Losing Your Urine When You Cough Or Sneeze-Treating Incontinence With a Pessary

Pessary For Treating Mild Stress Incontinence

Stress urinary incontinence or loss of urine with coughing, sneezing, or even bending over to put on your shoes affects millions of American women. Often times a woman is looking for a treatment that does not involve medication or surgery. For certain women a vaginal pessary is an option. A pessary is a removable device placed into the vagina. It is designed to support areas of the pelvis such as occurs with pelvic organ prolapse.
There are a variety of pessaries available, made of rubber, plastic, or silicone-based material. Among common types of pessaries are the inflatable , the doughnut, and the Gellhorn.

Frequent Urination: Causes and Treatments
Gotta go all the time? The technical name for your problem is frequent urination or overactive bladder. In most people the bladder is able to store urine until it is convenient to go to the toilet, typically four to eight times a day. Needing to go more than eight times a day or waking up in the night to go to the bathroom could mean you’re drinking too much and/or too close to bedtime. Or it could signal a health problem.

Why It Is Done
Pessaries are used as a nonsurgical approach to the treatment of pelvic organ prolapse. They are frequently used to treat uterine prolapse in young women during pregnancy. In this instance, the pessary holds the uterus in the correct position before it enlarges and becomes trapped in the vaginal canal.
Pessaries are also used when symptoms of pelvic organ prolapse are mild or when childbearing is not complete. They can be used in women who have other serious chronic health problems, such as heart or lung disease, that make a surgical procedure more dangerous.

Pessaries are sometimes used to see what the effect of surgery for pelvic organ prolapse will be on urinary symptoms. This is called a “pessary test.” If you have a problem with incontinence with a pessary inserted, a separate surgery to fix the incontinence problem may be done at the same time as a prolapse surgery
How Well It Works
Pessaries do not cure pelvic organ prolapse but help manage and slow the progression of prolapse by adding support to the vagina and increasing tightness of the tissues and muscles of the pelvis. Symptoms improve in many women who use a pessary, and for some women symptoms go away.

You will need to see a doctor to be fitted for a pessary which will hold the pelvic organs in position without causing discomfort. Pessaries come in a variety of sizes and should be fitted carefully.

What To Expect After Treatment
Your pessary will be fitted in your doctor’s office. You may need to experiment with different kinds of pessaries to find one that feels right. The pessary needs to be remove, clean, and reinsert the pessary on a regular schedule. Most often this is done by the doctor or his\her staff but some women prefer to do this themselves. The cleaning schedule is determined by the type of pelvic organ prolapse and the specific brand of pessary.

Risks
Possible complications from wearing a pessary include:
• Open sores in the vaginal wall.
• Bleeding.
• Wearing away of the vaginal wall. In severe cases, an opening can form between the vagina and the rectum.
• Bulging of the rectum against the vaginal wall (rectocele formation).

Complications can be minimized by having a pessary that fits correctly and that does not put too much pressure on the wall of the vagina.
In post menopausal women, estrogen (cream, ring, or tablets) is sometimes used with a pessary to help with irritation caused by the pessary.
What To Think About

Pessaries often are an effective tool for managing pelvic organ prolapse without surgery. They may be the best choice if you are a young woman who has not finished having children, if you have been told that surgery would be risky for you, or if you do not wish to have surgery for other reasons.
A pessary may not be a good choice after having a hysterectomy. This is because the walls of the vagina are no longer held in place by the uterus and cervix. Women with severe prolapse following a hysterectomy may have difficulty keeping the pessary in place.
Many women can have sexual intercourse with their pessary in place. But you cannot insert a diaphragm (a round rubber device used as a barrier method of birth control) while wearing a pessary. If you have not reached menopause, you may want to discuss birth control with your doctor.


Bottom Line: Stress incontinence is common condition affecting millions of American women. The treatment with a pessary is an option that does not require the use of medication or surgery.

For more information on women’s health, I suggest my new book, What’s Going On Down There-Everything You Need To KnowAbout Your Pelvic Health. the book is available from Amazon.com

New book on women’s health

When Things Are Coming Out “Down There”-Pelvic Organ Prolapse

Pelvic organ prolapse is a common that affects more than 30 million American women in the United States.  Unfortunately, only 15% of women who have prolapse seek treatment from a doctor.  This article will define prolapse, discuss the symptoms of prolapse and discuss some of the treatment options.

Pelvic organ prolapse is a condition where there is a weakening of the support tissues or muscles of the pelvis.  The symptoms of POP include a bulge or lump in the vagina or a pulling or stretching sensation in the groin.  Women with POP may complain of difficulty with sexual intimacy.  They may also have urine and\or fecal incontinence.  They may also have difficulty with bowel movements or difficulty emptying their bladder.

The causes of POP include menopause, multiple pregnancies and childbirth, prior pelvic surgery, obesity, and as a consequence of the aging process.

Treatment options for POP

Conservative therapies including strengthening the pelvic floor muscles.  This can be easily accomplished with Kegel exercises.  These are exercises named after the doctor who devised the treatment, which consists of contracting and relaxing the muscles in the pelvis.  These are the same muscles which hold urine in and rectal gas in place.  A woman should do the Kegel exercises multiple times a day and should not expect any changes for several months until the muscles are strengthened.

For more information on Kegel exercises go to http://www.neilbaum.com/pelvic-exercises-for-women-kegel-exercises.html.

Another conservative therapy is the use of pessaries or plastic or rubber rings which are inserted into the vagina to restore the fallen organ back into the normal anatomic position.   Peccaries will work immediately but they have to be changed periodically in order to avoid vaginal infections.

Probably the most common treatment is surgical repair of the prolapse.  The surgery is used to strengthen structures around the vagina to maintain support of the structures and organs in the pelvis.  These procedures can usually be accomplished through the vaginal opening.  Most women can have the procedure on a one-day stay basis or remain in the hospital for just 24 hours.  Most women need little or no pain medication after the procedure and can return to all activities including heavy lifting, exercise, and sexual intimacy in 3-4 weeks after the procedure.

Most of the surgical procedures that restore the normal anatomy are 90% successful and most patients are very satisfied after the procedure.

Bottom Line:  If something isn’t right “down there” you don’t have to suffer in silence.  There are several treatment options to restore your normal anatomy.  You can have an improved quality of life and return to your normal activities within a short time.  If you have any questions, call your doctor.

 

 

 

 

Loss of Urine After Vaginal Surgery-You Have To Depend On Depends!

There are many women who will develop urinary incontinence after vaginal surgery.  For example if a woman has a protrusion of her bladder, uterus, or rectum into the vagina and needs a surgical correction, the surgery may result in the involuntary loss of urine with coughing and sneezing after the surgery.  The reason is that the protrusion or prolapse kinks or bends the urethra or the tube from the bladder that transports urine to the outside of the body before the surgical correction thus preventing incontinence.  Once the normal anatomy has been restored and the urethra is no longer kinked, urinary incontinence may occur.  It is estimated that more than 30% of women who are continent before surgery will develop incontinence or loss of urine after the procedure.

 

What to do?  Be sure that your doctor checks for incontinence in the office BEFORE you have the surgery.  This may require some testing or maneuvers in the office to reduce the prolapse or protrusion and check for incontinence.  If incontinence is unmasked, then the doctor can perform a small procedure during the surgery to repair the prolapse that will prevent incontinence afterwards.

 

Bottom Line:  Urinary incontinence is a significant problem that results in loss of self-esteem, confidence, and may lead to a reclusive life-style.  In most instances this can be cured and prevented in women who are undergoing vaginal surgery if the doctor is aware of this possibility before the surgery takes place.

 

Menopause and Bladder Control

Some women begin to have problems with their bladder and experience overactive bladder (gotta go, gotta go right now) and urinary incontinence or loss of urine at inopportune times at the time or shortly after menopause.

Does Menopause Affect Bladder Control?

Yes. Some women have bladder control problems after they stop having periods (menopause or change of life). If you are going through menopause, talk to your health care team.

After your periods end, your body stops making the female hormone estrogen. Estrogen may help keep the lining of the bladder and urethra healthy. A lack of estrogen could contribute to weakness of the bladder control muscles.

Pressure from coughing, sneezing or lifting can push urine through the weakened muscle. This kind of leakage is called stress incontinence.

Although there is no evidence that taking estrogen improves bladder control in women who have gone through menopause, small does may help thicken the bladder lining and decrease the incontinence.  Your doctor can suggest many other possible treatments to improve bladder control.

What Else Causes Bladder Control Problems in Older Women?

Sometimes bladder control problems are caused by other medical conditions. These problems include:

Infections

Nerve damage from diabetes or stroke

Heart problems

Medicines

Feeling depressed

Difficulty walking or moving

A very common kind of bladder control problem for older women is urge incontinence. This means the bladder muscles squeeze at the wrong time and cause leaks.

If you have this problem, your doctor can prescribe medication that can certainly alleviate that problem.

What Treatments Can Help You Regain Bladder Control?

Your doctor may recommend limiting foods or fluids, such as caffeine, which are bladder irritants and increase the desire to go the rest room.

There are also pelvic exercises that can strengthen the muscles in the urethra and the vagina.   Life’s events like childbirth and being overweight, can weaken the pelvic muscles.

Pelvic floor muscles are just like other muscles. Exercise can make them stronger. Women with bladder control problems can regain control through pelvic muscle exercises, also called Kegel exercises.

Exercising your pelvic floor muscles for just five minutes, three times a day can make a big difference to your bladder control. Exercise strengthens muscles that hold the bladder and many other organs in place.

Two pelvic muscles do most of the work. The biggest one stretches like a hammock. The other is shaped like a triangle. Both muscles prevent leaking of urine and stool.

Pelvic exercises begin with contracting the two major muscles that stretch across your pelvic floor. There are three methods to check for the correct muscles.

1.     Try to stop the flow of urine when you are sitting on the toilet. If you can do it, you are using the right muscles

2.     Imagine that you are trying to stop passing gas. Squeeze those same muscles you would use.

3.     Lie down and put your index finger inside your vagina. Squeeze as if you were trying to stop urine from coming out. If you feel tightness on your finger, you are squeezing the right pelvic muscle.

Do your pelvic exercises at least three times a day. You can exercise while lying on the floor, sitting at a desk or standing in the kitchen.

Be patient. Don’t give up. It’s just five minutes, three times a day. You may not feel your bladder control improve until after three to six weeks. Still, most women do notice an improvement after a few weeks.

Other treatments include inserting a device, a pessary, directly into the vagina to lift the urethra and the base of the bladder to its proper position behind the pubic bone.  And finally, if the conservative methods of medication, exercises, and dietary modification don’t work, then you should talk to your doctor about one of the surgical procedures that can lift the bladder into the proper position to prevent leakage

Bottom Line: No one needs to suffer the embarrassment of urinary incontinence.  Help is available for all those women who have bladder control problems

A Kegel A Day Keeps the Doctor Away

Mary Ann is a 45-year old woman who loses urine (incontinence) when she coughs and sneezes.  She is provided with exercises to strengthen the pelvic floor muscles of her bladder. She does the exercises every day for 12 weeks and has significant improvement in her urinary symptoms.

There are many conditions that put stress on your pelvic floor muscles such as childbirth through vaginal deliveries, obesity, chronic coughing, and after menopause when there is a deficiency of estrogen or the female hormone produced in the ovaries.

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

How to perform Kegel exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. You can learn to identify the proper pelvic muscles by trying to stop the flow of urine while you’re going to the bathroom.

If you’re having trouble finding the right muscles, don’t be embarrassed to ask for help. Your doctor can give you important feedback so that you learn to isolate and exercise the correct muscles.

After you’ve identified your pelvic floor muscles contract your pelvic floor muscles and hold the contraction for three seconds then relax for three seconds.  Repeat this exercise 10 times.  After you have learned how to contract the pelvic muscles for 3 seconds, work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.  Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as sitting at a red light.

For those women who have trouble doing Kegel exercises, biofeedback training or electrical stimulation may help. In a biofeedback session, a nurse, therapist or technician will either insert a small monitoring probe into your vagina or place adhesive electrodes on the skin outside your vagina or rectal area. When you contract your pelvic floor muscles, you’ll see a measurement on a monitor that lets you know whether you’ve successfully contracted the right muscles. You’ll also be able to see how long you hold the contraction.

Results are not immediate or the first time you do the exercises.  You can expect to see some results, such as less frequent urine leakage, within about eight to 12 weeks. Your improvement may be dramatic — or, at the very least, you may keep your problems from worsening. As with other forms of physical activity, you need to make Kegel exercises a lifelong practice to reap lifelong rewards.

An added bonus: Kegel exercises may be helpful for women who have persistent problems reaching orgasm.

Bottom Line:  Many women have a problem of loss of urine with coughing and sneezing.  Kegel exercises are effective for very mild urinary incontinence.  It’s inexpensive, does not require use of medication, and if you are patient, it does, indeed, work.