.::: What is a Urogynecologist and Reconstructive Pelvic Surgeon?
He/she is a gynecologist with advanced fellowship training in the treatment of many benign bladder disorders like urinary leakage/incontinence, overactive bladder, painful bladder, voiding dysfunction, bed wetting, nocturia and pelvic organ prolapse (dropped bladder, uterus, vagina, or rectum). Urogynecologists spend several years focusing only on these disorders.
.::: When should I see a Urogynecologist?
If you have symptoms consistent with stress urinary incontinence (leakage with standing, walking, coughing, sneezing, or laughing), overactive bladder (urinary frequency, nocturia, urgency, urge incontinence, or enuresis), painful bladder (pain above the pubic bone), voiding dysfunction (difficulty passing urine), or pelvic organ prolapse (the presence or feeling of something falling out of the vagina) or if you have sexual dysfunction secondary to prolapse or weakness in the pelvic floor, you should see urogynecologist.
.::: 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. Urinary incontinence (leakage of urine) affects at least 10-20% of women under the age of 65 and up to 56% of women over the age of 65. While incontinence also affects men, it occurs much more commonly in women.
.::: Does treatment always involve surgery?
No, Therapy almost always begins with the most conservative, non-invasive methods prior to a consideration of surgery.
.::: How long will my surgery last?
It depends on the type of surgery. Most prolapse surgeries last between 45 minutes to two hours. Incontinence Surgery usually takes shorter time 30 minutes to one hour.
.::: Will I need a catheter after surgery?
Some anti-incontinence procedures require catheterization after the surgery for few hours. Almost always you will be discharged from the hospital without catheter.
.::: How long will I be in the hospital if I have surgery?
It depends on the surgical approach. Vaginal procedures (through the vagina) may require a hospital stay ranging from few hours to three days after surgery. Abdominal procedures (through an abdominal incision) may require a hospital stay ranging from twelve hours to four days after surgery. Laparoscopic procedures require a hospital stay of few hours to two days.
.::: 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”(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 under local anesthesia. No surgery, however, should be taken lightly. Some potential complications of surgery for incontinence include difficulty emptying the bladder and development of urge 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. Click here to see Pelvic Floor Exercise Another easy thing to try on your own is to avoid eating or drinking things known to irritate the bladder. Click here to see fluid and dietary modification.
.::: What does “prolapse” mean?
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. Click here to see Definitions and pictures of the various types of Pelvic Organ Prolapse.
.::: 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. Click here to see what problems does prolapse cause??
.::: 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.
.::: Do I need to have surgery for my prolapse?
No, there are two other choices – to 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. Click here to read more and see different types of pessaries. Many women, especially, old age are completely satisfied using a pessary for years – avoiding surgery all together.
.::: Are pessaries safe? Is vaginal infection common with pessaries?
Pessaries in general are safe. Following placement, the fit is checked and the surrounding tissue is examined periodically to ensure safety. Patient should be taught how to remove, clean and reinsert the pessary. 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.
.::: If I just ignore the prolapse, what will happen? 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 most 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 four days. Usually, bladder catheter and vaginal pack will stay for one day. Simple pain killer will be needed for one to two weeks after surgery. No lifting more than 8 pounds (the weight of a gallon of milk), no intercourse, and no exercise other than walking for 6 weeks after surgery.
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 for 6 weeks after surgery give themselves the best chance for permanent success.
.::: Do I still need bladder testing (Urodynamics) if I have prolapse, but I don’t leak urine?
Yes, if you are going to have surgery to correct the prolapse, bladder testing (called urodynamics) must be done first. That’s because the prolapsed portion of your vagina may be pushing on your urethra and preventing urine leakage (occult incontinence). 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.
.::: Does 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 6 weeks after your operation to allow proper healing. After waiting 6 weeks, getting used to having intercourse will take some time, but most patients report an improved sex life afterwards.
.::: Why you are 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.