Before any treatment is undertaken, step one is insuring patients are given comprehensive education about their particular condition, so that they understand clearly their options and opportunities for cure and/or relief from symptoms.
There are two types of urinary incontinence: stress (in which women experience leaking with coughing, sneezing or laughing) and urge (the sudden, urgent need to urinate.) There are both non-surgical and surgical options, depending on each woman’s individual presentation:
- Dietary modification instruction
- Medications to prevent bladder spasm
- Nerve electrical stimulation
- Kegel exercises instruction
- Vaginal cones or pessaries
- Urethral occlusion
- Collagen injections
- Anterior repair
- Burch urethropexy
- Pubovaginal slings
- TVT, TOT slings
These are complex anatomical presentations, demanding a high level of skill to treat. The most common forms of prolapse are:
Cystocele/urethrocele – the front wall of the vagina sags downward or outward, allowing the bladder to drop from its normal position. This may be referred to as a “dropped bladder.”
Rectocele – the back wall of the vagina sags outward, allowing the rectum to bulge into the vagina.
Uterine prolapse – the upper supports of the vagina and uterus/cervix are weakened, allowing the uterus and cervix to bulge downward and outward.
Vaginal vault prolapse – the vaginal cuff descends below a point that is 2cm less than the total vaginal length above the plane of the hymen. Seen when the upper vagina bulges into or outside the vagina, often in women who have undergone hysterectomy.
Enterocele – the support to the top of the vagina is weakened, allowing bulging of the small intestine. This type of prolapse is most often seen in women who have undergone a hysterectomy.
Surgical intervention, whenever possible, is done in the most minimally invasive procedure possible.
- Anterior repair
- Laparoscopic paravaginal repair
- Posterior repair
- Laparoscopic sacral colpopexy
- Laparoscopic uterosacral
- Ligament suspension
- Sacrospinous ligament