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What Women Aren't Talking About

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Some women deal with it as if it were a rite of passage in motherhood, or something they just have to “deal with” with age – that tiny bit of urine that comes out when she laughs or jumps up and down in an exercise class. It’s estimated that nearly 50 percent of women suffer from bladder and pelvic floor disorders at some point in their lifetime.

These disorders can be sources of embarrassment and impact a woman’s lifestyle.

Bladder and pelvic floor disorders, also known as urogynecologic disorders, include any pain or dysfunction in the uterus, cervix,vagina, bladder or rectum. Urogynecologic disorders effect women of all ages, but post-menopausal women and women who have given birth are at most risk. A urogynecologist is an obstetrician/gynecologist who specializes in pelvic floor disorders.The sudden urge to empty the bladder for no apparent reason, or urine leakage when coughing or sneezing is called urinary incontinence.

Stress Incontinence and Urge Incontinence

There are two types of conditions that cause urinary incontinence: stress incontinence and urge incontinence.

“When we talk about leaking urine from coughing, sneezing, laughing or exercising, that’s stress incontinence,” says urogynecologist Pamela Levin, MD, assistant professor of obstetrics and gynecology at Penn Medicine. “As women age, or have children, the urethra and surrounding muscles of the bladder can lose their strength.”

Dr. Levin says even women who haven’t delivered babies vaginally and have had cesarean sections, can suffer from stress incontinence. “Pregnancy itself can put stress on the pelvic region, which can weaken the muscles and supporting structures,” says Dr. Levin.

Stress incontinence can be treated with physical therapy including Kegel exercises or the use of a pessary, a removable appliance similar to a diaphragm that is inserted into the vagina to strengthen the pelvic muscles. In some cases, collagen injections may also be used to help minimize urine leakage from the bladder. Named after Dr. Arnold Kegel, Kegel exercises strengthen the muscles that create the pelvic floor.

“To locate the pelvic floor muscles, women should imagine they are trying to stop a flow of urine or keep from passing gas,” says Dr. Levin. “When they have located these muscles, they should hold and squeeze them for a few seconds, then release.”It’s recommended women work their way up to holding and releasing these muscles for 10 seconds at a time, and repeat up to three sets of 10 squeezes every day. In harder to treat cases, surgery is recommended.

Sling Procedure

A sling procedure may be used to support the urethra and bladder.

During the operation, a sling created from FDA-approved mesh is inserted behind the urethra to support the weakened pelvic muscles. Urge incontinence is a type of urinary incontinence that many people refer to as the “gotta go” syndrome.“Women with urge incontinence, or overactive bladder syndrome, experience sudden, strong urges to empty their bladder and can experience urine leakage,” says Heidi Harvie, MD, director of Penn Urogynecology at Pennsylvania Hospital. “Overactive bladder is caused by nerve damage in the bladder, which makes its treatment more complex.” The first line of treatment, says Dr. Harvie is to reduce the amount of fluids women drink. She also recommends women practice Kegel exercises.“Medications can block some of the nerves in the bladder,” says Dr. Harvie. “While these medications are safe, they can have side effects such as dry mouth and constipation.”

Two other alternative treatments: sacral nerve stimulation, or a bladder pacemaker; and Botox® injections can also be effective in treating urge incontinence.A bladder pacemaker is a reversible treatment that uses mild electrical pulses to stimulate the nerves going to the bladder. It acts like a cardiac pacemaker and is placed during an outpatient procedure. Botox injections treat overactive bladder by relaxing the muscles of the bladder.

Pelvic Organ Prolapse

Pelvic organ prolapse, also called vaginal prolapse, is a condition which the structures that stabilize the uterus weaken and the uterus falls or slides out of place into the vaginal area. Vaginal prolapse can be caused by conditions that stress the pelvic floor muscles such as childbirth or hysterectomy, as well as the decrease in estrogen experienced during menopause. Its treatment depends on the severity of the condition.A pessary may be used to hold the uterus in place, but for women who do not respond to this treatment a surgery called sacrocolpopexy may be recommended.

“Sacrocolpopexy, also called pelvic floor reconstruction, secures the pelvic organs in place with surgical mesh,” says Dr. Harvie. The mesh is attached to the cervix and stronger ligaments in the pelvis thereby lifting and holding pelvic organs in place. “This surgery can be performed robotically so, women can leave the hospital within a day with minimal incisions, less blood loss and have a quicker recovery.”

Dr. Levin, adds: “A woman shouldn’t have to face incontinence or pelvic organ prolapse alone. We offer the latest procedures, and work together to choose the best treatment to meet her needs.”

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