VERY COMMON

About 20-40% of women have bladder control problems. It is very common, but does not feel that way because women do not talk about it. Most women are in the 30-80 year age group. Approximately 80% of those affected by urinary incontinence can be cured or improved. Despite the high success rate in treating incontinence, only one out of every 12 people affected seeks help. Many types of treatment including simple exercises, medications or minimally invasive procedures are available. After a thorough evaluation, Dr. Rajan can recommend the treatment that is appropriate for you.

YES

The Pelvic Floor includes the muscles, ligaments, connective tissue, and nerves that help support and control the uterus, vagina, bladder and rectum. Damage to the pelvic floor can result in pelvic floor disorders that include:

The short answer is- NO.

Urinary and fecal incontinence become more common with advanced age, but are NEVER a normal part of aging.

Incontinence and prolapse are usually caused from weakening of the pelvic floor as a result of pregnancy, childbirth trauma, pelvic surgery, aging, and repetitive heavy lifting or straining.

Weakness of the vagina results in stretching of its walls that then allows the pelvic organs to drop into it causing prolapse.

FACT:Almost half of all women who exercise regularly experience some degree of stress urinary incontinence

FACT:Only 30% of these women seek medical attention. Many times, an athletic woman is embarrassed to raise the issue with her physician and may wear a pad, modify her technique or stop exercise all together to cope with her incontinence

Some important dos and don'ts on how to exercise and stay dry DON'T strain!! AVOID REPETITIVE HIGH IMPACT EXERCISE. You may be putting too much stress on your pelvic floor muscles causing damage.

DO feel free to exercise aerobically (low impact) as much as you would like. Swimming, , walking, water aerobics, or a stationary bicycle are great options. However, do not forget to exercise your pelvic floor, too! This can only be done through Kegel exercises.

A variety of surgical and non-surgical treatment options are available. Non-surgical options include pelvic floor muscle strengthening, bladder retraining, and use of a pessary. Surgical options include a minimally invasive sling, collagen injections and a bladder stimulator (sacral neuromodulation). Our goal is to educate you and provide you with the best treatment plan that fits your unique needs.

This is a minimally invasive outpatient procedure for the treatment of stress incontinence. During this procedure a tape is placed to support the bladder outlet tube ( creating a hammock) to prevent leakage. The procedure is done through a small vaginal incision. This procedure is very effective in relieving urinary leakage associated with laughing, coughing and physical exertion.

YES

Some foods and beverages are thought to contribute to urine leakage. They are called BLADDER IRRITANTS and include:

* Alcoholic beverages
* Carbonated Beverages (with or without caffeine)
* Coffee or Tea (even decaffeinated)
* Medicines with caffeine
* Citrus juice and fruits
* Tomatoes/Tomato-based products
* Highly spiced foods
* Sugar and artificial sweetener
* Chocolate

Cystocele:It is a bulging of the bladder through the front wall of the vagina. It occurs when the support structure between the vagina and bladder has torn or weakened.

Rectocele:It is a bulging of the rectum through the back wall of the vagina. It occurs when the support structure between the vagina and rectum has torn or weakened.

Enterocele:It is a bulging of the intestines through the top of the vagina.

Uterine prolapse: It is descent of the uterus.

Vault prolapse:It is the descent of the top the vagina after a hysterectomy.

The symptoms depend on which type of prolapse you have. Since prolapse usually occurs slowly over time, the symptoms can be hard to recognize in the early stages. The most common symptom is feeling something protruding outside of the vagina. Sometimes women have difficulty emptying the bladder or bowels and may notice a change in their urine stream.

A pessary is a flexible ring that can be inserted into the vagina to treat prolapse. It holds up the bulge and provides symptom relief. It is inserted in the office and needs to be cleaned and replaced every 2-3 months. Some women can remove and reinsert the pessary on their own.

NO.

A hysterectomy will only be recommended for treatment of some forms of prolapse. Your physician will discuss your desires for hysterectomy, and recommend the appropriate surgery after your initial evaluation.

There are many different procedures available to treat prolapse. Some procedures are done through the vagina, and others are done through the abdomen or through a laparoscope.

These include:
VAGINAL OPERATIONS

- Anterior repair: a procedure to treat cystocele

- Posterior repair:procedure to treat rectocele

- Vault suspension:procedure to anchor the top of the vagina to strong pelvic ligaments.

ABDOMINAL OR LAPAROSCOPIC OPERATIONS

- Sacrocolpexy:procedure to suspend the top of the vagina to the tailbone using a piece of mesh.

NO.

Some of the older surgical procedures had a high recurrence rate and this led to the bad rap for all surgeries. This is not true. With the latest advancements in technology and the newer minimally invasive surgical techniques the recurrence rate has decreased.

We don't fully understand all the factors that cause urinary leakage and prolapse, so it is difficult to recommend ways to prevent these problems. Pelvic floor exercises (Kegel's) - are probably the best way to prevent stress incontinence and prolapse. Other things that might help include not smoking, avoiding repetitive strenuous activities that involve very heavy lifting (for example lifting 50lb boxes onto a truck several hours a day), managing constipation and avoiding the use of forceps or vacuum.

There are multiple tests available to accurately diagnose your condition. These include urodynamic testing, uroflometry, simple cystometry, and cystoscopy. Not all tests need to be performed and your physician will recommend the appropriate tests that you need.

It is a comprehensive, computerized test to assess bladder function. It is performed in the office and usually takes 30-45 minutes. It provides detailed information to help diagnose bladder disorders and choose the appropriate surgery.

This test allows your physician to visualize the bladder and its outlet tube (urethra) using a thin camera. It can be done in the office and is relatively painless.

Common Bladder Irritants: Some foods and beverages are thought to contribute to

* Alcoholic beverages
* Carbonated Beverages (with or without caffeine)
* Coffee or Tea (even decaffeinated)
* Medicines with caffeine
* Citrus juice and fruits
* Tomatoes/Tomato-based products
* Highly spiced foods
* Sugar and artificial sweetener
* Honey
* Chocolate