Incontinence and Prolapse Treatment
GYN LA is a Los Angeles-based gynecological clinic that specializes in all areas of reproductive health for women. This includes incontinence and prolapse treatment, which can be complex and confusing to treat. There are various treatment tools that can work, including non-surgical options for less severe cases. We are innovative and compassionate in our work and will work with you to find the best treatment plan for your needs. Our staff is ready to help you today.
What is Incontinence?
Incontinence is the condition of losing control of one’s bladder. There are varying degrees of severity which can result in everything from a mild annoyance in a patient’s life to being entirely debilitating. There are also various types of incontinence. These include stress incontinence, which is a chronic and persistent leakage of urine, particularly when the patient sneezes, coughs, or exerts some kind of pressure or strenuous activity on their body. Another type is urge incontinence, whereby the urge of having to urinate is so sudden and strong that the patient is unable to make it to a toilet in time. Finally, there is overflow incontinence, in which a patient’s bladder is never entirely voided during urination and the patient experiences a constant dribbling of urine.
Urinary incontinence is not actually a disease itself, but is rather a symptom of a larger, underlying medical problem. It is caused by the urinary sphincter being damaged or weakened, resulting in a loss of control in the muscles that control the bladder. These muscles are also known as pelvic floor muscles, and are part of the musculature and system of tissues that hold the various organs of a woman’s reproductive system in place. General reproductive health and overall bladder function are both entirely dependent on the strength of the pelvic floor muscles.
There are various possible reasons that the pelvic floor muscles can be damaged or weakened, thereby causing cases of incontinence, including:
- Pregnancy and/or childbirth
- Pelvic prolapse
- Hormonal changes (such as menopause)
Urinary incontinence is a fairly common condition. Approximately one-third of all Americans will suffer from it at some point in time in their lives. However, it is far more common in women than men. In women between the ages of 30-60, approximately 30% of them will suffer from the condition as compared to less than 5% of men. Because it occurs more frequently in women, there are various gynecological treatment modalities that were developed specifically for treating women. These may include behavioral modifications (such as diet or exercise), medications, temporary implantation of a device, and/or surgical procedures.
How do you Treat Incontinence?
Some of the conditions that cause urinary incontinence are temporary, such as pregnancy, childbirth, or menopause. These can usually be treated with behavioral modifications or training techniques. These techniques may include doing what are known as Kegel exercises, which strengthen the pelvic floor muscles that are responsible for sphincter control. Kegel exercises can be highly effective in treating both stress and urge incontinence. They are done by tightening the sphincter muscles and holding off the urge to urinate for a few seconds at a time. As the patient becomes stronger, these Kegel contractions can then be done in longer increments of time, even up to several minutes. These contractions will build muscle tone in the pelvic floor muscles as well as the sphincter, thereby improving bladder function and decreasing instances of incontinence.
Furthermore, overall physical fitness and healthy weight management also help control bladder function. Obesity is a major contributing factor to incontinence so good cardiovascular health and a healthy body weight can be crucial in treating the condition. Another behavioral treatment is limiting the intake of diuretic fluids, like caffeine or alcohol, as these can make it difficult for a patient to properly control their urination when their bladder function is already compromised.
There are also various medications that can be used to treat incontinence, including anticholinergics that control an overactive bladder, muscle relaxants that allow the bladder to hold more urine for longer periods of time, and topical estrogen that help restore healthy hormone levels in women. However, if behavioral treatments or medications are insufficient to treat the urinary incontinence, then implantation techniques can also be used. A urethral insert is a device that can be inserted before strenuous activity to avoid instances of urine leakage caused by stress incontinence. It is essentially a tampon for the urethra; it is disposable and inserted by the patient on an as-needed basis.
These treatment modalities are effective only if the underlying reason for the urinary incontinence is largely temporary. If the case of incontinence is severe enough, and the underlying condition is permanent without treatment, then surgical procedures are usually required. These may include the insertion of a vaginal pessary, a ring of stiff plastic that acts as a support structure for the organs of the reproductive system in women. A vaginal pessary is a commonly used tool in a variety of gynecological procedures and its implantation is a very safe and non-invasive procedure. In cases of incontinence treatment, the pessary specifically holds the bladder up, thereby keeping the urine it contains from leaking out of the urethra.
Another device known as a sling may also be installed. The sling can be made up of issue taken from elsewhere in the patient’s body or a piece of plastic mesh. This plastic mesh is stiff but has a certain degree of flexibility, allowing it to provide proper support while still allowing the patient to have a full range of motion once the post-operative recovery process has been completed. The surgeon makes one small incision inside the vagina and another small incision just above the vagina, usually near the abdomen and just above the pubic hair line. The sling is hung around what is known as the bladder neck, which is an area of bulky muscle that connects the bladder to the urethra and is a crucial component in healthy functioning of pelvic floor muscles. The other end of the sling is attached to strong tissues in the lower abdomen, thereby allowing it to act as a synthetic support structure that decreases pressure on the sphincter and improves bladder control.
Both of these surgical procedures treat incontinence as well as another medical condition known as pelvic prolapse, which is a common underlying reason for urinary incontinence in women. A pelvic prolapse will cause cases of incontinence that are severe and permanent unless it is treated with surgical intervention. Urinary incontinence and pelvic prolapse are closely related as the same pelvic floor muscles that control both the sphincter and bladder also hold up the entire female reproductive system in its proper placement within the abdomen. Therefore, if there is damage or weakening to pelvic floor muscles, then pelvic prolapse may occur and in turn cause urinary incontinence.
What is a Pelvic Prolapse?
A pelvic prolapse is when the muscles, tissues, and ligaments supporting the various internal organs of the pelvis, including the bladder, uterus, and rectum, become weak and fail. This means that either one or even all of the organs can start to drop into or even press forward out of the vagina. In the most severe cases, the organs will emerge almost entirely out of the woman’s vagina. The uterus and reproductive system are also held in place by ligaments and musculature. These may become damaged or weakened due to:
- Having given birth to multiple children.
- Vaginal birth of a large baby (without a cesarean procedure).
- A prolonged labor with complications or difficulties.
- Lower estrogen levels following menopause as changes in hormone levels affect visceral musculature and tissue health.
- Frequent heavy lifting or chronic coughs that may cause herniated tissue.
- Morbid obesity or having a high Body Mass Index (BMI) as excessive weight and pressure on joints and ligaments may cause accelerated wear and tear.
- Auto-immune disorders such as lupus, whereby the patient’s immune system attacks its own ligaments and internal tissues, thereby causing damage and decreased function.
The prolapse of pelvic organs or uterus may vary in severity, from a partial displacement of internal organs within the abdominal cavity to “complete procidentia”, whereby the entire uterus, vaginal canal, bladder, and bowels may prolapse out of the body via the vagina. These are also known as incomplete uterine prolapse and complete uterine prolapse. There are 4 degrees of prolapse, in order from least to most severe with first being the least severe and fourth being the most severe. The first through third degree prolapses may spontaneously resolve. They may also respond to non-surgical treatments, including avoidance of heavy lifting, and exercises that strengthen the pelvic floor, such as Kegels.
Furthermore, the less severe forms of prolapse may be asymptomatic, meaning they do not show any symptoms. However, as the prolapse becomes more pronounced and more parts of the reproductive system slip out of place, the symptoms may become more severe. They include:
- Increased bleeding or vaginal discharge.
- Decreased function of the bowels, including severe constipation and gastrointestinal distress.
- Decreased function of the bladder, including both urinary leakage and incontinence.
- A body image that has been negatively affected or dissatisfaction with one’s body image.
- Increased pressure/discomfort in the abdomen or pelvis.
- A feeling of heaviness or pulling in the pelvis.
- A decrease in sexual function or satisfaction.
- Pain in the lower back.
The symptoms of a prolapse generally become more pronounced based on what degree of prolapse has occurred. Therefore, a first-degree prolapse will have minimal symptoms and effect on the patient’s life whereas a fourth-degree prolapse can have disastrous consequences.
How do you Treat a Prolapse?
In order to properly understand pelvic prolapse and the treatment modalities available to the patient, it is crucial to remember just where the pelvis and reproductive system are in relation to the other organs of the patient’s body. They are located in the lower abdomen, just below the digestive system of the stomach and small intestine as well as just above the vagina and pubis. If you go directly backwards from the pelvis, you will hit the lower spine and back. There is a triangular bone, known as the sacrum that is made up of two vertebrae that have fused together. The sacrum is located between the two hipbones and is the basis for the name of the surgery used to treat cervical or vaginal prolapse: sacrocolpopexy.
Sacrocolpopexy is the term used for the type of surgery needed to repair pelvic organ prolapse. It is most frequently used specifically in women who have had a hysterectomy and have had a prolapse as a side effect. Hysterectomies are the most common kinds of gynecological procedures and are carried out on nearly 30% of all women younger than the age of 60. A hysterectomy can be performed for a variety of reasons, including serious conditions like cancer or various medical dysfunctions of the uterus or reproductive system, though frequently patients undergo the procedure because of pelvic or vaginal organ prolapse. However, there is contradictory and poorly understood evidence that a prolapse may actually be a side effect of the hysterectomy. Essentially the medical community is not yet certain if hysterectomies cause prolapse or vice-versa.
An abdominal sacrocolpopexy is an open surgery that may perform several vital actions to restore the structural integrity of the pelvic organs and reverse any partial or complete prolapses that may occur. Firstly, the prolapsed and displaced uterus or vagina can be connected to the sacrum via a medical-grade polypropylene plastic known as the “mesh”. The sacrum, in this case, essentially acts as an anchor or stabilizer for the prolapsed uterus and provides a measure of stability as it is a bone. A sling may also be installed, holding up the vaginal canal by using the pubis as a support structure, or a plastic ring known as a vaginal pessary may be surgically implanted to provide support in the case of a cervical prolapse. Paravaginal sutures may also be sewn in. An abdominal sacrocolpopexy is performed via an abdominal incision that is anywhere from 15 to 30 centimeters long.
How is a Prolapsed Bladder Repaired?
The bladder is a hollow organ in the pelvis that is part of the urinary tract. It stores urine that has been sent from the kidneys until it becomes full and signals to the body that it is time to excrete the urine (the process of urination). In women, one wall of the bladder is supported by the front wall of the vagina. However, during menopause a woman’s estrogen levels drop precipitously and following a hysterectomy they can disappear entirely. Estrogen is the hormone responsible for keeping the muscles in those vaginal walls strong. Consequently, prolapsed bladders are frequently related to menopause in women.
A prolapsed bladder has the same four degrees of severity as any other organ in a pelvic prolapse. If the bladder is the only organ that has prolapsed, then the patient will most certainly notice the telltale signs of bladder prolapse: decreased function of the organ, primarily through urinary leakage and incontinence. They may also notice a sensation that the bladder is never really empty immediately after urination and that they experience sharp pain during intercourse. A prolapsed bladder is also referred to as cystoceles or fallen bladders.
Because a prolapsed bladder is generally associated with a vaginal and/or cervical prolapse in a women who is either post-menopausal and/or having undergone a hysterectomy. Both are contributing factors to various organs prolapsing, all of which primarily occur because the musculature and ligature have deteriorated due to a variety of reasons. Therefore, treating a prolapsed bladder is in some ways related to treating a vaginal prolapse.
During a sacrocolpopexy, the part of the vagina that has prolapsed will be lifted back up via the installation of a sling. The sling is anchored to the pubis bone for rigid support. The prolapse of the bladder in women is primarily linked to structural failure of the front wall of the vagina. This means that repairing a bladder prolapse largely relies on securing the vagina in to its proper place within the pelvis. However, if a cervical prolapse has occurred in addition to the vaginal prolapse, then a high-grade plastic support ring called a vaginal pessary may be inserted, non-surgically, into the vagina. Vaginal measurements must be taken to determine the proper dimensions of the pessary. The installation of this ring will act as a de facto support structure for the cervix and vagina, which in turn will support the bladder.
How is a Prolapsed Uterus Treated?
Because the prolapse of all these various pelvic organs are due to the same factors of failing musculature and ligature (though the underlying reasons may differ), the treatment options for the various prolapses all consist of some form or another of installation of some kind of support structure. Furthermore, generally when one organ prolapses the others follow soon after. This is because all the organs and structures within the pelvis are interconnected.
In the case of a prolapsed uterus specifically, it depends on the specifics of the medical case. Some variation of the aforementioned procedures could be used. Or the installation of medical-grade plastic mesh, which is sutured to the various prolapsed organs, can also be used. The mesh is an incredibly high quality, durable polypropylene plastic that will provide significant strength and support without deteriorating within the body. This polypropylene plastic is made up of two strips that are identical in size and dimensions. Much like the insertion of the pessary, precise measurements have to be taken to create a custom mesh that is suitable for the particular needs of the patient. This is because pelvic prolapses are complicated medical events with a variety of moving parts. One of the two mesh strips is sewn in from the vagina to the bladder, thereby arresting the prolapse of both organs. The second plastic mesh strip is attached between the rectum and vagina, thereby halting not just the prolapse of the vagina but also the uterus as a whole.
In order to give the mesh the strength, stability, and durability necessary for the procedure, it is also attached to the bone known as the sacrum. This is where the term sacrocolpopexy comes from. In this case the sacrum acts as a powerful support structure for the various prolapsed organs. The mesh now provides a higher level of stability than any other surgical treatment as it is attached to the sacrum bone. This plastic mesh acts the same way that the body’s natural ligaments, tissues, and muscles. They provide a scaffolding support structure for the pelvic organs. Pelvic prolapse happens when the natural support structures are damaged or weakened through any variety of causes, including disease, age, menopause, and other surgical procedures.
Can Pelvic Floor Exercises Cure Prolapse?
Pelvic floor exercises, alternately known as Kegels, are a suitable way to strengthen pelvic muscles. Because prolapse occurs due to weakening of muscles, then it does show some promise as a primarily preventative measure. Furthermore, it can only really be used if the degree of prolapse is the first through third degree; if it is more severe than that, then virtually no non-surgical intervention will be successful.
If Kegels are not working for a patient, they may also undergo physical therapy as well as biofeedback and electrical stimulation. Sensors are used to determine the strength of various muscles in biofeedback treatments, giving patients the knowledge of which muscles to target. In the electrical stimulation treatment, electrodes are attached to various muscles to cause contractions that will in turn create stronger muscles.
Contact an Incontinence and Prolapse Treatment Doctor Near Me
Because each medical case of prolapse can be complex and multi-faceted, GYN LA is the ideal gynecological clinic for your needs. We are located in Los Angeles. We specialize in robotic sacrocolpopexies as well as all the other procedures described above; determining which procedure would best benefit each patient requires a visit with our medical staff. Call us today at 310-375-8446 for a consultation.