August 05, 2020
Ever since I started practicing gynecology in 1994, I have seen and followed my patients throughout their adult life and transition into the menopause. I have managed them through their childbirth and later on for their female pelvic and menstrual problems. One thing that stands out as women come for their regular checkups, is that so many of those patients have problems with urinary leakage and some kind of vaginal bulging, prolapse or relaxation. When I ask them questions regarding those issues, many of the patients think that it is normal. That is where my real conversation with them starts.
First of all, it is not normal to have urinary leakage. It is not normal to have pelvic, vaginal, or bladder prolapse. Urine leaks because either the bladder is overactive or there are weak pelvic muscles, or both. There are medical reasons for women to have these problems. These could be the effect of multiple pregnancies, delivering a large baby, or the use of forceps during child birth, which are common for reasons for lot of women.
During pregnancy and labor, there is damage to the bladder, rectal, vaginal and perineal support. It causes some permanent damage to muscles and nerves in that area. Slowly, over a period of some years, the problem starts with urinary leakage with or without pelvic prolapse. During hysterectomy if careful stitching is not done to support the vagina, it can increase the risk of prolapse. Abnormal weight gain can cause aggravation due to pressure on weak tissue. And, there are always genetic and familial risk factors for weak muscle and ligaments which cause or aggravate these problems. Overactive bladder occurs because the bladder tissue itself has changed.
It is very important to know what you can do to prevent or decrease the severity of urinary leakage problems:
- Do pelvic muscle exercises, commonly known as a Kegel exercises regularly; definitely after childbirth.
- Watch your diet to avoid some common bladder irritants like excessive soda, caffeine, tea, alcohol and citrus fruits.
- Watch your weight.
I tell my patients that any condition such as a urinary leakage or prolapse problem causing a disturbance in your routine life or active lifestyle is cause for a visit to your physician. You must see a doctor to discuss it, as there are effective treatment options available. Often, an office procedure called urodynamics - the painless filling of the bladder with water and telescopic examination of the bladder - is used. A cystoscopy might be helpful to confirm the diagnosis and Pelvic Muscle Therapy is quite effective if started early.
Pelvic Muscle Therapy is a type of physical therapy for your pelvic muscles, done by a therapist without any pain or discomfort. You must continue to exercise those muscles yourself, too. Bladder training and lifestyle modification to change diet habits also help.
Additionally, there are effective medications available to treat overactive bladder.
If your urinary leakage is due to weak pelvic muscles and pelvic floor therapy or medication do not help, surgery can. Urethral Sling is an effective surgical therapy which provides support of the bladder and vagina. The sling keeps the urethra closed so you don't leak urine when you laugh, cough, or sneeze. A Pessary and/or surgery are effective treatments for pelvic vaginal prolapse, depending on the severity of the problem, desire for sexual intercourse and tone of the pelvic muscles. At Citrus Memorial Hospital, I perform robotic surgery which is minimally invasive laparoscopic surgery using a surgical robot as a tool to fix severe vaginal prolapse problems. Recovery after robotic surgery is faster and less painful.
If you are experiencing urinary leakage or pelvic prolapse, don't be shy! Your physician can provide non-surgical and surgical options to help you get back to your normal lifestyle.
Dr. Ashok Buddhadev is an Obstetrician/Gynecologist at Genesis Women's Center and member of the medical staff at Citrus Memorial Hospital.