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Carolina Continence Center
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 (avg 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 special testing 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. Stress incontinence is urine leakage that happens during activity that causes pressure (or “stress”) on the bladder such as laughing, lifting, coughing or sneezing. Urge incontinence is urine leakage that occurs before a woman has a chance to get to the bathroom in response to an urge to urinate. Women with this type of leakage may also experience frequent urge to urinate and frequent nighttime waking to urinate.
What treatment options are available?
Stress incontinence may be affectively treated with pelvic floor exercises, devices that “block” the loss of urine, or surgery. Urge incontinence is commonly treated with medications, biofeedback, electrical stimulation to the nerves that control the bladder or botulinum toxin (botox.) 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, hundreds of variations of incontinence surgery have been described in medical journals, and some did not work very well. Fortunately, research studies have identified two basic kinds of surgical procedures that seem to be the most effective: the retropubic urethropexy and the suburethral sling. There is no surgery that is 100% successful, but either of these procedures should permanently cure 75-90% of women with stress incontinence. These procedures have become the gold standard for urinary incontinence. Most procedures are done on an outpatient basis. Dr. Mattox has personally performed over 2000 slings.
How can I prevent this problem?
We don’t understand all the factor 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 know to irritate the bladder.
What does prolapse mean?
The word prolapsed simply means displacement from the normal position. The this word is used to describe the femal organs, ti usually means bulging, sagging or falling. It can occure quickly, but usually happens over the course of many years. There are various types of prolapsed, 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 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 fingers into the vagina during a bowel movement.
Why did this happen to me? Did I do something to cause this problem?
The simple answer is no. There are many factors that seem to contribute to the development of prolapsed, and almost none of them are things you can control (getting older, menopause, prior surgeries, genetics.) There are some things that do go along with prolapse: chronic constipation, obesity and repetitive heavy lifting. Make sure these are treated and controlled prior to considering any surgical intervention.
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 or wear a pessary. A pessary is a device placed 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 prolapsed be sure to get an examination and discuss this with your doctor.
If I choose 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 progress to kidney damage or infection. When this occurs, prolapse treatment is considered necessary. It 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?
Most surgeries today are performed vaginally, via laparoscopy or robotically (minimally invasive surgery). Because incisions are so small, most procedures are outpatient or require an overnight stay. Unless there is an injury to the bladder, most patients do not have a catheter when discharged from the hospital the next day.Most patients require 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 6-12 weeks to allow proper healing. This means no lifting of more than 8 pounds (weight of gallon of milk) in either hand, no vaginal penetrating intercourse for six weeks and no exercise other than walking or going up/down steps.
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 approximately 5-15% of women who have prolapse surgery. In failure cases, it is usually partial requiring no further treatment, a pessary, or surgery that is much less extensive. Patients who follow recommended restrictions have the best chance for permanent success.
If I have prolapse but don't leak urine, will I still need bladder testing?
Sometimes. If you are going to have surgery to correct prolapse, bladder testing (urodynamics) should be done first. That is because the prolapsed portion of your vagina may be pushing against the urethra, preventing urine loss. When the prolapse is corrected, the blockage is relieved and you may leak. The only way to tell if you are at risk for this is to perform urodynamics, typically with the prolapse in a reduced state. Women with prolapse may have other bladder problems: frequency, urgency and difficulty emptying—all of which should be known prior to any surgical intervention.
How will my prolapse treatment affect my sex life?
If you chose to use a pessary, your sex life should not 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 you refrain from penetrating intercourse for six weeks to allow for proper healing. After this period, getting used to having intercourse will take some time, but most report an improved sex life after surgery. When prolapse is severe, one surgical option is to close the vagina. It is a less invasive, outpatient procedure, typically reserved for older patients or patients who would not tolerate a major surgery because of medical problems. Intercourse is impossible after this procedure, so it is only appropriate for patients who are absolutely sure that they never want vaginal penetration for the rest of their life.
What made you want to treat incontinence?
Treating prolapse and incontinence is challenging and 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. It is rewarding to see patients back after successful treatment, because they are usually happier with an improved quality of life.