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Breaking the silence about Pelvic Prolapse

Breaking the Silence about Pelvic Prolapse

Though half of women who’ve delivered a child and half of women over 50 experience pelvic organ prolapse, it remains something rarely discussed except with a woman’s closest girlfriend or physician.

Why the embarrassment? Pelvic prolapse refers to a condition where the uterus, vagina, bladder and rectum shift positions in a woman’s body and move downward, resulting in some uncomfortable and awkward symptoms such as heaviness or aching in the pelvis, or the leaking of urine or stool. Luckily, there is help for women experiencing this situation.

Blame It On Gravity  Gravity pulls things down as we age: breasts, jaw lines and even the pelvic organs. Every woman experiences some degree of slippage, but some are more susceptible, especially those who’ve had multiple children or a single delivery that involved extensive straining.  Other experiences also can lead to prolapse, including chronic constipation, chronic cough or jobs that involve heavy lifting, says Wes Hilger, M.D., a urogynecologist with Sutter Independent Physicians. “Anything that repeatedly puts pressure on the abdominal organs can strain the ligaments and connective tissue,” he says.

Signs of Prolapse  Many women have some degree of prolapse with no symptoms. Others will feel pressure in their pelvic area or have constipation or pain during bowel movements.

In extreme cases, women may actually feel their uterus or bladder bulging toward the outside of the body through the vaginal opening. Many also leak urine or stool. After having a bowel movement, they feel the rectum isn’t completely emptied.

Even intimacy can be hampered as sensation in the vagina changes. Emotionally, many women feel embarrassment or shame about their symptoms – uncomfortable even telling their spouse or doctor.

Treatment Options  Dr. Hilger says the first step in treatment is to stop blaming yourself.

“You might think, ‘If only I’d done my Kegel exercises more diligently!’ and Kegels do strengthen the muscles of the pelvic floor , which can relieve certain symptoms. But serious prolapse usually involves connective tissues such as ligaments, which won’t respond to exercise,” he says. Once a woman understands what is happening with her body, she may be able accept the symptoms and live with prolapse without surgery. “A woman who feels a bulge or has difficulty urinating might fear a cancerous tumor. She is often relieved to find out it’s prolapse,” Dr. Hilger says.

Maintaining a healthy weight and avoiding heavy lifting may help reduce symptoms by reducing pressure on the organs. For others, a pessary may be needed. This device, inserted into the vagina, helps support the organs mechanically. It can be left in place, removed only for intercourse or occasional cleaning. A pessary also works well for active women with prolapse

If a pessary is not an option, women may be candidates for surgery to lift the organs and tighten connective tissues. Depending on the woman’s anatomy and degree of prolapse, surgeries can be done laparoscopically, vaginally or through an abdominal incision.

Surgeries have a high success rate, although Dr. Hilger “can’t give a lifetime guarantee” of success. “Women will continue to age, and gravity will continue its pull. But a successful surgery will restore women to comfort and functionality,” he says. Other Causes Women should keep in mind that other reasons could be causing symptoms, including urgency (the sudden need to urinate) and stress incontinence (leaking urine when sneezing, coughing or laughing). Not all of these symptoms are related to organ prolapse, but a good medical evaluation will help sort that out.

“Organs may not have slipped, but the urethra alone may be damaged or weakened, and it can be restored with new treatments,” Dr. Hilger says. Bottom line: If you have urinary or bowel symptoms, or feel pressure in the pelvis, have it evaluated. “Ask questions and don’t be embarrassed,” Dr. Hilger says. “This is a fairly common problem, it’s not life threatening, and there are treatments. That is good news.”

Posted in Female Pelvic Medicine, Gynecologic Conditions, Menopause, Reconstructive Surgery, Robotic Surgery, Urogynecology, Vaginal Prolapse | Leave a comment

Tips for Improving Sexual Health in Menopause

Trying to maintain a sense of ones sexuality and wellness can be difficult in menopause. Women in menopause and beyond may be experiencing life stress as children move out, retirement looms, and aging parents require time and attention. Also, as women age, they are more likely to require medications that can negatively affect sexual health. Body image issues, depression, anxiety, and discrepancy with partner desire levels can all be prevalent in women aged 45-64 years, the group most likely to experience distress from sexual problems.

When sex is good it can add to an already great relationship. But when sex is bad or nonexistent, it plays an inordinately negative role, reducing the quality of the relationship by 50%-70% in some studies.

At our clinic we know that intimacy is an important part of a woman’s sense of self. So, we will ask the questions some physicians may not ask, “Are you feeling well and complete in your sex life?” If questioning reveals unsatisfying or nonexistent sex, many problems can be addressed in the office.

First, careful questioning and an exam can tease out the extent to which dyspareunia and vaginal dryness may be limiting sexual pleasure. In that case, Mona Lisa Touch Laser Therapy, lubricants, moisturizers, and topical estrogen can be considered.

Office sessions with physical therapists certified in pelvic issues, combined with home use of dilators, can help overcome physical contributors to an uncomfortable sexual experience, she said.

In addition here are some tips for sexual health in menopausal women:

  • Add moisture and elasticity. Mona Lisa Touch Laser therapy can regenerate tissue to create a healthy, moist and more elastic vagina. This can significantly increase comfort and satisfaction with sex and make it easier to have an orgasm.
  • Nourish. A Mediterranean diet has been shown to promote sexual function, and regular exercise improves mood and overall health.
  • Talk. Partners can use “I” language to talk about sex honestly and in a nonaccusatory way.
  • Prioritize pleasure. Intimate time together won’t just happen; even a 20-minute block of time, scheduled weekly, for touching and intimate conversation can clear the way to better sex.
  • Think. Reading or watching erotica, being mindful of erotic thoughts as they occur, and focusing on sensation rather than distractions during arousal are all important.
  • Stimulate. After menopause, some women need more intense stimulation to reach orgasm, so vibrators can be incorporated into sex play.
  • Try. Just opening up and talking about sex problems shows that a woman is committed to her partner, and taking action shows her level of care and concern for the relationship.
Posted in Female Pelvic Medicine, Gynecologic Conditions, Menopause, Mona Lisa Touch, Pain with intercourse | Leave a comment

Will a pill or laser save your sex life?

In August 2015 the US Food and Drug Administration approved Flibanserin to treat a condition called Hypoactive Sexual Interest / Arousal Disorder (HSDD) in premenopausal women. HSDD is considered a type of sexual dysfunction. It is recognized that sexual dysfunction can refer to difficulties in libido (sex drive), arousal and orgasm. Many causes can lead to sexual dysfunction including life stressors, medical conditions and medications. Addressing these conditions first may help HSDD. Flibanserin works by interacting with certain receptors for serotonin which regulate mood, sleep, and digestion among many functions in the body. Researchers are not sure how Flibanserin leads to improved sexual desire in women but studies have shown that it has a beneficial effect in women diagnosed with HSDD. The pill is taken daily and side effects include sleepiness, decreased blood pressure and fainting. The pill should not be taken with alcohol.

It is important to note that the Flibanserin medication is for premenopausal patients. Most patients we see who have pain with intercourse that leads to decreased desire are postmenopausal. These patients suffer from Genital Atrophy Syndrome (GAS). Some premenopausal may also have atrophy symptoms. A pill will not change the atrophy that leads to their suffering. The GAS that leads to suffering can be changed with a laser. We offer the Mona Lisa Touch laser treatment. This resolves the pain from atrophy that leads to decreased pleasurable intercourse. Patients who have no estrogen or cannot take estrogen (Breast Cancer Patients) are ideal and see great results. It is amazing that a simple, painless office procedure improves the intimate relationships and overall sense of wellness for our patients.

Posted in Female Pelvic Medicine, Mona Lisa Touch, Pain with intercourse, Pelvic Pain | Leave a comment

Experience counts in reducing surgical complications

The 10-year incidence of serious complications after mesh-sling surgery for stress urinary incontinence is a relatively low 3.29, but patients treated by surgeons who perform a low volume of the procedures have a 37% higher relative risk of requiring further surgery for complications, compared with patients of experienced surgeons, according to a report published online Sept. 9 in JAMA Surgery. High volume was defined as a number at or above the 75th percentile for yearly volume in the province, or more than 16 procedures per year.

At Urogynecology Consultants Dr. Bowen, Dr. Hilger and Dr. Kasturi have performed thousands of sling operations over the years. They are a referral center for patients having complications with mesh slings for things such as urinary retention, recurrent urinary incontinence, vaginal mesh erosion and bladder mesh erosion. They have the experience to treat stress incontinence and treat patients having complications associated with surgery from stress incontinence. Experience counts in patients having few complications and a high success rate after a sling surgery.

Posted in Female Pelvic Medicine, Reconstructive Surgery, Transvaginal Mesh, Urinary Incontinence, Urogynecology | Leave a comment

Menopause symptoms deserve treatment

Most women are not receiving the treatment they deserve for menopause symptoms says a report published in the journal Menopause. The study interviewed over 2,000 women aged 40-65. The participants answered quality of life questionnaires regarding symptoms associated with lack of estrogen. It was striking that 18.3% of women reported moderate to severe sexual symptoms (dryness, pain, itching, in ability to have intercourse). However, only 11% of women received treatment for symptoms. The reason treatment was not used by the majority of women in the study is not known. However, many women are concerned about the use of hormones and risk of conditions such as breast cancer, endometrial cancer, dementia, heart disease among other medical conditions associated with long term hormone use. Fortunately there are non-hormonal treatment therapies for vaginal changes that occur when women start to lose estrogen in the peri-menopause and menopause stages of life. The FDA recently approved the Mona Lisa Touch laser for treatment of vaginal changes associated with decreased estrogen. The changes can lead to painful intercourse, vaginal itching, burning and urinary urgency. At Urogyneoclogy Consultants we are proud to be on the cutting edge of technology and offer the Mona Lisa Touch laser treatment. This office based treatment will be a revolutionary alternative for women who want to help their body heal itself and regenerate the tissue naturally rather than using artificial hormone therapy.

Posted in Female Pelvic Medicine, Gynecologic Conditions, Mona Lisa Touch, Pelvic Pain, Urinary Incontinence, Vaginal Atrophy | Leave a comment

You are not alone

You are not alone.

If you suffer from urinary incontinence or pelvic organ prolapse, you are not alone. Recent research indicates that women with pelvic floor disorders are not alone. A large analysis of women in the United States looked at women aged 20 years and older. The researchers examined women for urinary incontinence, vaginal prolapse (bulging) and fecal incontinence. Some interesting findings from the study included:

1. 23.7% of women had at least one disorder.
• 15.7% experienced urinary incontinence.
• 9% experienced fecal incontinence.
• 2.9% experienced pelvic organ prolapse.

2. The number reporting pelvic floor disorder symptoms increased with age.
• 9.7% of women aged 20-39 years compared to 49.7% in women aged 80 years or older.
3. The number reporting pelvic floor disorder symptoms increased with the number of deliveries a woman experienced.
• 12.8%, 18.4%, 24.6% and 32.4% of women with none, one, two or three or more deliveries, respectively.
4. The number reporting pelvic floor disorder symptoms increased with body weight.
• 15.1%, 26.3% and 30.4% in women who were normal weight, overweight or obese, respectively.
5. No differences were noted between racial or ethnic groups.

This study should be a wake up call for physicians who treat women. Pelvic floor disorders are quite common and physicians should ask patients about symptoms. A patient embarrassed by the symptoms may not spontaneously mention them to their doctor but a question by the doctor may help open the subject for discussion. At Urogynecology Consultants, we try to reassure a patient and ease their embarrassment over pelvic floor disorders with two important points: they are not alone and there is effective treatment to improve their quality of life.

Posted in Female Pelvic Medicine, Gynecologic Conditions, Reconstructive Surgery, Urinary Incontinence, Vaginal Prolapse | Leave a comment

Question from a patient: I have pressure in the uterus area, which seems less after urinating. Could I be dealing with a fallen uterus?

A fallen uterus (also called uterine prolapse) can occur when the normal suspensory ligaments that support the uterus weaken. These ligaments, the uterosacral ligaments can be stretched with vaginal childbirth, weaken with age or be stretched with conditions that put excessive pressure on the ligaments (chronic coughing, chronic heavy lifting, etc.). As the uterus begins to drop into the vaginal canal symptoms can arise. A sense of heaviness or fullness in the pelvis can be felt, a bulge may be felt in the vaginal opening, a sense of pulling or discomfort in the lower pelvis may be felt and pressure may be felt on the bladder. However, many women will be asymptomatic from prolapse until the prolapse begins to protrude through the opening of the vagina.

Uterine prolapse is not uncommon but conditions that cause bladder symptoms are not uncommon either. The bladder and uterus are right next to each other in the pelvis so concurrent conditions may be perceived by one symptom. A gynecologic examination can assess the suspensory ligaments that support the uterus. Further testing on the bladder may be required to see if the fallen uterus is contributing to your bladder symptoms or if you are dealing with a fallen uterus and a separate bladder condition.

Treatment for a fallen uterus can be non surgical or surgical. Non surgical options can include pelvic floor therapy or a pessary. Pelvic floor therapy can strengthen the muscles in the vagina to help support the weakened suspensory ligaments of the uterus. A pessary is a small rubber device placed in the vagina to support the uterus and weakened vaginal walls. Surgical treatments for a fallen uterus include laparoscopic, robotic and vaginal approaches that may not require removal of the uterus (also called a hysterectomy). Seeking out a physician who can treat a fallen uterus as well as bladder conditions will give you the best options in terms of treatment.

Posted in Uterine FIbroids | Leave a comment

What is the mesh controversy?

If you watch TV you may have seen commercials about lawsuits regarding vaginal mesh. What is the mesh controversy? The term “mesh” refers to a synthetic product used in surgical procedures. These can be made from various materials but the most commonly used mesh material in gynecology is polypropylene which is permanent and can be woven into sheets of various dimensions.

Polypropylene slings were introduced in the 1990’s to treat urinary stress incontinence with a minimally invasive approach. The success of the TVT Sling has resulted in it to becoming the minimally invasive procedure of choice for treating urinary stress incontinence. Medical device companies then took the technology of the TVT sling and applied it to treating pelvic organ prolapse in women with a minimally invasive approach. Transvaginal Mesh Kits were introduced in the early 2000’s with the theory being that it would be as effective for conditions like cystocele (bladder prolapse), rectocele (rectal bulging) and uterine prolapse as the sling was for Urinary Incontinence. The FDA approved the TVM products based on the fact that the TVT Sling had been so effective for urinary incontinence. Unfortunately, with time it was recognized the TVM procedures resulted in complications that could be quite debilitating to the patient. However, it should be noted that in experienced hands these complications may be reduced. Thus, in 2011 the FDA sent out a communication warning patients and physicians about the complications that were reported associated with the TVM devices. The lawsuits and commercials soon followed. Several points are worthy of note. The FDA did not recall any devices and the material of the mesh is not considered dangerous. Mesh used for slings for urinary stress incontinence and mesh used for laparoscopic procedures for pelvic organ prolapse was not part of the FDA communication and is considered safe and effective. The use of TVM can be an effective treatment for pelvic organ prolapse in experienced hands.

Posted in Female Pelvic Medicine, Minimally Invasive Surgery, Pelvic Pain, Reconstructive Surgery, Transvaginal Mesh, Urogynecology | Tagged , | Leave a comment

What is a Urogynecologist?

Urogynecology is a subspecialty of Obstetrics and Gynecology with a focus on the medical and surgical management of women with urinary or fecal incontinence, pelvic organ prolapse and other noncancerous disorders of the female pelvis. The American Board of Obstetrics and Gynecology doesn’t use the term “Urogynecology” for the subspecialty but rather Female Pelvic Medicine and Reconstructive Surgery.

A board certified subspecialist in Female Pelvic Medicine and Reconstructive Surgery must undergo extensive training. This training includes four years of medical school, a four year residency program in Obstetrics and Gynecology and finally a three year surgical fellowship in Female Pelvic Medicine and Reconstructive Surgery. The fellowship spots are limited and competitive. The fellowship focuses on pelvic surgical training with an emphasis on minimally invasive surgical techniques. After completing this training board certification is only granted after completing and passing board examinations in general obstetrics and gynecology and subspecialty Female Pelvic Medicine and Reconstructive Surgery. Board certification in the subspecialty is only maintained by completing yearly Continued Medical Education credits that demonstrate continued learning in the field.

A Urogynecologist is an advanced female pelvic surgeon for benign gynecologic conditions. The focus of my practice is to improve a patient’s quality of life by alleviating their symptoms with non-surgical or surgical techniques. Symptoms can involve the bladder, vagina, uterus or rectum. In my practice I apply my training for benign gynecologic conditions with an emphasis on incontinence, vaginal prolapse and the application of minimally invasive techniques for other gynecologic conditions such as congenital and post-surgical complications (ie vaginal mesh complications), uterine fibroids, vaginal bleeding and endometriosis.

Posted in Female Pelvic Medicine, Gynecologic Conditions, Minimally Invasive Surgery, Pelvic Pain, Reconstructive Surgery, Robotic Surgery, Urinary Incontinence, Urogynecology, Vaginal Prolapse | Comments Off on What is a Urogynecologist?

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