F.A.Q.
:::.Frequently Asked Questions
.:::
FAQ
about
URINARY INCONTINENCE.
.:::
FAQ
about PELVIC
ORGAN PROLAPSE.
.::: Frequently asked Questions about URINARY INCONTINENCE:
.::: 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.
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.::: FAQ
about PELVIC ORGAN PROLAPSE
.:::
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.
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