Pelvic Organ Prolapse / Urinary Incontinence

Uterovaginal Prolapse

Uterovaginal prolapse is the prolapse, or descent, of the uterus into the vagina. There are four stages of uterovaginal prolapse, ranging from the uterus drooping into the upper part of the vagina to the entire uterus protruding outside the vagina. Pelvic organ prolapse happens due to the damage to supporting structures that occurs naturally during childbirth and aging.

Types of Prolapse:

  • Uterine prolapse – the descent of the uterus into the vagina
  • Vaginal vault – top of the vagina protrudes out
  • Cystocele – the bladder descends into the vagina
  • Urethrocele – prolapse of the urethra
  • Enterocele – prolapse of the small intestine
  • Rectocele – prolapse of the rectum

Many women have no symptoms, but others may feel a variety of symptoms. These include:

  • Heaviness
  • A bulge in vagina
  • Lower back pain
  • Urinary incontinence
  • Difficulty with bowel movement
  • Difficulty with intercourse
  • Pelvic pressure that worsens with walking, coughing, or lifting.

Pessary Treatment

Pessary treatment uses a diaphragm-like device in the vagina to support the bladder, rectum, uterus, and vagina. They are available in a variety of sizes and are designed to treat specific patients. There are a variety of pessaries used for treatment of prolapse at different stages. These include

  • Ring pessary
  • Cube pessary
  • Donut pessary
  • Hodge pessary
  • Gelhorn pessary

Our providers are well versed in using all of these as necessary in order to best treat your individual case.

For more information on the types of pessaries, feel free to browse this page from the Mayo Clinic: http://www.mayoclinic.org/diseases-conditions/urinary-incontinence/multimedia/pessary-use/img-20006056.

Surgeries for Vaginal Prolapse

There are numerous surgical options available for treating a vaginal prolapse. They include:

  • Vaginal Hysterectomy: removes the uterus, cervix, ovaries, and fallopian tubes.
  • Anterior Colporrhaphy: reinforces the support between the bladder and vagina. It is used to fix a cystocele.
  • Posterior Colporrhaphy: similar to an anterior colporrhaphy, but is used to reinforce support between the vagina and rectum to fix a rectocele.
  • Sacrospinous Fixation: attaches the top of a prolapsed vagina (vaginal vault) to a pelvis ligament.
  • Sacrocolpopexy: attaches the top of a prolapsed vagina to the sacrum with synthetic or natural materials.

Urinary Incontinence

Urinary incontinence is the leakage of urine from the bladder. There are two types of incontinence:

  • Stress incontinence: the involuntary loss of urine during activities that put “stress” on the bladder (laughing, sneezing, coughing, etc.)
  • Urge incontinence: the involuntary loss of urine following a sudden, strong urge to urinate.
  • Mixed incontinence: A woman has symptoms of both stress and urge incontinence.

An assessment from your doctor will help determine which type of incontinence is causing your problem. A voiding diary or daily log of urination may be requested by your physician for evaluating your incontinence.

In-Office Urodynamic Testing and Cystoscopy

We offer a solution for incontinence called Urodynamic Testing. Urodynamic tests use measurements to evaluate the bladder’s function and efficiency. During the test, a small catheter is inserted into the bladder to evaluate lower urinary tract function (bladder and urethra), including storing and emptying urine. These procedures are performed in the office and vary depending on the circumstances of each patient.

Cystoscopy is a diagnostic procedure used to view the urethra and bladder with a small lighted scope. The procedure detects:

  • Inflammation
  • Stones
  • Tumors in the bladder
  • Other issues relate to incontinence

In addition to the procedures listed above, there are other treatment options available for treating urinary incontinence, including medications, losing weight, stoping smoking, Kegel exercises, physical therapy, electrical stimulation, and urethral bulking, many of which are attempted prior to opting for surgery such as sling (TVT).

If you experience urinary incontinence or you believe you are at risk for developing a problem, we can help. Contact us for more information about surgery and other options for treating urinary incontinence.