Forget-Me-Not-Program: pelvic floor exercise program

Frequently Asked Questions

Frequently asked questions about the bladder:

What is an overactive bladder?

Overactive bladder is a condition that can include urinary frequency, urgency, urge incontinence or nocturia. Frequency and urgency requires frequent trips to the bathroom. Urge incontinence is leakage on the way to the bathroom. Nocturia is waking up to void more than once during the night. There are many conditions of the bladder that can cause these symptoms. Common causes include urinary tract infections, interstitial cystitis and neurological disorders. There are treatment options available for most of these disorders.

How is overactive bladder treated?

The key to treatment is to identify which disorder is present. There are certain tests that may be needed to help make the diagnosis. Tests may include urine cultures, cystoscopy, KCL bladder lavage, simple CMG or complex urodynamics. Treatments can include the bladder diet, medications, pelvic rehab using biofeedback and neuromodulation.

What is interstitial cystitis?

Interstitial cystitis (IC) is a chronic condition of the bladder often causing symptoms of frequency, urgency, painful urination, painful intercourse, and chronic pelvic pain. One study showed that 85% of patients with chronic pelvic pain tested positive for IC. A common theory of interstitial cystitis is that it is a defect in the lining of the bladder (like an ulcer in the stomach). Treatment options include the bladder diet, medications, bladder lavage treatments and neuromodulation.

How common is urinary incontinence in women?

Women often assume that urinary leakage is normal. It is a common disorder but should never be considered normal. A large study from the National Institute on Aging found that 56% of postmenopausal women experience urinary incontinence at least weekly.

What causes urinary incontinence?

Urinary incontinence is a symptom not a disease. These symptoms often arise after childbirth has weakened the pelvic support tissues and muscles. There are different types and causes of urinary incontinence. Stress Incontinence is leakage when you lift, bend, laugh, cough or sneeze. Causes can be from a weakness in the bladder neck support causing it to drop from its normal position and/or weakness in the urethral sphincter muscle. Urge Incontinence is leakage when you feel the urge to go. Leakage often occurs while heading to the bathroom. Common triggers include hearing water running or feeling a cold blast of air. Causes can be from the bladder being out of position such as with a prolapse, reduced bladder capacity, obesity, interstitial cystitis, lack of estrogen, weakening of the urethral sphincter muscle, medications and other medical or neurological disorders including diabetes. It becomes more common with aging. Overflow Incontinence occurs when the bladder gets overfilled and overflows. This can occur with certain medical conditions that desensitize the bladder pressure sensors or weaken its ability to contract. This may also occur when prolapse causes a kinking of the bladder neck preventing complete emptying. Mixed Incontinence is a combination of one or more of the above.

How is urinary incontinence treated?

The key to treatment is to identify the specific type of incontinence. This can be done by performing a careful medical history and focused physical exam. Some diagnostic tests are used to help identify the disorders. Some of these tests include urinalysis, simple CMG, cystoscopy and complex urodynamics. Stress Incontinence can be treated with weight loss, estrogen creams, and pelvic rehab using biofeedback, pessary, trans-urethral bulking agents, or surgery. Urge Incontinence can be effectively treated with timed voiding, pelvic rehab using biofeedback, medications and neuromodulation using Interstim neuromodulation Overflow Incontinence may be treated with pelvic rehab using biofeedback, behavior modification, medications, or correction of a prolapse.

I've heard that surgical correction doesn't last very long. Is that true?

The surgical treatment for stress incontinence has evolved rapidly over the last 15 years. Hundreds of variations on surgical treatments have come and gone. There is no perfect treatment and no surgery that has a 100% success rate. Two procedures have been identified as being superior: retropubic cystourethropexy and the suburethral sling. Cure rates for these should approach 95%. The most common suburethral slings are called TVT for trans-vaginal tape sling or TOT for trans-obterator tape sling. Both involve placing a tension free tape under the urethra, which then tightens the urethral sphincter when you bear down. This procedure has quickly become the gold standard of care. A sling can be placed during an outpatient procedure and sometimes under local anesthesia. When stress incontinence involves a weakened urethral sphincter or dilated urethra, an alternative option is a trans-urethral bulking agent. This procedure is done in the office through a cystoscope. A bulking agent is injected into the urethra to narrow the diameter of the urethral lumen. This procedure is well tolerated and takes approximately 10 minutes. It has a 60-70% success rate. It is a nice option for patients who are poor surgical candidates.

How can I prevent this problem?

Because a lot of these problems get worse with age, pelvic floor exercises are the best prevention to help delay these conditions. Pelvic muscle exercises including Kegel's help keep the pelvic floor muscles and urethral sphincter muscle in shape.

Frequently asked questions about pelvic organ prolapse.

What is Pelvic Organ Prolapse?

Prolapse simply means displacement from the normal position. When pelvic organ prolapse occurs women experience bulging, sagging or falling from the vagina. This can occur quickly but usually is gradual over time. There are different types of organ prolapse that can occur individually or together. The terms most often used are:
Cystocele: prolapse of the bladder through the top of the vaginal wall.
Rectocele: prolapse of the rectum through the bottom of the vaginal wall.
Uterine Prolapse: When the uterus drops into or through the vagina.
Enterocele: prolapse of the small intestine through a space between the rectum and vagina

What are the symptoms of prolapse?

Symptoms depend on the type of prolapse you have. Most women don't seek treatment until they actually feel something bulging out of the vagina. Early symptoms can include pain with intercourse, difficulty keeping a tampon in, lower back pain after standing, urinary incontinence or constipation. As the condition grows women may begin to feel increased pressure in the vagina that worsens during the day. It may become difficult to completely empty the bladder and may require pushing against the vaginal to go. Initiating bowel movements may require pressing around the anus or in the vagina. Eventually a vaginal bulge will appear which protrudes out of the vagina and can grow to baseball size or larger.

Why me? What did I do to cause this?

There are many factors that seem to contribute to the development of prolapse. Pregnancy whether with vaginal delivery or C-section plays a major role. The more babies you have the higher your risk. Risks worsen with age. Genetic predisposition and race are key factors. We are unable to determine which patient is predisposed at this time. Other conditions may play a role including obesity, pelvic tumors, chronic constipation, and lack of estrogen.

Do I need to have surgery for my prolapse?

Prolapse is rarely a life threatening condition. There are three treatment options. 1) Do nothing. 2). Wear a pessary or 3) surgical correction. Pessaries are worn in the vagina like a diaphragm. They come in a variety of sizes and shapes and can be worn for many years with minimal maintenance. Surgical failure rates using the traditional repair were 30-to 40%. By using graft materials, failure rates have dropped to 5-8% failure.

If I do nothing will it get worse?

It may not happen quickly but, if left untreated, over time the condition can worsen. Prolapse can cause urinary retention, which may lead to kidney infection or damage. In these cases treatment is necessary. Otherwise, the decision to treat the prolapse should be based on your symptoms.

How do I use a pessary and how do I keep from getting an infection?

An ideal way to use a pessary is to insert it daily then take it out and clean it nightly. If doing this daily isn't possible it can be worn continuously then removed and cleaned in our office every 6-8 weeks. A lubricant should be used regularly to keep it from irritating the vaginal walls.

If I chose surgery, what will the recovery be like?

Depending on the extent of your surgery, the hospital stay will usually last from 1-4 days. Immediately after surgery, packing is placed in the vagina then removed 8 hours later. Upon removal some of the immediate pelvic pressure and discomfort will be relieved. A urinary catheter is usually kept in over night. After surgery sometimes swelling makes it difficult to void. The catheter is removed the day after surgery and bladder training begins. Sometimes it is necessary to have a catheter for several days. Most patients will require some prescription strength medicine for pain for several days after surgery. When grafts or slings are used you should avoid heavy lifting or straining for 12 weeks. (Lift nothing heavier than a gallon of milk; stay on stool softeners to avoid constipation) This will allow proper healing and scaring in of the tissues. This is important in the success of these procedures. Intercourse, weight bearing exercises and straining can usually resume after 12 weeks.

What is the success rate? Will it last forever?

Our goal is to have your pelvic reconstructive surgery recreate the normal pelvic anatomy and have it last forever. Unfortunately, not all procedures are successful 100% of the time. However, with the use of grafts and slings the success rates are 92-95%. If failure occurs, it is often only a partial failure requiring no treatment, pessary use or a less extensive surgical repair.

If I'm not leaking urine with my prolapse, do I still need bladder testing?

Yes. If you are having any type of prolapse surgery, bladder testing should be done before hand. If a repair is done without considering the bladder, new problems of urinary incontinence can develop.

How will this affect my sex life?

We hope that the repair will actually improve or enhance you sex life. Often rebuilding the vagina can tighten the vaginal walls and create more sensation for both partners. A recent study showed that before surgery, 40% of patients had sexual dysfunction because of their prolapse, after surgery the number was down to 10%. New onset sexual dysfunction was 5%. There are times when pelvic surgery causes scarring that can lead to painful intercourse. This usually responds to lubrication, estrogen cream and pelvic floor physical therapy. Ability to achieve orgasm should not change and has been enhanced on many occasions.

Frequently asked questions about anal incontinence:

What is anal incontinence?

Anal incontinence is the involuntary leakage of gas, liquid stool or solid stool.

What causes anal incontinence?

Like the other pelvic floor disorders, anal incontinence usually occurs because of childbirth injuries. Even normal easy vaginal deliveries can result in direct injury to the anal sphincter muscle or to the innervations of the rectum and sphincter. About 15% of the time anal incontinence occurs because of a direct injury to the anal sphincter. This may or may not be recognized during childbirth. After childbirth you can often compensate for this problem but as you age, the weakness in these muscles may become more apparent. There are other conditions that can lead to this disorder. Some of the more common include; hemorrhoids or hemorrhoid surgery, inflammatory bowel disease, radiation enteritis, Multiple Sclerosis, Parkinson's disease, spinal cord injuries, stroke, dementia, Diabetic Neuropathy, Rectal prolapse and descending perineum syndrome.

What can be done to treat anal incontinence?

There are different approaches to treating anal incontinence and it often depends on which condition is causing it. A complete history and physical will help identify potential problems. Trans-anal ultrasounds and pudendal nerve motor latency studies are diagnostic tests that may be helpful in the evaluation. Treatment options include dietary changes, weight loss, bowel management, pelvic floor rehab using biofeedback, anal sphincter repair, rectocele repair and neuromodulation.