When should women talk with a Urologist?
Pelvic Organ Prolapse (POP)
Pelvic Organ Prolapse (POP) is a result of weakening of muscles of the pelvic floor. The pelvic floor is a complex network of muscles and ligaments that support the surrounding organs, including the vagina, uterus, bladder, and rectum. As the pelvic muscles weaken, the structures of the pelvis begin to descend into the vagina.
Pelvic prolapse may occur after vaginal delivery (childbirth), menopause, or hysterectomy. Symptoms indicating pelvic prolapse include vaginal fullness, vaginal bulge, urinary incontinence, voiding difficulty, or some combination of these symptoms. However, many patients do not experience any symptoms, and are only diagnosed by their physician when addressing other concerns.
When the prolapse involves the anterior wall of the vaginal canal (bladder), it is called Cystocele. When it involves the posterior wall of the vaginal canal (rectum), it is called Rectocele. The prolapse may also involve the Uterus (Uterine prolapse), the intestine (Enterocele) and the apex of the vaginal canal after hysterectomy (Vault prolapse). These forms of prolapse may coexist in different combinations with or without urinary incontinence.
Treatment Options for Pelvic Organ Prolapse
Treatment options for the prolapse depend on the type of the prolapse, the degree of the prolapse and the associated symptoms. The treatment options may include:
- Pelvic muscle exercises (also known as KEGEL Exercises)
- BIOFEEDBACK (pelvic muscle training)
- A vaginal pessary (a removable device placed in the vagina similar to a diaphragm designed to hold up the pelvic structures in position)
- Minimally invasive surgical repair of the prolapse using human tissue or synthetic mesh grafts.
Pelvic muscle exercises (KEGEL Exercises)
First published in 1948 by Dr. Arnold Kegel, Kegel exercises are designed to strenthen the pelvic floor and reduce symptoms of urinary incontinence. Kegel exercises consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. Just as a personal trainer improves the results of your exercise regimen, it is important to learn the right way to contract the pelvic muscles in order to make these exercise effective. At Genesis we offer tools such as Biofeedback to teach you to perform Kegal exercises correctly.
BIOFEEDBACK (pelvic muscle training)
The challenge with Pelvic muscle exercises (KEGEL Exercises) is that it can be difficult to know for sure if you are doing them correctly and that you are actually exercising the right muscle. Many women who try Kegel exercises don’t achieve the results they want and often give up too soon. Biofeedback helps you perform these exercises in a manner that is truly engaging the muscles of the pelvic floor. In addition, you will be able to measure your progress and determine the strength of your Kegel contractions over time. Biofeedback is an excellent tool that helps many women achieve positive results and is available through your Genesis Female Urology Specialist.
Vaginal Pessary
A vaginal pessary is a removable device placed in the vagina, similar to a diaphragm, to provide support to the pelvic structures and relieve pressure on the bowel and bladder. Pessaries do not cure pelvic organ prolapse but may help manage the progression of prolapse by adding support to the vagina. If you are not candidate for surgery or other therapies, a vaginal pessary may offer an alternative. A Genesis Female Urologist can help determine if a pessary will work for you.
Pelvic Organ Prolapse (POP) Repair
A variety of surgical approaches are used to repair and correct pelvic organ prolapse when other less invasive therapies are not effective. Today, many surgical techniques are minimally invasive with procedures performed vaginally or occasionally via a small incision in the abdomen. Native tissue, human tissue graft, xenograft and mesh graft are used to reinforce pelvic support structures. As with all surgeries – each technique has risks and benefits associated with the procedure.
A Unio Specialty Care Female Urology Specialist can help you evaluate the alternatives and determine what treatment option is best for you.
Bladder Control for Women
Is Urinary Incontinence Affecting Your Quality of Life?
One of the most common urinary problems experienced by women is the involuntary loss of urine. In fact, women experience incontinence twice as often as men. For some women, it’s a few drops while running or coughing. Others lose urine for no apparent reason while suddenly feeling the urge to urinate. Urine loss can also occur during sexual activity and cause tremendous emotional distress. The frequent need to urinate even prevents some women from participating in normal activities. Bladder control issues range from slightly annoying to completely debilitating. It’s a quality of life issue that women should discuss with a urologist. There are many causes and many treatment options to consider. No single treatment works for everyone, but many women can find improvement, often without surgery.
The Answer May Be Easier Than You Think
We understand that it can be difficult to talk with a doctor about these very personal symptoms. You are not alone. Our staff and physicians will do everything possible to make you completely comfortable. All discussions and information shared with our professionals are completely confidential.
A Genesis Female Urologist can assist you in determining the underlying cause of your condition and offer a variety of solutions that meet your personal needs and lifestyle. There is a wide range of choices and we will help you find the options that are right for you. Evaluation starts with a private, confidential questionnaire, followed by the appropriate diagnostic tests to determine how your bladder is functioning, including:
- URINALYSIS, and urine culture are done to rule out the possibility of urinary tract infection.
- POST VOID RESIDUAL (PVR) measurement using sophisticated ultrasound equipment to assess bladder emptying
- CYSTOSCOPY is a state of the art fiber-optic scope that allows the urologist to inspect the lining of the urethra and the bladder including the sphincter and identify any abnormality in the bladder and urethra.
- URODYNAMICS is a state of the art test that uses sophisticated electronic equipment and a computer to evaluate your bladder function, and define the exact nature of the problem causing your symptoms.
Once the underlying cause of your problem is clearly identified, your Genesis Urologist will thoroughly discuss with you the diagnosis, and the variety of treatment options available and help you determine the choice that is best for you.
Stress Incontinence is urinary leakage that occurs with physical activities such as coughing, laughing, sneezing, lifting, and standing up or any form of exercise or sports. The major cause of this form of incontinence is the damage that may occur to the urinary sphincter and pelvic muscles during pregnancy and childbirth, or after menopause due to loss of estrogen, and after hysterectomy.
Treatment Options for Urinary Incontinence
A wide spectrum of treatment options are available for this form of urinary incontinence including:
- Pelvic muscle exercises (also known as KEGEL Exercises)
- BIOFEEDBACK (pelvic muscle training)
- Transurethral injection of bulking agent
- Transurethral Radiofrequency treatment (RENESSA)
- Surgical alternatives such as vaginal sling procedures
Pelvic muscle exercises (KEGEL Exercises)
First published in 1948 by Dr. Arnold Kegel, Kegel exercises are designed to strenthen the pelvic floor and reduce symptoms of urinary incontinence. Kegel exercises consists of repeatedly contracting and relaxing the muscles that form part of the pelvic floor. Just as a personal trainer improves the results of your exercise regimen, it is important to learn the right way to contract the pelvic muscles in order to make these exercise effective. At Genesis we offer tools such as Biofeedback to teach you to perform Kegal exercises correctly.
BIOFEEDBACK (pelvic muscle training)
The challenge with Pelvic muscle exercises (KEGEL Exercises) is that it can be difficult to know for sure if you are doing them correctly and that you are actually exercising the right muscle. Many women who try Kegel exercises don’t achieve the results they want and often give up too soon. Biofeedback helps you perform these exercises in a manner that is truly engaging the muscles of the pelvic floor. In addition, you will be able to measure your progress and determine the strength of your Kegel contractions over time. Biofeedback is an excellent tool that helps many women achieve positive results and is available through your Genesis Female Urology Specialist.
Transurethral injection of bulking agent
Injectable therapy using bulking agents offer a minimally invasive alternative for women with stress urinary incontinence due to intrinsic sphincteric deficiency (ISD) when weakness of the smooth muscle around the urethra (the tube from which urine flows) occurs. This weakness results in a partial opening of the urethra that allows urine to come out with minimal physical activities. Injectable agents have been used to manage stress urinary incontinence for more than a decade. These injections augment the urethral wall and help close the urethra to prevent urinary incontinence. A Genesis Female Urology Specialist can help evaluate if this simple office-based procedure is right for you.
Transurethral Radiofrequency treatment (RENESSA)
Renessa utilizes radiofrequency energy to deliver low temperature controlled heat to firm the urethral sphyncter. The gentle heat from this 10-minute treatment firms the natural collagen in your tissue and increase your bladder’s ability to resist leaks. Patients are typically back to normal activities within a day and start to see improvement within 60 to 90 days. A Genesis Female Urology Specialist can perform this simple procedure within the comfort of the doctor’s office.
Vaginal sling procedures
A vaginal sling creates a hammock of support and to prevent the urethra from opening when you cough, laugh, or sneeze. This surgical procedure involves placing a piece of material (synthetic mesh, your own tissue or human graft tissue) under the urethra.
The graft material will be incorporated into your own tissue to reduce and or eliminate urinary incontinence. If less invasive treatments fail to solve your problems with urine leakage, surgery may be your best option. A Genesis Female Urology Specialist can help you evaluate the risk and benefits of surgery and other treatment options to find the solution that works for you.
Overactive Bladder (OAB) is the name given to a common condition that causes a variety of urinary symptoms in both women and men. This form of bladder dysfunction is associated with a strong desire to urinate (Urgency) usually with frequent voids (Frequency) and/or night voids (Nocturia) with or without urinary incontinence (Urge Incontincence).
Treatment Options for Overactive Bladder
A variety of treatment options are available for this form of incontinence including:
- Behavioral Modification (Bladder Training Program)
- BIOFEEDBACK (Pelvic Muscle Training)
- Oral Therapy (Medications)
- Posterior Tibial Nerve Stimulation (PTNS)
- Botox Injection In The Bladder
- Bladder pacemaker (Interstim Neuromodulation)
Behavioral modification (Bladder Training Program)
Overactive Bladder can often be helped through behavior modification – a type of “training program” for your bladder. When you have overactive bladder, over time your bladder becomes conditioned to react in a certain way. By retraining the pelvic muscles, you can hold urine better. Bladder retraining involves working with your Genesis Female Urology Specialists to learn how to resist or inhibit the feeling of urgency; postpone voiding; and urinate according to a timetable rather than in response to a feeling of urgency. Dietary changes and other healthy lifestyle changes can add to the success of bladder training. Medications may also be helpful in controlling urgency. A Genesis Urology Specialist can create a Bladder Training Program specifically for your needs and help determine if some simple steps can help resolve your overactive bladder.
BIOFEEDBACK (Pelvic Muscle Training)
The challenge with Pelvic muscle exercises (KEGEL Exercises) is that it can be difficult to know for sure if you are doing them correctly and that you are actually exercising the right muscle. Many women who try Kegel exercises don’t achieve the results they want and often give up too soon. Biofeedback helps you perform these exercises in a manner that is truly engaging the muscles of the pelvic floor. In addition, you will be able to measure your progress and determine the strength of your pelvic muscle contractions over time. Biofeedback is an excellent tool that helps many women achieve positive results and is available through your Genesis Urology Specialist.
Oral Therapy (Medications)
There are several effective medications available for women with overactive bladder and/or urge incontinence. The type of medication is based on your specific bladder control problem. Ask your Genesis Urology Specialist about the risks and benefits of drug therapy for your specific condition.
Posterior Tibial Nerve Stimulation (PTNS)
Percutaneous tibial nerve stimulation (PTNS) is an FDA cleared device. The technique uses electrical stimulation for the management of urinary frequency, urgency, and incontinence. The idea of stimulating the tibial nerve is based on the traditional Chinese practice of using acupuncture to affect bladder activity. An electrode is used to send an electrical pulse that travels to the sacral nerve plexus via the tibial nerve. The procedure is short and is administered weekly over a period of 12 weeks. A Genesis Urology Specialist can discuss the details of this treatment with you.
Botox Injection In The Bladder
Botox injections in the bladder is another alternative management option for patients with OAB who have failed or are unable to tolerate Behavioral Mediation or Oral Therapy. Botox injections is an effective therapy for patients with OAB. The procedure is short and is usually done in the office. As the effects of Botox wear off over time, the procedure may need to be repeated once or twice a year.
Bladder Pacemaker (Interstim Neuromodulation)
Interstim Neuromodulation uses mild electrical pulses to modulate the nerves that control the bladder and the muscles related to urination. Similar to a pacemaker, this implantable device sends mild electrical pulses to regulate the sacral nerves, located near the tailbone. The sacral nerves control the bladder and the pelvic muscles related to urinary function. Neuromodulation is an option for managing the symptoms of overactive bladder and/or urge incontinence, and/or urinary retention. Talk with your Genesis Urology Specialist about whether a bladder pacemaker is right for you.
Other Forms of Incontinence
The most common form of urinary incontinence is called Mixed Urinary Incontinence in which the patient has both stress incontinence due to weak sphincter and urge incontinence due to overactive bladder.
Other forms of urinary incontinence are less common including Overflow incontinence caused by the inability of the bladder to empty properly due to obstruction, and Functional Incontinence that is caused by the inability to get to the bathroom in time due to limited mobility (such as severe arthritis) or cognitive impairment (such as Alzheimer’s disease and Dementia).