will it get worse? Probably. It may not happen quickly, but if left untreated, pelvic organ prolapse usually gets worse. However, treatment of prolapse should be based on your symptoms. In rare cases, severe prolapse can cause urinary retention that progresses to kidney damage or infection, When this occurs, prolapse treatment is considered necessary. In most other cases, patients should be the ones to decide when to have their prolapse treated - based on the symptoms they are having.
If I decide to have surgery, what can I expect during the recovery period? Depending on the extent of your surgery, the hospital stay usually lasts one to two days. Some women have difficulty urinating immediately after the surgery which diminishes as anesthesia is eliminated from the body. If this persists, patients can be taught self catheterization and in unusual cases a catheter may be needed for serveral days. Most patients require at least some prescription strength pain medicine for about one week after surgery. Following any of our surgeries to correct urinary incontinence or prolapse, we ask that patients take it easy for 12 weeks to allow proper healing. This means no lifting more than 8 pounds (the weight of a gallon of milk), no intercourse for 6 weeks, and no exercise other than walking.
If my surgery is successful, how long will it last? The goal of continence or pelvic reconstructive surgery is to recreate normal anatomy permanently. However, none of these procedures are successful 100% of the time. According to the medical literature, failures occur in approximately 5 - 15% of women who have prolapse surgery. In these cases, it is usually a partial failure requiring no treatment, pessary use, or surgery that is much less extensive than the original surgery. Patients who follow our recommended restrictions after surgery give themselves the best chance for permanent success. We also follow you every 2-3 weeks after surgery to help you strengthen your pelvic muscles and optimize outcomes.
I have prolapse, but I don't leak urine. Do I still need bladder testing? If you are going to have surgery to correct the prolapse, bladder testing (called urodynamics) should be done first. That's because the prolapsed portion of your vagina may be pushing on your urethra and preventing urine leakage. If that is the case, having the prolapse corrected can give you a new problem - urinary incontinence. The only way to tell whether a continence procedure is needed at the time of prolapse surgery is to perform urodynamics while holding the prolapse up in its normal position. Also, many women with prolapse may have other bladder problems such as frequency, urgency, or trouble emptying - all of which should be addressed prior to surgery.
How will my prolapse treatment affect my sex life? If you choose to use a pessary, your sex life shouldn't change, except for the fact that the pessary usually needs to be removed prior to intercourse. If you have reconstructive surgery to correct prolapse, we recommend that you refrain from intercourse for six weeks after your operation to allow proper healing. After this period, getting used to having intercourse will take some time, but most patients report an improved sex life afterwards. When prolapse is severe, one surgical option is to completely close the vagina. This procedure (called colpocleisis or colpectomy) is less invasive than reconstructive surgery, which makes it especially useful for patients with severe medical conditions. Of course, intercourse is impossible after having this procedure, so it is only appropriate for patients who are ABSOLUTELY sure that they never want to be sexually active again.
How did you ever get interested in this field? Treating prolapse and incontinence is challenging and very rewarding. Every patient has a unique set of symptoms, disorders and expectations, so we must individualize each treatment plan. Unlike most specialists, Urogynecologists have the opportunity to diagnose a condition; plan treatment based on the patient's lifestyle and preferences; and follow up on the patient after treatment. It's rewarding to see patients back after successful treatment, because they are usually very happy with their improved quality of life. . |
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