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Pelvic Organ Prolapse - a condition that occurs when muscles and ligaments supporting the pelvic organs weaken allowing the pelvic organs to slip from their normal position creating a bulge in the vagina. Severe prolapse can cause the uterus to slip partially into the vagina and may cause the upper part of the vagina to sag into the vaginal canal or even outside the vagina.

Some women with prolapse have no symptoms, however, many experience symptoms such as the feeling of sitting on a ball, pulling in the pelvis, pelvic or abdominal pain, painful intercourse, protrusion of tissue from the vagina, bladder infections, or frequent urination.

Prolapse is common and can be caused by pregnancy and childbirth, aging, obesity, chronic cough, chronic constipation, or heavy lifting. Typically, pelvic prolapse worsens over time, but can be corrected by various surgical or non-surgical options.

Urinary & Fecal Incontinence

Urinary Incontinence - involuntary leakage of urine due to loss or weakened voluntary control of the urinary sphincter. Approximately 13 million Americans suffer from urinary incontinence and occurs more often in women than men. The main symptom is the involuntary release/leakage of urine. When and how this occurs depends on the type of urinary incontinence. The two most common types are:

Stress Incontinence - refers to the leakage that happens when physical pressure is placed on your bladder. Such causes include sudden cough, sneezing, laughing, heavy lifting, and exercise.

Stress incontinence can be caused when pelvic floor muscles lose some of their strength from:

  • Pregnancy
  • Childbirth
  • Menopause - when estrogen levels drop, the muscles may get weaker
  • Hysterectomy
  • Other surgical procedures
  • Age
  • Obesity

Urge Incontinence - is also known as reflex incontinence and is present when there is an overactive or unstable bladder. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes urinary urgency. Most often, there is an involuntary loss of urine for no apparent reason while still feeling the sudden urge to urinate. When this urge happens, the person has a very short time to reach the bathroom regardless of what they try to do.

This sudden urge can be caused by a sudden change in position, the sound of running water, or sex.

Some causes of urge incontinence can be:
Cystitis - the inflammation of the lining of the bladder, which occurs when the normally sterile urethra and bladder are infected by bacteria and become irritated and inflamed.

Central nervous system problems such as multiple sclerosis, stroke, or Parkinson's disease.

Overactive Bladder - frequent urination occurring during daytime or nighttime and urinary urgency that in most cases interferes with your lifestyle and habits. An overactive bladder causes a sudden and unstoppable need to urinate even though the bladder may contain only a small amount of urine. It is typically caused by spasms of the muscles of the bladder resulting in an urge to urinate. It is primarily a problem of the nerves and muscles of the bladder.

An overactive bladder's muscles and nerves may have been affected by pregnancy and childbirth, surgery, medication, natural aging, chronic disease, trauma, or obesity.

Fecal Incontinence - the inability to control bowel movements, causing stool to leak unexpectedly. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage while passing gas to a complete loss of bowel control.

Fecal incontinence can be caused by diarrhea, constipation, or muscle or nerve damage.

The muscle or nerve damage may be associated with aging or giving birth. Muscle damage is injury to the rings of muscles at the end of the rectum making it difficult to hold stool back, while nerve damage affects the nerves that sense stool in the rectum or those that control the anal sphincter. Nerve damage may be caused by childbirth, constant straining during bowel movements, spinal cord injury, or stroke.

Constipation, if it is chronic, may lead to a mass of dry hard stool in the rectum that is too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool to move around the impacted stool and leak out. Chronic constipation can also lead to nerve damage that causes fecal incontinence.

Diarrhea - solid stool is easier to retain in the rectum than loose stool, so the diarrhea can cause or worsen fecal incontinence.

Fistulas - an abnormal connection that forms between two organs or vessels. Examples of fistulas are those that form between the bladder and vagina resulting in urinary leakage or between the intestine and the vagina resulting in bowel leakage.

While fistulas are typically caused by injury or surgery, they may also form after an infection has led to severe inflammation.

Fistulas can be surgically repaired allowing the patient to live an active, normal life.

Painful Bladder Syndrome/Intestinal Cystitis - a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. Many women experience mild discomfort, pressure, tenderness, or intense pain in the pelvic region. Symptoms may include an urgent need to urinate, frequent urination, or a combination of these symptoms. Pain intensity is sharpened as the bladder fills with urine or as it empties. These symptoms often get worse with menstruation and pain can be experienced with intercourse. Many women have other conditions such as irritable bowel syndrome and fibromyalgia.

Because the causes of painful bladder syndrome/intestinal cystitis are unknown, treatments are aimed at relieving symptoms. Such treatments include bladder distention, bladder instillation, oral medications and electrical nerve stimulation. Surgery is considered when all available treatments have failed.

Surgical Mesh Complications - complications that may have occurred from the use of surgical mesh to repair pelvic organ prolapse. Many physicians have used surgical mesh to repair weakened tissues caused by pelvic organ prolapse. The implants are put in to reinforce the vaginal wall, or to support the urethra to prevent urine leakage.

The most frequent complications include mesh erosion through the vagina, pain infection, bleeding, pain during intercourse, and urinary problems.



Urodynamic Testing - measures bladder function and efficiency. Urodynamics refers to a group of tests that are performed to examine the bladder's ability to empty steadily and completely. This series of tests can also evaluate abnormal bladder contractions, bladder storage, and the flow of urine. These tests focus on the lower urinary tract that includes the bladder, urethra, and sphincter muscles.

Increasing age, chronic illnesses, injury, and pregnancy can cause problems in the urinary system. The bladder and urethral muscles become weaker with age and cause problems with emptying the bladder completely or more commonly, urinary incontinence.

Reasons for urodynamic testing include: frequent urination, urine leakage, sudden or strong urge to urinate, problems starting to urinate, painful urination, and recurrent urinary tract infections.