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Urinary Incontinence:
How common is urinary incontinence among women?
Many women assume that urine leakage is normal part of aging. Although common, it should never be considered normal. A frequently quoted study estimates that 11 million American women currently suffer from urinary incontinence. This estimate, however, may be low. Researchers funded by the National Institute on Aging studied 2800 postmenopausal women and found that 56% of these women experienced urinary incontinence at least weekly.
What causes urinary incontinence?
Urinary incontinence is a not a disease, but a symptom, with many possible causes. These causes define and group incontinence into different types. Information from a carefully taken medical interview and from a thorough physical exam, can help a physician determine the patient's specific type(s) of incontinence. Special testing called urodynamic testing may also be necessary to diagnose the problem. Two common types of urinary incontinence are stress incontinence and urge incontinence. CLICK HERE for more information on urodynamic testing.
Stress incontinence is urine leakage that happens during activities that cause pressure (or "stress") on the bladder such as laughing, lifting, coughing, or sneezing. CLICK HERE for more information about stress incontinence.
Urge incontinence is urine leakage that occurs before a woman has a chance to reach the bathroom in response to an urge to urinate. Women with this type of incontinence may also experience frequent nighttime waking to urinate. CLICK HERE for more information about urge incontinence.
What treatment options are available?
Stress incontinence can 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. One new form of nerve stimulation treatment, called neuromodulation, involves placing an electrical stimulator (similar to a pacemaker) under the skin. Fortunately, a wide variety of non-surgical and surgical treatment options are available for all types of urinary incontinence.
CLICK HERE for more information about biofeedback.
CLICK HERE for more information about pelvic floor stimulation.
I've heard that surgical repairs may not last. Is that true?
When treating stress incontinence, not all surgical procedures are created equal. Over the years, many different surgeries that correct incontinence have been developed, and some are more effective than others. Researchers have identified two effective types of surgical procedures: the retropubic urethropexy and the suburethral sling. No surgery for incontinence has a 100% cure rate, but either the retropubic urethropexy or suburethral sling may permanently cure 85-95% of women with stress incontinence. A new modification of the suburethral sling procedure, known as tension-free vaginal tape (TVT), can be performed on an outpatient basis and under local anesthesia. No surgery, however, should be taken lightly. Potential complications of surgery to correct incontinence include difficulty emptying the bladder and development of urge incontinence.
How can I prevent urinary incontinence?
We don't fully understand all the factors that cause urinary incontinence, therefore recommending ways to prevent the problem is difficult. Pelvic floor exercises - also known as Kegel exercises - are probably the best way to prevent stress incontinence. Because certain foods and fluids can irritate the bladder, often causing or aggravating incontinence, patients can avoid eating or drinking things known to irritate the bladder.
CLICK HERE for more information about pelvic muscle exercises.
CLICK HERE for more information about dietary irritants.
Pelvic Organ Prolapse:
What does "prolapse" mean?
The word prolapse simply means downward displacement from the normal position. When used to describe the female organs, it usually means bulging, sagging, or falling. It can occur quickly, but typically progresses over many years. Different organs can prolapse individually or together.
CLICK HERE for more information about pelvic organ prolapse.
What symptoms does prolapse cause?
The symptoms depend on which organ has prolapsed. Because prolapse typically progresses slowly, the symptoms may be hard to recognize. Most women don't seek treatment until they actually feel something protruding outside of their vagina. The first signs may be subtle - such as pain during intercourse or an inability to keep a tampon inside the vagina. As the prolapse worsens, some women complain of a bulging or heavy sensation in the vagina that intensifies by the end of the day or during bowel movements. A woman with severe prolapse may need to place her finger into the vagina to push stool out of the rectum during defecation.
Why did this happen to me? Did I do something to cause this problem?
Many factors contribute to pelvic organ prolapse, but only a few of these factors can be controlled. Genetics definitely plays a major role. Vaginal deliveries can place certain women at risk to develop prolapse, but we haven't learned how to identify these women before they have children. Other conditions associated with the pelvic organ prolapse include severe obesity, pelvic tumors, and chronic constipation. Repetitive lifting of heavy objects may also contribute to prolapse.
Do I need to have surgery for my prolapse?
No. Women may choose no medical therapy, especially if the prolapse is minimal, or may choose to use a pessary. A pessary is a device worn in the vagina similarly to a diaphragm. Designed in many different shapes and sizes, pessaries lift and support prolapsed pelvic organs. Many women are completely satisfied using a pessary - avoiding surgery altogether. CLICK HERE for more information about pessaries.
If I choose to wear 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 to take it out for cleaning each night. When this is not possible, women should go to their physician's office 4 to 6 times a year for an exam and pessary cleaning. Even if a pessary is worn almost continuously, vaginal infections are rare.
CLICK HERE for more information about pessaries.
What will happen if I ignore this problem? Will it worsen?
Pelvic organ prolapse may not occur quickly, but if left untreated, typically worsens with time. The choice of treatment should be based on the impact of symptoms on the patient's health and activities. In rare cases, severe prolapse can cause urine to be retained in the bladder and the kidneys, leading to kidney damage or infection. In this situation, treatment is necessary. In most other cases though, patients can decide, based on symptoms, when their prolapse should be treated.
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 1 to 4 days. Many women have difficulty urinating immediately after surgery and have to go home with a catheter in place to drain the bladder. To avoid wearing a catheter, some women may learn to catheterize themselves. These catheters are usually necessary for only 3 to 7 days. Most patients require at least some prescription strength pain medicine for 1 to 2 weeks after surgery. Following any surgery to correct urinary incontinence or prolapse, we ask that patients lighten their activities for 12 weeks to allow proper healing. This means no lifting of objects weighing more than 8 pounds (the weight of a gallon of milk), no intercourse, and no exercise other than walking.
CLICK HERE for more information about preparing for surgery.
CLICK HERE for more information about recovery after surgery.
How long will my surgical repair remain effective?
The goal of continence surgery or pelvic reconstructive surgery is to recreate normal anatomy that will remain permanently. None of these procedures, however, has a 100% success rate. According to medical studies, failures occur in 5% to 15% of women who have surgery to correct prolapse. In many cases, only a partial failure occurs, requiring no treatment, pessary use, or surgery that is less extensive than the original surgery. Patients who follow our recommended restrictions for 12 weeks after surgery give themselves the best chance for permanent success.
I have prolapse, but I don't leak urine. Do I still need bladder testing?
Yes. If you plan to have surgery to correct prolapse, bladder testing called urodynamics testing must be done first. In some patients, the prolapsed portion of the vagina may be pushing on and closing the urethra, preventing urine leakage. In this situation, surgery that corrects the prolapse and lifts pressure off the urethra may create a new problem - urinary incontinence. Urodynamic testing is the only way to determine whether a continence procedure is needed in addition to the surgery to correct prolapse.
CLICK HERE for more information about urodynamic testsing.
How will treatment of my pelvic organ prolapse affect my sex life?
If patients choose to use a pessary, their sex life shouldn't change, except that the pessary usually needs to be removed prior to intercourse. If patients have reconstructive surgery to correct prolapse, we recommend that they refrain from intercourse for 3 months after their operation to allow proper healing. After waiting three months, adjusting to 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 and is 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.
General Knowledge:
How did you ever get interested in this field?
Treating prolapse and incontinence is challenging and rewarding. Every patient has a unique set of problems 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 happy with their improved quality of life after successful treatment. We also enjoy the challenge of improving patient care through medical research. Since our specialty is relatively new, many questions still need to be answered through research studies.
CLICK HERE for information about our staff.
How can I keep my bladder healthy?
The following bladder facts and tips may help patients maintain a healthy bladder:
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The average person should urinate 6-8 times per day.
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Individuals should drink 6-8 glasses of water daily.
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There should be 2-5 hours between trips to the bathroom.
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Individuals should not awaken during the night to urinate more than 2 times.
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Individuals should not avoid drinking fluids out of fear of an accident.
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The amount of urine should not be a "dribble". Individuals should be able to count to 10 from the beginning to the end of urination.
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Avoid acidic foods. CLICK HERE for more information about dietary irritants.
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Relax, don't strain to empty your bladder.
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Reduce or eliminate smoking, as nicotine can irritate the bladder.
Gynecology and Fertility Clinic
Aston Ambulatory Care Building
5303 Harry Hines Blvd., Fifth Floor, Room U5.104
Dallas, Texas 75390-8865
For a complete list of phone numbers CLICK HERE
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