GENERAL TERMS
- Pelvic floor muscles
- A group of muscles in the pelvis that support and help to control the vagina, uterus, bladder urethra and rectum
- Bladder
- A muscular organ which stores urine
- Ureters
- A pair of tubes, each leading from one of the kidneys, to the bladder
- Urethra
- A short narrow tube that carries urine from the bladder out of the body.
- Voiding
- Passage of urine out of the body
COMMON PELVIC FLOOR DISORDERS
- Urinary incontinence
- leakage of urine
- Stress incontinence
- involuntary loss of urine during activities that put "stress" on the bladder such as laughing, coughing, sneezing, lifting, etc.
- Urge incontinence
- An involuntary loss of urine preceded by a strong urge (also known as "overactive bladder")
- Dysuria
- Painful urination
- Urgency
- A powerful need to urinate immediately
- Frequency
- The need to urinate more often than normal (more than every 2 hours or more than 7 times a day)
- Nocturia
- Waking up frequently (more than once) during the night to urinate
- Cystocele
- Prolapse or bulging of the bladder into the vagina
- Rectocele
- Prolapse or bulging of the rectum into the vagina
- Enterocele
- Prolapse or bulging of the small intestine into a space between the rectum and vagina
- Uterine prolapse
- Prolapse or descent of the uterus into the vagina
- Fecal Incontinence
- Accidental loss of solid stool, liquid stool, or gas
- Constipation
- Variously defined as infrequent bowel movements (< 3 bowel movements per week), incomplete emptying of bowel contents, need to excessively strain to effect a bowel movement, passage of small, hard stools, or need to place your fingers in the vagina or the space between the vagina and anus to effect a bowel movement.
DIAGNOSTIC TESTS
- Cystoscopy
- Using a lighted scope to view the inside of the bladder.
- Urodynamics
- A test that uses a small catheter inserted in the bladder to study the function of the bladder and urethra during, filling, leakage and urinating
- Dynamic cystoproctogram
- A procedure that uses x-rays to measure the extent of prolapse
- Electrodiagnostic testing (EMG)
- A test that evaluates nerve and muscle function
- Intravenous pyelogram (IVP)
- An x-ray procedure that examines the kidneys, ureters and bladder
- Urinalysis
- A test that evaluates chemicals and cells in the urine
- Urine culture
- A test that determines whether a urinary tract infection (UTI) is present
SURGICAL TREATMENTS FOR STRESS INCONTINENCE
- Burch retropubic urethropexy
- Procedure done through an abdominal incision or through a laparoscope to resupport the bladder base by placing sutures in the vagina to attach it to a ligament on the pubic bone
- Suburethral sling
- Placing a "strap" of material under the urethra to support it and prevent stress incontinence. The sling material can be synthetic or natural. The natural material can be taken from your own body or from cadavers.
- Periurethral injections
- Injection of material next to the opening of the bladder in an effort to prevent stress incontinence. This procedure is performed in the office.
- Tension-free vaginal tape
- type- sling
- A special type of suburethral sling that requires a less invasive procedure, which allows it to be performed under local anesthesia on an outpatient basis. CLICK HERE for more information
- Suprapubic catheter
- A catheter placed into the bladder through the abdomen - it is used to drain the bladder after surgery
- Neuromodulation
- This is a new approach in the treatment of the overactive bladder, urinary retention and urinary frequency. Electrodes are surgically inserted into the nerves that control the bladder. For more information about this option, CLICK HERE
SURGICAL PROCEDURES TO CORRECT PROLAPSE
- Anterior colporrhaphy
- A vaginal procedure to reestablish the supports between the bladder and vagina to fix a cystocele.
A synthetic mesh or organic graft material made be placed to reinforce this repair
- Paravaginal repair (vaginal or abdominal approach)
- support the vaginal wall by attaching it to the pelvic sidewall to fix a cystocele.
A synthetic mesh or organic graft material made be placed to reinforce this repair
- Posterior colporrhaphy
- A vaginal procedure to reestablish the supports between the vagina and rectum to fix a rectocele.
A synthetic mesh or organic graft material made be placed to reinforce this repair
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- Transvaginal enterocele repair
- Close the space between the vagina and rectum through a vaginal incision to prevent the small bowel from pushing the vagina out. This procedure will also resuspend the top of the vagina.
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- Total abdominal hysterectomy (with or without bilateral salpingo/oophorectomy)
- Remove the uterus (including the cervix), tubes and ovaries through an abdominal incision.
- Total Laparoscopic Hysterectomy
- removal of the uterus (including the cervix) and possibly the tubes and ovaries through a laparoscopic approach
- Total vaginal hysterectomy (with or without bilateral salpingo/oophorectomy)
- Remove the uterus (including the cervix), tubes and ovaries through a vaginal incision.
- Bilateral salpingo/oophorectomy
- Removal of tubes and ovaries (performed eiter abdominally, vaginally or laparoscopically).
- Uterosacral ligament suspension
- Suspend the top of the vagina to the uteroscral ligaments. this can be performed vaginally, abdominally or laparoscopically.
- Sacrospinous vaginal vault suspension
- A vaginal procedure that attaches the top of the prolapsed vagina to a ligament in the pelvis
- Sacral colpopexy
- A procedure (performed abdominally or laparoscopically) that attaches the top of the prolapsed vagina to the sacrum using either synthetic mesh or cadaveric material.
- Illiococcygeal fascial attachment
- A vaginal procedure that attaches the top of the prolapsed vagina to pararectal supportive tissue.
- Supracervical hysterectomy
- Removal of most of the uterus – leaving the cervix behind. This approach can be done abdominally or laparoscopically
- Total colpectomy
- Complete closure of the vagina to correct prolapse. This procedure is only performed when the patient is ABSOLUTELY sure that she will never want to have intercourse again.
- Total colpocleisis
- Closure of the vagina (similar to colpectomy) while leaving channels at the side for drainage from the uterus (which is not removed)
- Overlapping anal sphincteroplasty
- Reattach divided muscle edges around anus to correct fecal incontinence
NON-SURGICAL TREATMENT OPTIONS FOR PROLAPSE
- Pelvic muscle exercises (PME)
- Also known as Kegel's exercises, they strengthen the support of the pelvic organs and are most commonly used to treat stress urinary incontinence. PME techniques are also useful in prolapse prevention. Once the symptoms of prolapse are severe, however, these exercises are of little benefit.
- Pessary
- A device worn in the vagina like a diaphragm. Pessaries are used to support the vagina, bladder, rectum and uterus as necessary. They come in a variety of shapes and sizes, so a doctor or nurse must fit them. CLICK HERE for a picture of the various pessaries that are available.
NON-SURGICAL TREATMENT OPTONS FOR URINARY INCONTINENCE
- Pelvic Muscle Exercises (PME)
- Also known as Kegel exercises, PME techniques are an effective treatment option for stress incontinence. Most women require guidance from a medical professional to learn how to contract the pelvic floor muscles correctly. For specific instructions on how to do these exercises CLICK HERE.
- Biofeedback
- This term refers to a variety of techniques that teach patients bladder and pelvic muscle control by giving positive feedback when the patient performs the desired action. This feedback can be from an electronic device or directly from health professional.
- Bladder Training
- This treatment for urge incontinence involves teaching a patient to urinate according to a timetable rather than an urge to do so. Gradually, the scheduled time between trips to the bathroom is increased as the patient's bladder control improves. CLICK HERE for a copy of the instruction sheet we use to help with bladder training.
- The Bladder Diet
- This is a list of dietary irritants to the bladder. Avoiding the items on this list can greatly improve such bladder symptoms as frequency and urgency. For a copy of the bladder diet CLICK HERE.
- Medications
- There are a number of drugs that are used in the treatment of urge incontinence.
Four commonly prescribed drugs are Detrol, Ditropan XL, Oxytrol patch, and Sanctura
Occlusive devices - Several types of pessaries are available that are designed specifically for the treatment of stress incontinence. These are especially useful for women who leak urine during specific activities such as exercise. There is also a new device that fits in the urethra and acts like a plug. This device is called FemSoftTM. CLICK HERE for more information on this device.
Pelvic Floor Electrical Stimulation (PFES) - Vaginal or anal probes that deliver electrical current to the pelvic floor may be useful in the treatment of urge and mixed incontinence. CLICK HERE for more information on PFES.
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