Urogynecology

Urinary incontinence describes the loss of bladder control. A range of issues can cause it, and it can be a temporary or long-lasting condition. Urologists at Lahey have the training and expertise to help you manage your symptoms and find a solution.

Treatments for urinary incontinence include:

Overactive bladder is a complex condition affecting women of all ages. Bladder conditions — such as infection, bladder stones and abnormal growths — and age increase the risk for overactive bladder.

Women with overactive bladder feel a sudden urge to urinate, sometimes followed by leaking. Made of muscle, the bladder walls hold urine. In women with overactive bladder, the bladder muscle is overactive and squeezes too often. These bladder spasms make it feel like you need to urinate often and quickly, even if there isn’t much urine in your bladder.

A physical exam can help your doctor identify other conditions that influence the bladder, such as prolapse. For an accurate diagnosis, testing might include urine analysis, ultrasound or urodynamics.

Treatments for overactive bladder may include:

Pelvic Organ Prolapse occurs when pelvic organs (uterus, bowel, bladder) begin to bulge into the vagina. This is caused by weakening the the muscle, ligaments and supporting tissue (fascia), which make up the pelvic floor. The pelvic floor normally supports the uterus and other organs in the pelvis.

There are four main types of prolapse:

• Cystocele: A cystocele occurs when the wall between a woman’s bladder and vagina weakens, causing the bladder to drop from its normal position. In its most advanced form, the bladder may bulge through the opening of the vagina.
• Enterocele: Small bowel prolapse, known as an enterocele, occurs when the small intestine descends into the lower pelvic cavity, creating a bulge at the top part of the vagina. In women who have had surgery to remove the uterus (hysterectomy), small bowel prolapse is also called apical prolapse.
• Rectocele: When the front wall of the rectum bulges into the back wall of the vagina, this is referred to as a rectocele. Rectoceles are usually due to thinning of the tissue between the rectum and vagina and weakening of the pelvic floor muscles.
• Uterine prolapse: Uterine prolapse occurs when the uterus sags or slips from its normal position and descends into the vagina.

Prolapse is a common problem. Many women have it without symptoms. Symptoms to watch for include:

• Feeling or seeing tissue coming out of the opening of your vagina
• Feeling pressure in the vaginal area
• Trouble urinating or having bowel movements
• Slow urinary stream
• Feeling unable to fully empty the bladder
• Increased frequency of urination
• Urgent need to pass urine
• Stress Urinary Incontinence
• Difficulty having a bowel movement or feeling unable to fully empty
• Needing to press of the vaginal wall to have a bowel movement
• Pain with intercourse

You can prevent the prolapse from worsening by making lifestyle and behavior changes. For example:

• Eliminate constipation and don’t strain during bowel movements
• Don’t lift extremely heavy items
• Avoid repeated heavy lifting
• Maintain a healthy weight, and lose weight if needed
• Quit tobacco use

Treatments available at Lahey for uterine prolapse include:

• Kegel exercises: For mild cases of uterine prolapse, we teach women how to perform these exercises to strengthen their pelvic muscles.
• Pessary: A silicone device that comes in different shapes an sizes. It helps support pelvic organs when placed into the vagina.
• Surgery: In some cases, surgery may be the best way to correct pelvic organ prolapse. Surgical options may include:
  • Vaginal Repairs (Anterior and/or Posterior)
  • Sacrocolpopexy
  • Uterosacral Ligament Suspension
  • Sacrospinous Ligament Suspension
  • Colposcleisis