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Urogynecological FAQ's
How common is urinary incontinence?

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.
Are there different types of Urinary Incontinence?

Stress incontinence is the leakage of urine that happens when you cough, laugh, exercise, sneeze and sometimes can happen with just walking. It happens because that bladder outlet valve (called a sphincter muscle) has become weak. This often happens due to pelvic floor trauma due to childbirth.

Urge incontinence is leakage that happens when you feel a strong urge to urinate. It is caused by a sudden strong contraction (spasm) of the bladder muscle. Dysfunction of the nerves that control the bladder can also lead to this type of leakage

Mixed incontinence Women who have both stress and urge incontinence are said to have mixed incontinence.

There are other less common types of incontinence
What is the pelvic floor?
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:

Incontinence:Loss of bladder or bowel control resulting in leakage of urine or feces.

Prolapse:Descent of pelvic organs that often presents as a protrusion of tissue from the vagina

Emptying Disorders:Difficulty urinating or moving bowels.

Overactive Bladder:Bladder condition that includes a frequent need to void, urgency (strong sensation to urinate that cannot be postponed), and difficulty holding urine.
Is incontinence a normal part of aging?
The short answer is- NO.

Urinary and fecal incontinence become more common with advanced age, but are NEVER a normal part of aging.
What causes incontinence and prolapse?
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.
I leak when I exercise. What can I do ?
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.
What treatment options are available to treat incontinence?
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.
What is a minimally invasive sling?
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.
Can diet affect urinary leakage?

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
What are the different types of prolapse?
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.
What are the symptoms of prolapse?
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.
What is a pessary?
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.
Is a hysterectomy always necessary to treat prolapse?

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.

What surgeries are available to treat prolapse?
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.
Surgeries to correct prolapse
These include:

- 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.


- Sacrocolpexy:procedure to suspend the top of the vagina to the tailbone using a piece of mesh.
Is it true that surgery does not work most of the time?

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.
How can I prevent incontinence and prolapse?
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.
What are some of the tests done during my evaluation?
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.
What is urodynamic testing?
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.
What is cystoscopy?
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
   Losing urine when you laugh, cough,jump or sneeze is very common and often goes untreated. Don't let fear or embarrassment keep you from seeking help. Regain your confidence by calling New England Urogynecology for an appointment today! 781.460.2120