Instead of suffering alone with embarrassment, women can get help they
need for pelvic area conditions associated with childbirth and age
Women’s health care has come a long way, particularly for Baby Boomers
who experience age-related problems that affect their quality of life.
In the past, conditions such as incontinence and pelvic organ prolapse
might have been addressed by gynecologists or urologists, but today doctors
who specialize in female pelvic medicine can provide a variety of effective
treatments, from physical therapy to minimally invasive surgery.
Incontinence – causes and cures
Women are more likely to suffer from incontinence, and their chance of
developing it increases with age. But not all incontinence is age-related.
“Stress incontinence” refers to a condition where a person
leaks urine while coughing, lifting a heavy object, laughing hard or sneezing.
For women, having given birth vaginally can be a contributing factor,
and weakened pelvic muscles are the culprit. “It’s due to
a loss of support at the neck of bladder or urethra,” explains
Patricia A. Wallace, MD, a board-certified gynecologist and female pelvic medicine and reconstructive
Remedies include doing Kegel exercises—consciously contracting and
releasing muscles used to control urine flow. “The baseline treatment
is pelvic floor strengthening,” says Dr. Wallace. “A trained
therapist can show women how to do these exercises, and other strength
exercises of the core muscles.”
Other treatments include a pessary ring which a doctor inserts into the
vagina to give support under the bladder neck, says Dr. Wallace. “A
new tampon called Impressa can be used — this puts a bolster under
the urethra bladder area,” she adds.
A surgical sling is another treatment. “A doctor puts a strap of
mesh under the urethra to give it support,” says Dr. Wallace, explaining
that this is done with a patient under general anesthesia. “It’s
the gold standard for stress incontinence,” she says.
“Urgency incontinence” is an age-related condition where a
person’s bladder becomes hyperactive or spastic. Since the brain
isn’t able to control the bladder spasms, the person might accidently
leak urine at any time, Dr. Wallace explains. “Urgency incontinence
can also be caused by MS, Parkinson’s disease or spinal cord injuries.
It is not directly related to childbirth,” she says. Medications
that relax the bladder muscles, and acupuncture that treats the nerves
of the bladder are other nonsurgical treatments, she adds.
Another option is sacral nerve stimulation, in which a small device is
implanted near the sacrum to regulate the nerve signals between the bladder
and the brain.
Pelvic organ prolapse treatment
Prolapse (or dropping down) of the bladder, vagina or uterus is the result
of weakening connective tissue around those organs. Having multiple vaginal
childbirths or chronic constipation can cause it. A telltale sign of this
condition is when a woman feels pressure or a bulging sensation in her
Inserting a pessary ring to hold the organs in place is one simple treatment.
But to repair severe prolapse, doctors often opt to surgically place mesh
patches in the pelvic area in order support the organ walls.
Mission Hospital is fortunate to have a Da Vinci Robot, a machine that
provides surgeons three-dimensional views for precision, small-incision
Dr. Wallace is certified as a Da Vinci robotic-assisted surgeon. “For
prolapse surgery, the robotic approach allows me to get into smaller deeper
spaces than if I had an open incision,” she says. The upside for
patients? Less pain, shorter hospital stays and less blood loss than with
other kinds of surgeries, Dr. Wallace says.
(This article originally appeared in OC Catholic, February 2017)