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FREQUENTLY ASKED QUESTIONS?
Urinary incontinence (or uncontrollable urine leakage) currently affects 30% of women beyond the age of 35 yet only 25-30% of these women seek care. Although much more commonly experienced by women, incontinence also can affect men. Although urinary
incontinence should never be considered normal, it is not a disease but a
symptom with many possible causes. Through a careful medical interview and
focused physical exam, Dr. Heit and Dr. Graham identify the specific type of
incontinence that requires treatment. They also may perform a urodynamics test,
especially if you are considering surgery to correct the problem. There are two common
types of urinary incontinence. Stress
incontinence is uncontrollable urine leakage that occurs when pressure is
placed on the bladder through activities such as laughing, lifting, coughing or
sneezing. Urge incontinence is uncontrollable urine leakage that occurs too quickly for a woman to reach the bathroom following an urge to urinate. Frequent urges to urinate and frequent nighttime waking to urinate are commonly associated with urge incontinence. Back to TopWhat are my options for treatment?There are a wide variety of non-surgical and surgical treatments for urinary incontinence. For example, pelvic floor exercises, devices that block the loss of urine, or surgery are all effective treatments for stress incontinence. Medications, biofeedback, or electrical stimulation to nerves that control the bladder also are commonly used to treat urge incontinence. A new treatment for urge incontinence involves placing an electrical stimulator similar to a pacemaker under the skin. For more information, click here on Treatment Options. Back to TopFor how long is surgery effective?The many surgical procedures available to treat urinary incontinence vary in their effectiveness. Although none of these procedures has a 100percent cure rate, research has shown that two basic kinds of procedures - retropubic urethropexy and the suburethral sling - should permanently cure 85 percent of stress incontinence cases. A new procedure using a suburethral sling made with tension-free vaginal tape can now be performed on an outpatient basis under local anesthesia. But patients should be aware of potential complications from any surgery for incontinence, including difficulty emptying the bladder and development of urge incontinence. Back to TopCan I prevent urinary incontinence from developing?Probably the best way to prevent stress incontinence is to perform pelvic muscle exercises, also called Kegels. Click here for Instructions for Performing Kegels. Until all the factors that cause urinary incontinence have been identified, however, it is difficult to recommend ways to prevent it. You might also try avoiding substances known to irritate the bladder. Click here for a recommended Bladder Diet. Back to TopWhat is Pelvic Organ Prolapse?When used to describe female organs, prolapse usually means bulging, sagging or falling from the normal position. Although it usually occurs over the course of many years, it can happen quickly. On average, 11 percent of affected women will have surgery to correct this condition. For explanations and diagrams of the various types of prolapse (such as cystocele, rectocele, uterine prolapse and enterocele) click here on Glossary. Back to TopWhat causes prolapse?
Many factors that appear to contribute to prolapse are beyond your control. Genetics, vaginal deliveries, obesity, pelvic tumors, chronic constipation and repeated heavy lifting are all conditions that seem to be associated with prolapse. Prior hysterectomy may also predispose you to prolapse of the vaginal vault and enterocele. Back to TopWhat are the symptoms of prolapse?If it develops over a number of years, symptoms can be subtle and can vary depending on the type of prolapse you have. You may experience pressure while standing for long time periods or be unable to wear a tampon. Most women don't seek treatment until they actually feel a protrusion from their vagina and an interference with bowel movements. Back to TopIs surgery the only
option for treatment?
Surgery is one option, but you may also choose to do nothing or wear a pessary. A pessary, similar to a diaphragm, can be used satisfactorily for years and comes in many different shapes and sizes to accommodate individual conditions and requirements. Back to TopWill a pessary cause
infection?
It is best to insert your pessary each morning and remove it for cleaning each night. Some women schedule an appointment at our office four to six times a years for an exam and pessary cleaning. Even with continuous wearing, however, vaginal infections from wearing a pessary are rare. Click here for diagrams of various Pessaries we use. Back to TopIf I ignore the problem will it get worse?In most cases, you may determine when it is time for treatment based on the symptoms you are experiencing. However, untreated pelvic organ prolapse almost always eventually worsens. Although rare, the urinary retention that can be caused by severe prolapse may lead to kidney infection and damage. At that point, treatment is necessary. Back to TopWhat can I expect of the surgical recovery period?Most patients stay in the hospital for one to three days, depending on the extent of the surgery. If you have difficulty urinating after the surgery, you will be sent home with a catheter in place to drain your bladder for anywhere from three to seven days. You will probably require prescription pain medication for a week or two following surgery, and we ask that you take it easy for 12 weeks to allow for proper healing. You should not lift more than eight pounds, refrain from intercourse, and limit your exercise to walking. Click here for more information about What to Expect After Surgery. Back to TopIf my surgery is successful, for how long will it be effective?Although no procedure is successful 100 percent of the time, our goal for continence or reconstructive surgery is to permanently solve the problem. Research shows that approximately 5-30 percent of prolapse surgeries will be unsuccessful. In most of these cases, use of a pessary, less extensive surgery, or no treatment at all will be required. If you carefully follow our post-operative instructions for 12 weeks following your procedure, you will have the best chance for permanent recovery. Back to TopIf I have prolapse but do not leak urine, is bladder testing still necessary?If you need to have surgery to correct the prolapse, bladder testing (or urodynamics) is necessary because the prolapsed portion of your vagina may be pushing on your urethra and blocking urine leakage. If so, correcting the prolapse may leave you with urinary incontinence. Urodynamics performed when holding the prolapse in its normal position will determine if you will need a continence procedure at the time of prolapse surgery. Back to TopWill prolapse treatment affect my sex life?With a pessary, your sex life probably will not change other than the time it takes to remove the device before intercourse. Following reconstructive surgery to correct prolapse, however, you should refrain from intercourse for three months to allow yourself to heal properly. Once you are fully recovered, return to normal sexual relations may be gradual, but the result is usually a sex life that is improved from before the surgery. When prolapse is severe, it may be determined that completely closing the vagina is the best surgical option. Less invasive than reconstructive surgery, this procedure (called colpocleisis or colpectomy) is useful for patients with severe medical conditions or patients who are sure they never want to be sexually active again. Back to Top |
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