Posts Tagged ‘Depends’

When Things Aren’t Right “Down There”-Pelvic Organ Prolapse

March 30, 2010

This is a common condition that affects millions of American women. It is a condition that occurs when one of the pelvic organs such as the uterus, bladder, intestines, or rectum protrudes through the vagina. Prolapse ranges from mild to severe levels where mild prolapse is found by the doctor at the time of a pelvic exam and a severe condition when the organs protrude the vaginal opening and is visible and can be felt by the women when she is in the standing position.

Prolapse is caused by a weakness in the muscles and support structures in the vagina that normally hold the pelvic organs in place and when weakened allows one of the organs such as bladder or uterus to drop into the vagina and when severe protrudes through the vaginal opening. The process of childbirth through the vagina stretches the vaginal muscles and supporting structures and weakens the vagina and allows the organs to drop into the vagina. Each additional vaginal delivery adds more stretch and leads to the potential for more prolapse. Also aging and the accompanying estrogen deficiency also promotes weakness of the vaginal muscles and promotes prolapse. Less common causes include obesity, asthma, bronchitis and other pulmonary conditions that are associated with chronic coughing.

Symptoms of Prolapse?

The most common symptom of prolapse is a feeling of pressure in the vaginal or rectal area. Women often describe a sensation as if they have a ball in the vagina. If the prolapse is severe, the woman can see the lump protruding from the vagina. If the protrusion is present all the time, the tissue can be come irritated and be associated with a discharge or bleeding. With more severe degrees of prolapse it may be difficult to urinate because the urethra, the tube that transports urine from the bladder to the outside of the body, becomes kinked causing the women to strain in order to empty the bladder. In rare situations the woman may be unable to urinate and have to go to the emergency room to have a catheter inserted. Occasionally, prolapse is associated with urinary incontinence especially when the woman coughs and sneezes. Sexual problems include irritated vaginal tissues and painful intercourse. When the rectum prolapses through the vagina, there may be a problem of constipation and the woman may have to insert her finger in the vagina to express the stool. With very severe prolapse the tubes from the kidney to the bladder or the ureters are kinked and can cause obstruction and lead to kidney failure if the prolapse is not repaired.

Treatment of Prolapse

There are two treatment options for prolapse especially if the prolapse is producing significant symptoms. These are the insertion of a pessary or surgical correction.

A pessary is a device that is usually made out of a plastic substance and is usually in the shape of a donut or ring. It is placed in the vagina, like a tampon, to restore the organs to their normal position. Pessaries are quite safe, although in some patients they seem to be associated with recurring bladder infections.

If a pessary works, and it is comfortable, it can be a lifetime treatment. It can be left in place for several months at a time, however, it needs to be removed and cleaned and then reinserted.

Surgery to correct prolapse is indicated if there are significant symptoms such as a protrusion that is uncomfortable or causes vaginal bleeding, for women who have difficulty with urination such as straining to urinate or urinary incontinence, or chronic constipation. If the uterus is prolapsed it may be necessary to have a hysterectomy as well as repair the prolapse. In addition, it may be necessary to repair incontinence. Most of the surgery is performed through the vagina and can be done on a one-day stay basis or with one overnight stay in the hospital. Women have to avoid heavy lifting for 4-6 months after the surgery and must abstain from sexual intercourse for a similar time period. The surgery is successful in most cases and restores the quality of life to those who suffer from this common condition.

For additional information please visit my website, www.neilbaum.

Bladder Spasms – When You Really Gotta Go!

March 7, 2010

Have you ever had that strong desire to urinate or a cramping sensation in your lower abdomen that comes without warning and if you didn’t get to the restroom in a nanosecond, you would urinate on yourself?  Most of us have one of these bladder spasms at one time or another but some people have them all the time and their quality of life is certainly diminished.  This article will discuss the causes and the treatment of bladders spasms.

Causes of bladder spasms

Bladder spasms can occur because of something in your diet, such as alcohol, acidic or citrusy foods, that irritate the bladder.  There are also medications such as diuretics that can make you go to the bathroom frequently.  A urinary tract infection, or an irritation of the nerves that supply the bladder are frequently associated with bladder spasms.  The latter situation is referred to as neurogenic bladder.  Another condition that causes bladder spasms is interstitial cystitis, which is associated with urinary frequency, burning on urination, pelvic pain and bladders spasms.  Bladder spasms are commonly associated with the use of a urinary catheter, which is inserted into the bladder to drain the urine from the bladder to a bag on the outside of the body.  When the catheter is removed, the bladder spasms will quickly subside.  However, there are many times when the cause of bladder spasms cannot be identified.

Who is at risk for bladder spasms?

Anyone at any age can have bladder spasms. You are more likely to have bladder spasms with urine leakage if you:

  • Are elderly
  • Are going through menopause
  • Recently delivered a baby or are pregnant
  • Have a urinary tract infection
  • Have recently had lower abdominal or pelvic surgery
  • Have nerve or bladder muscle damage caused by disease or injury

Treatment of bladder spasms

Your doctor will attempt to identify the cause of your bladder spasms and select an appropriate treatment.  Often a combination of treatments will work best.

Change in diet. This may help prevent bladder pain if certain foods and beverages are the culprit behind your spasms. Avoid spicy, acidic, or citrusy foods, as well as excessive caffeine and alcohol.  Your doctor can provide you with a food list of the most common culprits.

Timed voiding. This involves timed trips to the bathroom to urinate, usually every 1.5 to 2 hours. As the bladder spasms get better and fewer wetting accidents occur, you can extend the time between trips to the bathroom.

Pelvic floor exercises (“Kegels”). Kegels and other forms of physical therapy help strengthen and relax the bladder and other muscles that help the body hold in urine. To tighten your pelvic muscles, squeeze your muscles in the same way as if you were trying to stop the flow of urine or prevent yourself from passing gas. Your doctor can provide you with instructions for performing Kegel exercises.

Medicines to relax the bladder. The most commonly prescribed drugs to prevent spasms are called anticholinergics. They include Detrol, Ditropan, Vesicare, Enablex, Gelnique, and Toviaz.  A common side effect of all of these medications is dry mouth.

Electrical stimulation implant (Inter-Stim). This is placed under the skin to deliver gentle electrical pulses to the bladder at regularly timed intervals. This treatment is only recommended for the most severe bladder spasms that do not get better with other treatments.

Biofeedback. Biofeedback is a method that teaches the mind how to control normally automated body functions. Bladder training is a type of biofeedback. Some doctors believe biofeedback and behavioral changes work better than medicines for treating urge incontinence. A combination of biofeedback and medications may work best.

Bottom Line:  Bladder spasms occasionally occur in nearly everyone.  However, if they are so frequency that they impact your quality of life, then it is time to see your doctor.  Help is available for nearly everyone who suffers from bladders spasms.

Dr. Neil Baum is a physician at Touro Infirmary and can be reached at (504) 891-8454 or via his website,