Every year, 300,000 American women have an injury during vaginal childbirth that leads to incontinence and other pelvic floor disorders, including prolapse. But what do you really know about these disorders? Here are some of the most common questions that our Michigan Medicine urogynecologists answer about pelvic floor disorders:
What is urogynecology?
Urogynecology comes from two words – urology and gynecology. Urogynecologists specialize in both the urinary system and the female reproductive system. Urogynecology is a subspecialty of obstetrics and gynecology, and is the study and treatment of female pelvic medicine.
What is the Pelvic Floor?
The pelvic floor is composed of muscles and ligaments that form a sling across the opening of the pelvis. Muscles and ligaments work together in women to support pelvic organs such as the vagina, uterus, bladder and bowel. Pelvic floor disorders are caused by weakening support of the muscles, ligaments and connective tissue in the pelvic area.
What is incontinence?
Incontinence occurs when women have trouble controlling their urine (urinary incontinence) or their bowels (fecal incontinence). There are many possible causes of incontinence. The two most common forms of urinary incontinence are stress incontinence and urge incontinence.
Stress incontinence happens when something you do – such as coughing, laughing, sneezing jumping, lifting or exercising – increases the pressure in your abdomen enough that it pushes urine past the urethra. In other words, some external force pushes on the bladder and urine squirts out.
Urge incontinence happens when women are not able to wait until they empty their bladder. They find that "When I have to go, I have to go." This occurs because the normal ability to tell the bladder to wait until it is the right time is weakened. With incontinence, when a woman feels the need to empty her bladder, telling the bladder to wait simply doesn't work anymore.
What is urodynamic testing?
Urodynamic testing is a series of bladder tests that are done in order to observe how your lower urinary tract reacts under certain conditions. It is usually done to see if you have problems with loss of urine (urinary incontinence) or to figure out what type of incontinence you may have. Testing usually consists of filling your bladder with sterile water, then observing the pressure and how your bladder reacts under these conditions. When the test begins, the physician inserts a small soft catheter in your bladder and a tube is hooked up to a bag of sterile water. Your bladder is then filled to around 250 cc (approximately one cup), which most women can hold without needing to urinate. A second catheter, which is connected to a machine or computer, also is inserted. This catheter measures the pressures within your bladder. Once the bladder is filled, you will be asked to cough and strain in order to see how much urine you leak.
What treatment options are available for urinary incontinence?
Treatment options include habit training, prompted voiding, pelvic muscle rehabilitation (Kegel exercises), pessaries, medications and surgery.
What is Pelvic Organ Prolapse?
Prolapse is the bulging or dropping of the uterus, rectum or bladder into the vagina. There are several different types of pelvic organ prolapse and it is common to have more than one type at the same time. While prolapse is not considered a life threatening condition, it may cause a great deal of discomfort and distress. The various types are:
- Cystocele - when the bladder falls down into the vagina
- Uterine prolapse - when the womb drops down into the vagina
- Vaginal vault prolapse - when the vagina itself falls down
- Enterocele - when the small bowel pushes against the vagina causing a bulge
- Rectocele - when the rectum falls
What causes pelvic organ prolapse?
Many different factors may increase your risk of developing pelvic organ prolapse, such as number of vaginal deliveries, family history of prolapse, menopause, heavy lifting, obesity, chronic coughing from smoking, asthma or chronic bronchitis, neurologic diseases or ethnicity/race.
What are the symptoms of prolapse?
Physical symptoms include:
- Bulging or pressure from the vagina
- A sense that something is falling out
- Pelvic pressure
- Urine leakage, frequency, chronic urinary tract infections, difficulty urinating
- Difficult bowel movements or trapping of stool
- Lower backache
- Painful intercourse (dyspareunia) because of a bulge or protrusion
Women with pelvic organ prolapse can experience all, some or none of these symptoms.
Women with pelvic organ prolapse often feel alone, isolated and depressed. They may feel embarrassed by this condition and, because the condition is generally not discussed, do not seek treatment.
When should I contact a doctor?
- If you have any concern at all about any condition with your body
- If you feel a bulge or lump on the outside of your vagina
- If you have lower back pain or increased pelvic pressure that interferes with your daily activities
- If you have irregular vaginal spotting or bleeding
- If you experience frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the symptoms listed here that interfere with your daily routine
- If sexual intercourse is painful or difficult
How will I be evaluated?
When you see your doctor, you will have a health history taken in order to get a thorough explanation of your symptoms. A pelvic exam is necessary to diagnose pelvic organ prolapse. If you do have prolapse, the urogynecologist will determine which organs are involved and how severe the prolapse is. Other tests might be ordered, based on your individual examination.
What treatment options are available for prolapse?
Treatment options depend on the severity and discomfort of the prolapse. Three main choices exist for the treatment of prolapse:
- Do nothing if your prolapse is not bothersome
- Wear a pessary, a small plastic or silicone device placed inside the vagina to hold the organs inside your body
- Have surgery
Vaginal Surgeries: In general, vaginal-approach surgeries have a faster recovery time and cause less pain than abdominal surgeries.
Abdominal Surgeries: Abdominal-approach surgeries are performed through a larger abdominal incision, have a longer recovery time and generally cause more discomfort than vaginal surgeries. Sometimes, however, due to the patient's anatomy or other existing conditions, the only approach can be an abdominal one.
Robotic-assisted Laparoscopic Surgery: Robotically assisted laparoscopic surgery, with the daVinci Robot, is performed through several very small, one-centimeter incisions with the use of a video camera. The advantage of this approach is faster healing time and shorter hospital stays than with a more traditional abdominal approach.
Will treatment for prolapse affect my sex life?
If you choose to do nothing or wear a pessary, your sex life shouldn't change except you would have to remove the pessary prior to intercourse. If you choose to have surgery, you are asked to wait to have intercourse for a period of time, after which many patients report an improved sex life.
Where can I go to find out more information or get treatment?
The Division of Urogynecolgy in the Department of Obstetrics and Gynecology at the University of Michigan is committed to providing consultation services, comprehensive treatment planning and a broad range of services for patients with urinary incontinence, pelvic organ prolapse, fecal incontinence and other conditions associated with the pelvic floor. For further information, you can contact us at 734-763-6295.
What do I need to bring to my first visit?
Fill out the questionnaire sent to your home prior to your visit or fill out the questionnaire at your first appointment. This is a long questionnaire, but it asks important questions about your reproductive and general health and family history. This information will help us help you.
Please bring relevant and important medical records, radiology reports or laboratory reports. We ask that you do not send or fax records to our clinic. Please hand-carry all medical records to your first visit.
What can I expect at my first visit?
- The doctor will review your questionnaire and conduct a thorough history of your symptoms as well as some physical exams and tests
- Pelvic exam
- Evaluation of pelvic support
- Evaluation for loss of urine or stool
- Possible placement of a catheter in your bladder to check for the amount of urine left after you void (post-void residual)
- Neurological exam
- Evaluation of pelvic muscles
- Discussion with your physicians about your diagnosis and possible treatment options
- Make follow-up appointments or schedule surgery