Bladder Problems & Prolapse
What are bladder control problems?
Bladder control problems are conditions that affect the way a person holds or releases urine. Accidental loss or leaking of urine, called urinary incontinence (UI), is one of the most common bladder control problems. UI is not a disease, but a condition that may be related to another health problem or a life event, such as pregnancy, after child birth and menopause. These events, and how the female urinary tract is built, make this more common in women than men.
Bladder control problems can be a small annoyance or can greatly affect a person’s quality of life. A person may be too embarrassed or afraid to participate in activities or may be unable to complete his or her normal routine. For example, a person may lose urine while running or coughing. Or, it may be hard to get to a toilet in time.
Bladder control problems are common, and a person’s life may get better with proper treatment. The sooner you get help, the soonerit may improve.
Do bladder control problems have another name?
Urinary incontinence (UI), urine leakage, and urine loss are other names for a bladder control problem that causes urine to leak.The most common bladder control problems include
- Stress incontinence
Occurs when movement—coughing, sneezing, laughing, or physical activity—puts pressure on the bladder and causes urine to leak.
- Urgency Incontinence
Urgency incontinence occurs when someone has a strong urge, or need, to urinate and leaks before getting to a toilet, when women are not able to wait until they empty their bladder. They find that “When I have to go, I have to go.”
Sometimes a person can have urgency and stress incontinence at the same time, which is also called mixed incontinence.
- Overflow incontinence
Overflow incontinence occurs when the bladder doesn’t empty all the way, causing too much urine to stay in the bladder. With overflow incontinence, urine leaks because the bladder becomes too full.
Who is more likely to develop bladder control problems?
Factors that make you more likely to develop UI include
- being female.
- being older. As you age, your urinary tract muscles weaken, making it harder to hold in urine.
- life events, such as pregnancy, childbirth, and menopause
- health problems, such as diabetes, obesity, or long-lasting constipation.
- birth defects. You may have a problem with the structure of your urinary tract.
Your doctor can help find the cause of bladder control problem and let you know your options for treatment.
Related bladder symptoms and problems
If you have UI, you are more likely to have other bladder symptoms or problems, such as
- urinary frequency
- getting up from sleep to urinate,
- difficulty urinating
- trouble emptying your bladder fully, also called urinary retention
- dribbling urine after you think you’ve finished
Which tests help find the cause of a bladder control problem?
(in addition of taking your medical history and completing a physical examination.): Urinalysis (both routine microscopy & culture) Blood test (can show problems with kidney function or a chemical imbalance in your body)
Bladder function tests also called urodynamic testing, show how well your bladder, urethra, and sphincters work. Most urodynamic tests focus on how well your bladder can hold and release urine.
Doctors use urinary tract imaging to diagnose other conditions that may cause LUTS.
How can I treat my bladder control problem?
Treatment depends on the type of UI you have. Your doctor may recommend you first try self-care treatments.
Make lifestyle changes
- Drink the right amount of liquid at the right time
- Be physically active
- Keep a healthy weight
- Avoid constipation
- Stop smoking.
- Train your bladder (bladder diary)
- Do pelvic floor muscle exercises
How can my doctor treat my bladder control problem?
If you can’t manage your UI using self-care and new habits, your doctor may prescribe medicine, a medical device, a bulking agent, or—as a last resort—surgery to help treat UI.
If you have overflow incontinence caused by a blockage or a narrowed urethra, a doctor can treat it with surgery to remove the blockage.
A weak bladder neck or poorly supported urethra can cause stress incontinence and may be treated with sling surgery, a surgeon works through the vagina to insert a strip of material—usually mesh—in the tissue between the vagina and urethra.
PELVIC FLOOR DISORDERS
Many a women have an injury during vaginal childbirth that leads to incontinence and other pelvic floor disorders, including prolapse. But what do you really know about these disorders? Here are some of the most common questions about pelvic floor disorders:
What is the Pelvic Floor?
The pelvic floor is composed of muscles and ligaments that form a sling across the opening of the pelvis. Muscles and ligaments work together in women to support pelvic organs such as the vagina, uterus, bladder and bowel. Pelvic floor disorders are caused by weakening support of the muscles, ligaments and connective tissue in the pelvic area.
What is Pelvic Organ Prolapse?
Prolapse is the bulging or dropping of the uterus, rectum or bladder into the vagina. There are several different types of pelvic organ prolapse and it is common to have more than one type at the same time. While prolapse is not considered a life threatening condition, it may cause a great deal of discomfort and distress. The various types are:
- Cystocele – when the bladder falls down into the vagina
- Uterine prolapse – when the womb drops down into the vagina or buldges out
- Vaginal vault prolapse – when the vagina itself falls down
- Enterocele – when the small bowel pushes against the vagina causing a bulge
- Rectocele – when the rectum falls
What causes pelvic organ prolapse?
Many different factors may increase your risk of developing pelvic organ prolapse, such as number of vaginal deliveries, family history of prolapse, menopause, heavy lifting, obesity, chronic coughing from smoking, asthma or chronic bronchitis, neurologic diseases or ethnicity/race.
When should I contact a doctor?
- If you feel a bulge or lump on the outside of your vagina
- If you have lower back pain or increased pelvic pressure that interferes with your daily activities
- If you have irregular vaginal spotting or bleeding
- If you experience frequent urinary incontinence, urinary tract infections, difficulty urinating, frequent urination or any of the symptoms listed here that interfere with your daily routine
- If sexual intercourse is painful or difficult
Women with pelvic organ prolapse can experience all, some or none of these symptoms.
How will I be evaluated?
When you see your doctor, you will have a health history taken in order to get a thorough explanation of your symptoms. A pelvic exam is necessary to diagnose pelvic organ prolapse. If you do have prolapse, your doctor will determine which organs are involved and how severe the prolapse is. Other tests might be ordered, based on your individual examination.
What treatment options are available for prolapse?
Treatment options depend on the severity and discomfort of the prolapse. Three main choices exist for the treatment of prolapse:
- Pelvic floor rehabilitation
Pelvic floor rehabilitation includes “pelvic floor muscle training” (kegel’s exercise) to improve your strength and function.
- Wear a pessary, a small plastic or silicone device placed inside the vagina to hold the organs inside your body
Vaginal Surgeries: In general, vaginal-approach surgeries have a faster recovery time and cause less pain than abdominal surgeries.
Abdominal Surgeries: Abdominal-approach surgeries are performed through a larger abdominal incision, have a longer recovery time and generally cause more discomfort than vaginal surgeries.
Robotic-assisted Laparoscopic Surgery: Robotically assisted laparoscopic surgery, with the daVinci Robot, is performed through several very small, one-centimeter incisions with the use of a video camera. The advantage of this approach is faster healing time and shorter hospital stays than with a more traditional abdominal approach.
Will treatment for prolapse affect my sex life?
If you choose to wear a pessary, your sex life shouldn’t change except you would have to remove the pessary prior to intercourse. If you choose to have surgery, you are asked to wait to have intercourse for a period of time, after which many patients report an improved sex life.
What can I expect at my first visit?
- The doctor will conduct a thorough history of your symptoms as well as some physical exams and tests
- Pelvic exam
- Evaluation of pelvic support
- Evaluation for loss of urine or stool
- Possible placement of a catheter in your bladder to check for the amount of urine left after you void (post-void residual)
- Neurological exam
- Evaluation of pelvic muscles
- Discussion about your diagnosis and possible treatment options
- Make follow-up appointments or schedule surgery