Conditions Affecting Continence

Expert Treatment for Various Conditions

At Lahey Hospital & Medical Center’s Continence Center, our urologists are experts in the surgical and nonsurgical treatment of various physical conditions that can be related to urinary continence.

Pelvic Organ Prolapse

Pelvic organ prolapse is a downward descent of female pelvic organs – including the bladder, uterus and the small or large intestine – that results in a protrusion of the vagina, uterus or both.

Prolapse can be attributed to several factors, including vaginal childbirth, advancing age, obesity, heavy lifting, repeated straining during bowel movements or various surgical procedures. Prolapse can cause a variety of symptoms including urinary or fecal incontinence, vaginal discomfort and painful sexual intercourse.

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.

Urethral Diverticulum

Urethral diverticulum is a condition in which a small bulge similar to a pocket or pouch forms next to the urethra. Because it often connects to the urethra, this pouch gets filled with urine during urination and can cause symptoms such as frequent or urgent urination.

A urethral diverticulum is more common in females than in males. With the right treatment, cure rates are high and recurrences are rare.

Complex Lower Urinary Tract Fistulas

There are two types of complex lower urinary tract fistulas:

• Vesicovaginal fistula (VVF) is an abnormal connection between the bladder and the vagina that results in continuous urine leakage. Trauma from childbirth remains the most common cause of VVF in developing countries. In industrialized nations, however, most fistulas result from complications of gynecologic and other pelvic surgery, such as a hysterectomy. VVF is treated with surgery.
• Urethrovaginal fistula (UVF) is an abnormal connection between the urethra and the vagina that results in continuous urine leakage. UVF may result from trauma during childbirth, pelvic surgical procedures or radiation therapy for pelvic cancer. Because they are uncommon, most UVFs are seen and treated in specialized centers such as Lahey’s Continence Center, where we offer both open and robotic surgical repair.

Interstitial Cystitis (Painful Bladder Syndrome)

Interstitial cystitis (IC), also called painful bladder syndrome (PBS), is a condition in which a person feels bladder pressure and pain that can range from mild to severe. It most often affects women. The cause is unknown, although experts believe several factors, such as heredity and an immune system reaction, may be responsible.

Specialists at Lahey’s Continence Center have devised various therapies that have been successful for many of our patients.

Nervous System Injury & Disease

Neurourology is the study of how injuries and diseases of the nervous system affect the bladder. Among the advantages of Lahey’s group practice model is the ability of physicians from multiple subspecialties to work together as a team.

In caring for patients with spinal cord injuries, multiple sclerosis, Parkinson’s disease, stroke, and other neurologic conditions, Lahey urologists work collaboratively with neurologists, neurosurgeons and orthopedic surgeons to develop individualized treatment plans.