Urogynecology is a surgical subspecialty of surgery and gynecology and is primarily focused on the diagnosis and treatment of pelvic floor disorders. However, the practice includes treatment for a number of wide-ranging conditions:
Urinary incontinence affects 10-35% of all adults. Some studies have reported that up to 50% of women have occasional incontinence and as many as 10% have daily incontinence. Urinary incontinence increases with age, and by the age of 75 approximately 1 in 5 women will suffer from incontinence. Continence is dependent upon a coordinated system of muscles and nerves surrounding the bladder. The brain constantly sends signals relaxing the muscles of the bladder while keeping the muscles surrounding the urethra strong. If the bladder muscles contract inappropriately or the muscles around the urethra relax or are not strong enough, incontinence occurs.
During laughing, coughing, or with straining (like in exercise), pressure in the abdomen is transmitted to the bladder. Weakened pelvic muscles supporting the bladder and urethra may not be able to withstand the increased abdominal pressure. When this happens and those muscles are overcome, leakage occurs. This is called stress incontinence. Many people live with stress incontinence for years before seeking care. Treatment for stress incontinence can range from exercises women do by themselves, or with the assistance of a specially-trained physical therapist. In some cases, surgery is recommended. Typically, surgical treatment of stress incontinence is a day-stay procedure that lasts about 30 minutes.
Some people know where all the bathrooms are in the shopping mall, and even then, they can't seem to make it in time without leaking. A strong urge to void, which cannot be overcome is another common experience in patients with urge incontinence. Sometimes these symptoms can be caused by medications or health conditions, so it's important to have a full evaluation before initiating therapy. Many times patients can initiate easy behavioral changes that can dramatically reduce or eliminate their symptoms. Sometimes medications are necessary, although good health habits are always the first place to start.
Some people are unable to completely empty their bladder and so the urine continues to accumulate, overflowing and resulting in leakage. Frequently, these people are not even aware that they don't adequately empty their bladder. This occurs sometimes in patients who suffer from long-standing neurologic disease like multiple sclerosis or diabetes, or even spinal cord problems. It is important to diagnose urinary retention, as these patients.
Rectal prolapse occurs when the tissue that lines the rectum falls down into or sticks through the anal opening.
Uterine prolapse is falling or sliding of the womb (uterus) from its normal position into the vaginal area.
A vaginal fistula is an abnormal opening in your vagina that connects it to another organ such as your bladder or colon. Whatever the cause of your fistula, you may need to have it closed by a surgeon to restore your normal function.
Painful Bladder Syndromes, including Interstitial cystitis
Interstitial cystitis (in-tur-STISH-ul sis-TI-tis) is a chronic condition characterized by a combination of uncomfortable bladder pressure, bladder pain and sometimes pain in your pelvis, which can range from mild burning or discomfort to severe pain. While interstitial cystitis - also called painful bladder syndrome - can affect children and men, most of those affected are women. Interstitial cystitis can have a long-lasting adverse effect on your quality of life. The severity of symptoms caused by interstitial cystitis often fluctuates, and some people may experience periods of remission. Although there's no treatment that reliably eliminates interstitial cystitis, a variety of medications and other therapies offer relief.
Recurrent Urinary Tract Infections
Chronic bladder infections are due to bacteria within the bladder that cause symptoms of pain with urination or frequent urination more than two times in six months. Antibiotics are used to clear the bacteria from the bladder. Causes of recurrent infections may be due to antibiotic resistant bacteria. Resolution is usually achieved by switching antibiotics. Incompletely treated infections may also lead to recurrent infections. Other causes of chronic infections include diabetes, kidney or bladder stones, sexual intercourse, spermicide use, and genetics. The key to prevention is good hygiene. Your doctor may advise you to take an antibiotic for a longer period of time or after intercourse to prevent recurrent infections.
Some common practices that can help reduce the frequency of urinary tract infections include:
- Drinking adequate amounts of clear fluid (usually 6-8 glasses a day)
- Cranberry extract pills, twice a day
- Good hygiene; wiping front to back; voiding and showering after intercourse
- Frequent and complete bladder emptying
- Vaginal estrogen cream in post-menopausal women
Sometimes it is necessary to test a patient's bladder function with urodynamic studies, or to look inside the bladder to identify the cause of recurrent urinary tract infections. Urinary retention (inability to completely empty one's bladder) can lead to urinary tract infections which may spread up through the ureters to the kidneys. It is important to seek medical care immediately if you develop fevers, chills or back pain.
Pyridium is a medicine that helps the pain associated with bladder infections. It can be used safely for a few days, but should not be used continuously. It usually turns urine a striking orange color.
Fecal incontinence is the inability to control your bowel movements, causing stool (feces) to leak unexpectedly from your rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control in someone who is older than 4 years old. Common causes of fecal incontinence include constipation, diarrhea, and muscle or nerve damage. Fecal incontinence may be due to a weakened anal sphincter associated with aging or to damage to the nerves and muscles of the rectum and anus from giving birth. Whatever the cause, fecal incontinence can be embarrassing. But don't shy away from talking to your doctor. Treatments are available that can improve, if not correct, fecal incontinence.
Excessive Urination, daytime or during the night
Signs and symptoms of overactive bladder may mean you:
- Feel a strong, sudden urge to urinate
- Experience urge incontinence, the involuntary loss of urine immediately following an urgent need to urinate
- Urinate frequently, usually eight or more times in 24 hours
- Awaken two or more times in the night to urinate (nocturia)
Although you may be able to get to the toilet in time when you sense an urge to urinate, frequent and nighttime urination, as well as the need to suddenly "drop everything," can disrupt your life.
When to see a doctor:
Many people never talk to their doctors about their overactive bladder symptoms. Although it can sometimes be difficult to discuss such a normally private matter with your doctor, it's important that you do, especially if you experience urge incontinence or if other symptoms of overactive bladder disrupt your work schedule, social interactions and everyday activities.
Sometimes, people assume that an overactive bladder or urinary incontinence is just a normal part of aging, and simply deal with the condition by wearing absorbent undergarments or pads. But, symptoms of urgency and incontinence aren't an inevitable part of getting older, and treatments are available that might help you. Additionally, it's important to talk to your doctor because an overactive bladder and urge incontinence may occur as a result of a serious underlying problem, such as a cancerous tumor.
Constipation is a common condition that happens when your BM (bowel movement) is hard and dry, or when you go a longer time than usual without having a BM. For some people it is normal to have two or three BMs daily. For others, it is normal to have a BM every three to five days. It may be painful and hard for you to push out the BM. You may also feel you need to have a BM, but cannot. You may have a very hard time pushing out your BM. Other signs may be pain or bleeding during or after a BM. You may feel like you did not finish having your BM. You may also have nausea (upset stomach), feel full, or not feel hungry.
Common causes of constipation:
- You may not be eating enough high fiber foods (roughage), such as fruits, vegetables, bran, or whole-grain cereals.
- You may not be drinking enough water or other liquids each day.
- You may not be exercising enough.
- You may be taking a certain medicine or have an illness, such as depression, that could cause constipation.
- You may have weakened muscles or a loss of feeling of the anus (where BMs come out of).