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Woman And Infants

Web-Exclusive Q&A: Urogynecology

Millions of American women suffer from urogynecological problems, including incontinence. As common as these problems are, women still believe they must cope with them instead of seeking treatment. Kyle Wohlrab, MD, of Women & Infants' Division of Urogynecology and Pelvic Reconstructive Surgery, answers some basic questions about different urogynecological issues women may face.

How common are urogynecological problems in women? Are they more common than in men?
Urinary incontinence is the most common urogynecologic problem, afflicting13 million American men and women. The United States spends more than $12 billion annually on incontinence-related health care and products. Women are three times as likely as men to suffer from this disorder.

How common is urinary incontinence? What causes it?
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 it.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.

Why might someone leak urine only occasionally, like when she laughs?
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 those muscles are overcome, leakage occurs.

What can be done to help women with urogynecologic problems? Is surgery the only option?
Treatment options vary according to patient complaints and preferences. Although there are multiple surgical options for treating urinary incontinence and genital prolapse, surgery is not the only option. Specialized pelvic physical therapy may help strengthen the muscles surrounding the bladder and vagina. Sometimes, lifestyle modifications – such as decreasing caffeine and alcohol intake, stopping smoking, or losing weight - may alleviate some of the symptoms. A physician may also recommend keeping a bladder diary that can help regulate fluid intake and time intervals between bathroom visits.

What sort of tests are done to determine the problem?
A complete physical exam by a gynecologist or urogynecologist is the first step in determining the extent of a urogynecologic problem. Your doctor may advise you to complete urodynamic testing. This specialized test looks at the ability of your bladder to hold urine at different capacities by using a specialized catheter (tube into the bladder.

Is there such a thing as chronic bladder infections? What causes them and what can be done to prevent them?
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. Recurrent infections may be due to antibiotic resistant bacteria. We can usually resolve this 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 that you take an antibiotic for a longer period of time or after intercourse to prevent recurrent infections.

What is genital prolapse?
Genital prolapse is the relaxation of the pelvic floor muscles that support the bladder, uterus and rectum. Prolapse is described by its location and severity. Descent of the bladder into the vagina is called anterior prolapse. Apical prolapse is usually due to relaxation of the uterus (or vagina after a hysterectomy). Posterior prolapse is the term given to relaxation of the rectum into the back wall of the vagina. The severity of prolapse may range from the feeling of a bulge into the vagina to the complete protrusion of the bladder or uterus outside of the vagina.

What is pelvic floor dysfunction and what causes it?
Pelvic floor dysfunction refers to the inability of the connective tissue and muscles of the pelvis to perform the anatomic functions that they had once successfully managed. This may include the involuntary leakage of urine, gas or feces. Pelvic floor dysfunction is likely the result of repeated stress on the pelvic floor muscles, most commonly from pregnancy and childbirth. The connective tissue and muscles that stretch during the pregnancy may not fully return to their pre-partum strength possibly due to trauma sustained during childbirth. Other conditions that increase abdominal pressure may also lead to pelvic floor dysfunction. These include age, obesity, chronic lung conditions, repetitive heavy lifting, some neurologic or spinal cord conditions, and genetics.

Do these problems limit a woman's life, including her intimate relations?
These problems often limit a woman's desire to engage in physical activity, travel on long trips, or even socialize with friends in public places because of the fear of involuntary passage of urine or feces. They may also prevent a woman's desire to be intimate or to enjoy intimate relations with her partner. There are multiple options available to address the many types and severity of pelvic floor dysfunction. These options range from medications to surgery. Women no longer have to be limited by pelvic floor dysfunction and, with treatment, many are able to resume an active and normal lifestyle.

What are some signs of urogynecologic problems? When should a woman call her doctor?
Some of the common signs of urogynecologic problems are in the inability to urinate or the leakage of urine involuntarily, the feeling of a bulge in the vagina, the appearance of a bulge outside of the vagina, difficulty with intercourse due to a bulge or the inability to hold urine or feces during intercourse, difficulty having a bowel movement or the need to facilitate urinating or having a bowel movement by changing position or using a hand in the vagina to assist in evacuation. A woman should call her doctor if symptoms present suddenly or when chronic symptoms become troublesome or interfere with her quality of life.


For more information, or to set-up an appointment, contact the Women & Infants' Division of Urogynecology and Pelvic Reconstructive Surgery.


In order to provide answers to your most pressing health care questions, the clinicans at Women & Infants participate in an ongoing series of web-exclusive interviews.

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