Faculty/Staff
University Physicians Home Page
Print    Email
Decrease (-) Restore Default Increase (+) font size
Continence and Advanced Pelvic Surgery
Our Center
Providers
Clinic Staff
Urinary Incontinence
Pelvic Organ Prolapse
Frequently Asked Questions
Your First Visit
Patient Resources
All Women's Health Center Services
Frequently Asked Questions


Urinary Incontinence

What are pelvic floor disorders?

How common is urinary incontinence among women?

What causes urinary incontinence?

I've heard that surgery doesn't work for very long. Is that true?

How can I prevent this problem?

What are pelvic floor disorders?
The pelvic floor is the muscles, ligaments, connective tissue and nerves that help support and control the rectum, uterus, vagina and bladder. The pelvic floor may be damaged by childbirth, repeated heavy lifting, chronic disease or surgery. Some problems classified as pelvic floor disorders and their symptoms include:

  • Incontinence: Loss of bladder or bowel control, leakage of urine or feces.
  • Prolapse: Descent of pelvic organs or a bulge and/or pressure. It also is known as "dropped uterus, bladder, vagina or rectum."
  • Emptying disorders: Difficulty urinating or moving bowels.
  • Pelvic (or bladder) pain: Discomfort, burning or other uncomfortable pelvic symptoms such as bladder or urethral pain.Overactive bladder: Frequent need to void, bladder pressure, urgency, urgency incontinence or difficulty holding back a full bladder.

How common is urinary incontinence among women?
Many women incorrectly assume that urine leakage is a normal part of aging and one of the effects of childbirth. While the problem of urine leakage is very common, it should never be considered normal. The most commonly quoted study estimates that 11 million American women currently suffer from leakage of urine. A study of 2,800 postmenopausal women (average age 67) funded by the National Institute on Aging found that 56 percent of women experienced urinary incontinence at least weekly.

What causes urinary incontinence?
Urinary incontinence is a symptom, not a disease. This means that there are many possible causes of urinary incontinence. The key to treatment is identifying the specific type(s) of incontinence that a woman has through a careful medical interview and focused physical exam. Also, it may be necessary to perform a special test called urodynamics to diagnose the problem. Urodynamics are necessary if a woman is considering surgery to correct incontinence. The two most common types of urinary incontinence are stress incontinence and urge incontinence. Stress incontinence is urine leakage that happens during activity that causes pressure (or "stress") on the bladder such as laughing, lifting, coughing or sneezing. Urge incontinence is urine leakage that occurs before a woman has a chance to get to the bathroom in response to an urge to urinate. Women with this type of leakage may also experience frequent urges to urinate and frequently waking during the night to urinate.

I've heard that surgery doesn't work for very long. Is that true?
When it comes to treating stress incontinence, not all surgical procedures are created equal. Over the years, literally hundreds of variations of anti-incontinence surgery have been described in medical journals; and some of them don't work very well. Fortunately, research studies have identified two basic kinds of surgical procedures that seem to be the best options: the retropubic urethropexy and the suburethral sling. There is no surgery for incontinence that has a 100 percent cure rate, but either the retropubic urethropexy or suburethral sling should permanently cure 75 to 95 percent of women with stress incontinence. The tension free vaginal tape (TVT) suburethral sling has rapidly replaced most other surgeries for stress incontinence. Many surgeons consider the TVT-type sling to be the "gold-standard" treatment for stress incontinence. The TVT procedure can be performed on an outpatient basis. Our doctors have performed thousands of TVT Slings and prefer this procedure for treating stress incontinence.

How can I prevent this problem?
We don't fully understand all of the factors that cause urinary incontinence, so it is difficult to recommend ways to prevent the problem. Kegel exercises (Pelvic muscle exercises) are probably the best way to prevent stress incontinence. You can be assessed by a physician regarding your ability to effectively perform these exercises and can start an exercise regimen to reduce your incontinence.
Other suggestions that may help include:

  • Avoid heavy lifting (no more than 20 pounds).
  • Watch your weight. Being over weight increases pressure on your pelvic floor.
  • If you smoke, try to quit. Smoking decreases circulation to your pelvis; and a chronic cough will aggravate pelvic floor prolapse. In addition, the effects of inhaled smoke cause bladder irritation as those products are cleared through the urine.
  • Avoid constipation. Straining with bowel movements increases prolapse. If constipation is a problem, please talk to your primary care doctor or us about treatment.
  • Vaginal hormone therapy may be an option to increase the circulation to your pelvis and reduce irritation to the bladder by restoring vaginal tissue tone.

Pelvic Organ Prolapse

What does "prolapse" mean?

What symptoms are caused by my prolapse?

Why did this happen to me? Did I do something to cause this problem?

Do I need to have surgery for my prolapse?

If I choose to use a pessary, won't that give me an infection?

What will happen if I just ignore this problem? Will it get worse?

If I decide to have surgery, what can I expect during the recovery period?

If my surgery is successful, how long will it last?

I have prolapse, but I don't leak urine. Do I still need bladder testing?

How will my prolapse treatment affect my sex life?

What does "prolapse" mean?
Prolapse means displacement from the normal position. When this word is used to describe female organs, it usually means bulging, sagging or falling. Prolapse is essentially a hernia in the vagina. It can occur quickly, but usually happens over the course of many years. There are various types of prolapse that can occur individually or together. Terms used to describe different types of prolapse or hernias in the vagina include cystocele, rectocele, enterocele and uterine prolapse.

What symptoms are caused by my prolapse?
The symptoms depend on which type of prolapse you have. Since prolapse usually occurs slowly over time, the symptoms can be hard to recognize. Most women don't seek treatment until they actually feel something protruding outside of their vagina. The very first signs may be subtle such as pain during intercourse or an inability to keep a tampon inside the vagina. As the prolapse continues, some women complain of a bulging or heavy sensation in the vagina that worsens by the end of the day or during bowel movements.

Why did this happen to me? Did I do something to cause this problem?
No. There are many factors that seem to contribute to the development of prolapse and almost none of them are things you can control. Genetics plays a major role. Vaginal deliveries may predispose certain women to develop prolapse, but we haven't learned how to identify these women before they have children. Other conditions that seem to go along with the development of prolapse are severe obesity, pelvic tumors and chronic constipation. Repetitive heavy lifting may contribute to prolapse as well.

Do I need to have surgery for my prolapse?
Only a trained physician can help you answer this question. There are two non-surgical choices -- do nothing about it or wear a pessary. A pessary is worn in the vagina like a diaphragm. Pessaries come in many different shapes and sizes all designed to support the prolapsed pelvic organs. Many women are completely satisfied using a pessary for years and avoid surgery. Other women prefer surgery. Again, if you have prolapse be sure to get an examination and discuss this with your doctor.

If I choose to use a pessary, won't that give me an infection?
The ideal way to use a pessary is to insert it each morning and take it out for cleaning each night. When this is not possible, women come to the office about four to six times a year for an exam and pessary cleaning. Even when a pessary is worn almost continuously, vaginal infections are rare although vaginal discharge is common.

What will happen if I just ignore this problem? Will it get worse?
Probably. It may not happen quickly, but if left untreated, pelvic organ prolapse usually gets worse. However, treatment of prolapse should be based on your symptoms. In rare cases, severe prolapse may cause urinary retention that progresses to kidney damage or infection. When this occurs, prolapse treatment is considered necessary. In most other cases, patients should be the ones to decide when to have their prolapse treated based on the symptoms they are having.

If I decide to have surgery, what can I expect during the recovery period?
Depending on the extent of your surgery, the hospital stay usually lasts one to three days. Some women have difficulty urinating immediately after the surgery and have to go home with a catheter in place to drain the bladder. These catheters are usually only necessary for three to seven days. Most patients require at least some prescription strength pain medicine for about one week after surgery. Following our surgeries to correct urinary incontinence or prolapse, we ask patients take it easy for 12 weeks to allow proper healing. This means no lifting more than 8 pounds (the weight of a gallon of milk), no intercourse for 6 weeks and no exercise other than walking. Further instructions may be found in our post-operative instructions patient education packet.

If my surgery is successful, how long will it last?
The goal of continence or pelvic reconstructive surgery is to recreate normal anatomy permanently. However, none of these procedures are 100 percent successful. According to medical literature, failures occur in 5 to 15 percent of women who have prolapse surgery. In these cases, it is usually a partial failure that may require pessary use or surgery that is much less extensive than the original surgery. Patients who follow our recommended restrictions after surgery give themselves the best chance for permanent success. Also, we follow you after surgery to help you strengthen your pelvic muscles and optimize outcomes.

I have prolapse, but I don't leak urine. Do I still need bladder testing?
Sometimes. If you are going to have surgery to correct the prolapse, urodynamics (bladder testing) should be considered. That's because the prolapsed portion of your vagina may be pushing on your urethra and preventing urine leakage. If that is the case, having the prolapse corrected may give you a new problem -- urinary incontinence. The only way to tell whether a continence procedure is needed at the time of prolapse surgery is to perform urodynamics while holding the prolapse up in its normal position. Also, many women with prolapse may have other bladder problems such as frequency, urgency or trouble emptying - all of which should be addressed before surgery.

How will my prolapse treatment affect my sex life?
If you choose to use a pessary, your sex life shouldn't change, except for the fact that the pessary usually needs to be removed before intercourse. If you have reconstructive surgery to correct prolapse, we recommend you refrain from intercourse for six weeks after your operation to allow proper healing. After this period, getting used to having intercourse will take some time, but most patients report an improved sex life afterwards.

When prolapse is severe, one surgical option is to completely close the vagina. This procedure, called colpocleisis or colpectomy, is less invasive than reconstructive surgery. It is especially useful for patients with severe medical conditions. Of course, intercourse is impossible after having this procedure, so it is only appropriate for patients who are absolutely sure they never will be sexually active again.




Human Resources Giving Disclaimer Notice of Privacy Practices Web Communications Social Media Site Index
Mizzou University of Missouri University of Missouri System