What Every Woman Should Know About Pelvic Organ Prolapse & Urinary Incontinence

By, Felicia Rhaney, MD

Urogynecologist & Pelvic Reconstructive Surgeon

Approximately 17 million women in the United States cope with urinary incontinence and more than 30 million women suffer from prolapse. For many women, their quality of life has been adversely affected by these conditions. Consider these statistics:

  • Between the ages of 18 and 44, approximately 1 out of 4 women experience incontinence.
  • For women over age 45, 1 out of 3 women deal with incontinence
  • Out of 2 women over the age of 45 suffers from some form of prolapse Although no one talks about it much, pelvic organ prolapse and urinary incontinence are common problems experienced by many women which can often be easily treated.

Ask yourself the following questions:

  • Do you ever experience urine leakage while laughing, sneezing, jumping or performing other movements?
  • Do you have trouble holding your urine as you hurry to the bathroom?
  • Do you currently wear pads or liners to protect again unplanned leaks?
  • When planning a trip, outing or event, does the availability or location of a restroom affect your decision?
  • Have you ever felt a bulge or lump in your vagina?
  • Do you feel like something is falling out of your vagina – almost as if a tampon is sliding out of place?
  • Is intercourse uncomfortable or even painful?
  • Do you have a delayed of slowed urine stream?
  • Do you experience frequent lower back pain?
  • Do you have difficulty with bowel movements?

Answering yes to any of these questions could be an indication that you are suffering from some form of vaginal prolapse or experiencing incontinence. What a relief to know that these conditions are treatable and there are now a number of conservative and minimally invasive, outpatient treatment options available.

WHAT IS PELVIC ORGAN PROLAPSE

Your pelvis is the area between your hip bones in the lower part of your abdomen which encloses your vagina, uterus, bladder, urethra, and rectum. These organs are held in place by muscles, ligaments, and connective tissues. These support tissues can stretch or tear, causing the organs to drop lower in the pelvis. Factors such as childbirth, menopause, obesity, and normal aging may contribute to this process.

Risk Factors for Pelvic Organ Prolapse

  • Neuromuscular damage that occurs during vaginal delivery
  • Factors associated with increased intra-abdominal pressure resulting from pregnancy, obesity, chronic coughing, constipation, or heavy lifting
  • Estrogen deficiency associated with menopause
  • Genetic predisposition due to connective tissue weakness
  • Parity (particularly vaginal birth)
  • Prior pelvic surgery

Symptoms of Pelvic Organ Prolapse

Women with prolapse will often describe feeling a bulge or sense of heaviness or the sensation that something has "fallen" in the pelvic area. Other common symptoms include:

  • Palpable bulge in the vagina
  • Perception of something "falling out"
  • Pelvic pressure, lower back pain
  • Urinary incontinence
  • Urinary retention
  • Spontaneous improvement of urinary incontinence
  • Sexual dysfunction
  • Difficult evacuation of the rectum, splinting

Treatment of Pelvic Organ Prolapse

Prolapse can be effectively treated with non-surgical and minimally invasive surgical methods. Conservative, non-surgical treatment options consist of

  • Pelvic floor muscle exercises
  • Biofeedback
  • Space-occupying devices (e.g. pessaries)
  • Behavioral medication (avoidance of heavy lifting, maintenance of a healthy weight, avoidance of chronic coughing and constipation)

When surgery is necessary, it is often possible to perform the surgery through a short procedure involving a single vaginal incision.

WHAT IS URINARY INCONTINENCE

Urinary incontinence involves the involuntary loss of urine from the bladder and affects 17 million people in the United States. For most women affected, it is an embarrassing condition that decreases their overall quality of life. There are five types of urinary incontinence and these can result from permanent or temporary conditions. Fortunately, most of these conditions can be treated

Types of Urinary Incontinence

Stress Incontinence – Loss of urine associated with running, coughing, sneezing, laughing, exercising, and other activities that require exertion. It is the most common type of urinary incontinence occurring in women.

Urge Incontinence (Overactive Bladder) – begins with a sudden strong need to urinary, following by bladder contraction, and involuntary loss of urine.

Overflow Incontinence – occurs when the bladder is full to capacity and is unable to empty completely. Patients usually describe having a weak urinary stream and dribbling.

Functional Incontinence – patients have normal bladder control but cannot always get to the toilet in time due to physical or mental limitations that interfere with normal toilet use.

Mixed Urinary Incontinence – is a combination of different types of urinary incontinence.

Temporary Causes of Urinary Incontinence

Some of the causes of incontinence are the result of temporary conditions. Once the condition is treated, the incontinence usually resolves. Temporary causes include:

  • Constipation
  • Excessive fluid intake
  • Certain medications (such as diuretics, muscle relaxants, sedatives, antidepressants, pain medications, and certain blood pressure medications)
  • Urinary tract infections
  • Pregnancy and childbirth
  • Poorly controlled diabetes
  • Menopause
  • Increased dietary intake of caffeine, carbonated beverages, alcohol, and artificial sweeteners

Long-Term Causes of Urinary Incontinence

Other causes of incontinence may not temporary. However, treatment is still available for many of these conditions. Long-term urinary incontinence may result from conditions such as:

  • Weakness of the bladder muscles or sphincter muscles surrounding the urethra
  • Neurologic disorders such as Alzheimer's disease, Parkinson's Disease, Multiple Sclerosis
  • Nerve damage following pelvic radiation
  • Overactive or under active bladder muscles

Treatment of Urinary Incontinence

Urinary incontinence can often be easily managed with medication, behavioral and dietary modification, pelvic floor physiotherapy, and minimally invasive surgery. Pelvic organ prolapse and urinary incontinence are both common conditions affecting women that can easily be treated. The first step to treatment is to acknowledge the problem followed by seeking out a physician specially trained in the treatment of pelvic floor disorders, such as an Urogynecologist. Although an Obstetrician/Gynecologist may have knowledge about these conditions, an Urogynecologoist can offer additional help by combining his/her knowledge of treating disorders of the female reproductive system with expertise in managing disorders of the urinary tract, bowel, and pelvic support.

 

Felicia Rhaney, MD
Urogynecologist & Pelvic Reconstructive Surgeon
404-845-2530, ext. 4852

 

 
 
 
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