Urinary Incontinence in Women

Many women suffer unnecessarily from conditions involving pelvic relaxation
by Ted M. Roth, M.D., Urogynecology, Women’s Specialty Center, Central Maine Medical Center, Lewiston, Maine

Thirty million American women suffer from symptoms of pelvic organ prolapse also known as 'vaginal relaxation' and urinary incontinence. Many women have difficulty controlling their urine in certain situations or notice changes in their bowel habits, even anal incontinence. These symptoms may be related to a common set of problems that may occur as a result of childbirth, aging or a combination of both.

The female pelvic organs include the vagina, uterus, blad der, and rectum. These organs are held in position by three types of supports: muscles; sheets of tissue called fascia; and liga­ments. When these supports become damaged for various rea sons, one or more of the pelvic organs may sag and or even pro trude outside the vagina.

During childbirth, as the baby passes through the birth canal, the muscles, fascia, and liga ments separate and may be weak ened. This weakening gradually worsens and, in later years, may cause the pelvic organs to drop from their normal positions. This weakening of the muscles and tissue may occur in women who have never had children or in younger women. In these women, the cause may be:

The general symptoms associat ed with pelvic relaxation depend on which organs are affected. Often there is a feeling of heavi ness or fullness. Small or moderate amounts of urine may be lost with normal physical activities such as laughing, coughing, walking, or running. A mass or bulge may protrude from the vaginal opening. Based on the organ or organs involved, pelvic support defects can be defined more specifically as:

Cystocele – occurs when the bladder falls or descends from its normal position.

Urethrocele – (most of the time the cystocele and urethrocele occur in combination – cystourethrocele)

Rectocele – usually occur as a result of injuries sustained during childbirth. With a weakened or bulging rectum, bowel movements become more difficult and a bulge is typically felt at the floor of the vagina.

Enterocele – bulging of small intestines into the back wall of the vagina.

Uterine prolapse – occurs when the uterus falls or is displaced from its normal position. There are varying degrees of severity depending on the descent. This produces a general feeling of heaviness and fullness, or a sense that the uterus is falling out.

The diagnosis of these problems will typically include a thorough history and physical examination, urodynamic studies (a painless 30 minute computerized bladder and urethra functional study), and cystoscopy (instrument used to evaluate the inside of the bladder and urethra).

For all practical purposes, definitive treatment is surgical correction of the specific defects. As in other fields of medicine and surgery, there continues to be a push for more minimally invasive procedures and more outpatient surgeries. At CMMC, we are offering these exciting techniques for the management of pelvic organ prolapse and urinary incontinence.

Endoscopic implants are now available for women with urinary incontinence. These implants provide immediate relief and patients are ambulatory within minutes after the procedure. Excellent results are available without the fear of the implications of surgery. One to three treatment sessions may be needed over the course of several months, with excellent cure rates, long-term durability, without the consequences of surgery.

For women considering surgery for pelvic organ prolapse, we are using materials to restore anatomic support that don't require a hysterectomy at the time of the repair. The procedure is done vaginally, utilizes synthetic mesh material, and has excellent durability. Because the procedure is performed vaginally, there are no incisions made on the abdomen and most patients have minimal discomfort after surgery.

Many women suffer unnecessarily from conditions involving pelvic relaxation. If you have any of these symptoms described in this section, contact us at 207-795-7180. Appropriate diagnosis and treatment will often restore patients to a life free of the aggravations and discomforts associated with pelvic relaxation.

Ted Roth, M.D., is affiliated with the Women's Specialty Center and Bladder Control Center at Central Maine Medical Center in Lewiston. Dr. Roth practices urogynecology, which encompasses urodynamic testing, ultrasound and electromyographic investigations of the pelvic floor and surgery. He has a particular interest in the use of minimally invasive and transvaginal procedures for both incontinence and pelvic organ prolapse. For more information go to https://www.cmhc.org/cmmc.




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