Nearly one in three women today suffer from what doctors call “the hidden epidemic.” They are talking about pelvic floor disorders which include pelvic organ prolapse and urinary incontinence, two problems treated by urogynecologists, who each year perform some 200,000 procedures nationwide to fix the problems. On our latest edition of Medical Rounds with Baystate Health, Dr. Keisha Jones, a urogynecologist from Baystate Urogynecology, located in Springfield and Northampton, explained for viewers on Western Mass News exactly what pelvic organ prolapse and urinary incontinence is and how it can be treated.
Q: What is pelvic organ prolapse (POP) and how does urinary incontinence sometimes coincide with it.
A: Pelvic organ prolapse,or POP for short, is herniation of the pelvic organs to or beyond the vaginal walls, which can involve a feeling of pressure or fullness. This problem often coexists with urinary incontinence, which is the involuntary loss of urine. Incontinence can be stress related occurring with activities like coughing, laughing, or walking. We call that stress incontinence. Or it can be associated with frequent urination and sudden urges to urinate, which can be accompanied by leaking urine. We call this an overactive bladder.
Q: What places a woman at risk for these disorders, and can they do anything to prevent pelvic prolapse?
A: Most of the risk factors for prolapse and incontinence overlap, including those women who have had a baby, age, obesity, race and ethnicity, and those who have undergone a hysterectomy. Women cannot change their genetic risks for prolapse, but lifestyle changes can sometimes be effective, such as maintaining a healthy weight, eating high fiber foods and drinking plenty of liquids, and exercising the pelvic muscles through what many women know as Kegel exercises.
Q: What treatment options are available today for pelvic prolapse?
A: It really depends upon to what extent a woman is bothered by symptoms. For patients with no complaints, we simply follow them over time with no interventions. For others, treatment may include physical therapy to strengthen the pelvic floor. We can also insert a special vaginal device called a “pessary” to support the pelvic organs. The other option is minimally invasive surgery called “laparoscopic prolapse repair,” which we perform through a small incision in the vagina or through the abdomen by making several very small incisions in the skin. We then insert a laparoscope, which has small instruments and a very small camera attached to it to assist us in reconstructing the pelvic floor. We can also perform this procedure robotically. The good news is that patients go home from the hospital within one day.
Q: What about treatment for incontinence, a problem we hear a lot about today?
A: Treatment varies for incontinence. Physical therapy is an option, but studies show that most women ultimately opt for surgery, which only takes about 20 minutes to perform. It is a minimally-invasive vaginal procedure in which we insert mesh to support the weakened bladder neck. I want women to know that this procedure is not controversial or experimental in any way. It is not the mesh referred to on television commercials placed by lawyers for women who experienced problems with a different type of mesh. These midurethral slings, as we refer to them, are the standard in the world to treat stress incontinence. They are well-studied with a high degree of patient satisfaction. As for an overactive bladder, we usually treat this problem with behavior modification or medications. Severe cases involve treatment with Botox in the bladder or a bladder pacemaker.