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Pelvic Organ Prolapse Review

The vagina and pelvic female organs and their surrounding structures (bladder, rectum, etc.) are attached to the pelvis bones by connective tissues such as muscle ligaments, tendons and fascia. These tissues help form walls around the vagina and ensure the functions but also that normal urinary voiding and bowel movements can occur. As the pelvic muscles and other supporting structures become weak the connective tissues can fail, allowing pelvic structures like the bladder or rectum to bulge into the vaginal wall. Pelvic Organ prolapse can worsen over time.

This can cause the following symptoms:

  • A feeling of vaginal fullness, heaviness, or even pain
  • Pain or discomfort during intercourse
  • Loss of bladder control
  • Involuntary urination or inconsistent urinary stream
  • Difficulty with bowel movements
  • Recurrent urinary infections

Common Causes:

Pelvic muscles, ligaments and connective tissues which have been weakened with age are the primary causes, but many other factors may play a role. These may include vaginal childbirth, previous vaginal surgeries, menopause, smoking, diabetes, obesity, a history of heavy lifting, chronic coughing, and chronic constipation. Sometimes pelvic organ prolapse can be caused simply by genetic factors.

What are the different types of pelvic organ prolapse?

When vaginal prolapse occurs, an organ has dropped (prolapsed) out of its normal position and can sometimes even protrude from the vagina. The definition of pelvic organ prolapse is different depending on what anatomic structure in the pelvis is pushing into the vagina, such as the bladder or rectum. When vaginal prolapse occurs, the upper part (apex) of the vagina has dropped to a lower position. It is possible for more than one organ to prolapse into the vagina at the same time.

The different types of pelvic organ prolapse:

How is Pelvic Organ Prolapse Treated?

The best treatment for a specific type and severity of pelvic organ prolapse will vary from patient to patient. If your symptoms are mild, the doctor may recommend lifestyle changes, Kegel exercises to strengthen the pelvic muscles, medication, the use of a pessary, or a biofeedback stimulation device to relieve the symptoms. When the symptoms are severe enough to affect your quality of life, your physician may recommend implantation or surgery.

Urinary Urgency & Incontinence

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Urinary incontinence is an inability to hold your urine until you get to a toilet. More than 13 million people in the United States--male and female, young and old--experience incontinence. Women experience incontinence two times more often than men do. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference.

Older women, more often than younger women, experience incontinence. But incontinence is not inevitable with age. Incontinence is treatable and often curable at all ages. If you experience incontinence, you may feel embarrassed. It may help you to remember that loss of bladder control can be treated. You will need to overcome your embarrassment and see a doctor to learn if you need treatment for an underlying medical condition.

Incontinence in women usually occurs because of problems with muscles that help to hold or release urine. The body stores urine--water and wastes removed by the kidneys--in the bladder, a balloon-like organ. The bladder connects to the urethra, the tube through which urine leaves the body.

During urination, muscles in the wall of the bladder contract, forcing urine out of the bladder and into the urethra. At the same time, sphincter muscles surrounding the urethra relax, letting urine pass out of the body. Incontinence will occur if your bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax.

What Are the Types of Incontinence?

Stress Incontinence

If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause are common events that cause stress incontinence. It is the most common form of incontinence in women and is treatable.

Pelvic floor muscles support your bladder. If these muscles weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the muscles that do the squeezing weaken.

Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.

Urge Incontinence

If you lose urine for no apparent reason while suddenly feeling the need or urge to urinate, you may have urge incontinence. The most common cause of urge incontinence is inappropriate bladder contractions.

Medical professionals describe such a bladder as "unstable," "spastic," or "overactive." Your doctor might call your condition "reflex incontinence" if it results from overactive nerves controlling the bladder.

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when someone else is taking a shower or washing dishes).

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, brain tumors, and injury--including injury that occurs during surgery--all can harm bladder nerves or muscles.

Overflow Incontinence

If your bladder is always full so that it continually leaks urine, you have overflow incontinence. Weak bladder muscles or a blocked urethra can cause this type of incontinence. Nerve damage from diabetes or other diseases can lead to weak bladder muscles; tumors and urinary stones can block the urethra. Overflow incontinence is rare in women.

Other Types of Incontinence

Stress and urge incontinence often occur together in women. Combinations of incontinence--and this combination in particular--are sometimes referred to as "mixed incontinence."

"Transient incontinence" is a temporary version of incontinence. It can be triggered by medications, urinary tract infections, mental impairment, restricted mobility, and stool impaction (severe constipation), which can push against the urinary tract and obstruct outflow.

How Are Urgency & Incontinence Evaluated?

The first step toward relief is to see a doctor at The Women’s Health Group who is well acquainted with incontinence to learn the type you have.

To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence. Other obvious factors that can help define the problem include straining and discomfort, use of drugs, recent surgery, and illness. If your medical history does not define the problem, it will at least suggest which tests are needed.

Your doctor will physically examine you for signs of medical conditions causing incontinence, such as tumors that block the urinary tract, stool impaction, and poor reflexes or sensations, which may be evidence of a nerve-related cause.

Your doctor will measure your bladder capacity and residual urine for evidence of poorly functioning bladder muscles. To do this, you will drink plenty of fluids and urinate into a measuring pan, after which the doctor will measure any urine remaining in the bladder. Your doctor may also recommend:

Stress test--You relax, and then cough vigorously as the doctor watches for loss of urine.

Urinalysis--Urine is tested for evidence of infection, urinary stones, or other contributing causes.

Blood tests--Blood is taken, sent to a laboratory, and examined for substances related to causes of incontinence.

Ultrasound--Sound waves are used to "see" the kidneys, ureters, bladder, and urethra.

Cystoscopy--A thin tube with a tiny camera is inserted in the urethra and used to see the urethra and bladder.

Urodynamic Testing

How Is Incontinence Treated?

Pessaries

A pessary is a stiff ring that is inserted by a doctor or nurse into the vagina, where it presses against the wall of the vagina and the nearby urethra. The pressure helps reposition the urethra, leading to less stress leakage. If you use a pessary, you should watch for possible vaginal and urinary tract infections and see your doctor regularly.

Other Treatments

Many women manage urinary incontinence with pads that catch slight leakage during activities such as exercising. Also, you often can reduce incontinence by restricting certain liquids, such as coffee, tea, and alcohol. If your urine loss is mostly during exercise the FemSoft urethral insert is a “plug” that is single use, inserted prior to exercise and disposed of after that. They cost about seven dollars per device.

Finally, many women who could be treated resort instead to wearing absorbent undergarments, or diapers--especially elderly women in nursing homes. This is unfortunate, because diapering can lead to diminished self-esteem, as well as skin irritation and sores. If you are an elderly woman, you and your family should discuss with your doctor the possible effectiveness of treatments such as timed voiding, pelvic muscle exercises, and electrical stimulation before resorting to absorbent pads or undergarments.

Points to Remember

  • Urinary incontinence is common in women.
  • All types of urinary incontinence can be treated.
  • Incontinence can be treated at all ages.
  • You need not be embarrassed by incontinence.

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