Vaginal prolapse and urinary incontinence: How a urogynecologist can help

Unlike what some people might think, urinary incontinence and/or pelvic organ prolapse are not normal parts of aging for women, even though they are common. If you have either of these conditions, you don’t have to just “live with it” or stop enjoying the things you love to do.

As a urogynecologist, my goal is to restore functional anatomy when someone experiences internal pelvic, urinary and/or sexual issues, such as pelvic organ prolapse and urinary incontinence. These conditions can be isolating, because people often don’t talk about these problems with friends and family (though if they did they might realize they’re far from alone!).

You don’t need to suffer in silence with pelvic floor conditions.

When a urogynecologist can help

There are many reasons to see a urogynecologist (a specialist in the pelvic floor), but the most common genitourinary issues we care for are pelvic organ prolapse (a weakening of the supports of the uterus/cervix, vagina, bladder and rectum) and urinary incontinence (loss of bladder control or leaking urine).

So let’s talk more about these conditions:

Pelvic organ prolapse (also called vaginal prolapse or uterine prolapse)

It can cause a feeling of vaginal pressure or fullness, or even a feeling of a bulge at or past the opening of the vagina. Some people with pelvic organ prolapse may even be able to see this bulge at the vaginal opening.

Urinary incontinence

It can feel like a strong urge to go to the restroom (known as urgency urinary incontinence) or due to activities that put pressure on the bladder (known as stress urinary incontinence), like coughing, laughing, sneezing, jumping, running, etc.

People who have these symptoms may end up altering their daily routine, such as visiting the bathroom more frequently to avoid leaking, identifying all the restrooms ahead of time in public places, drinking less often so that they don’t need to pee as often, wearing incontinence briefs or pads, etc. For people who leak urine while exercising or during intercourse, they might simply stop doing those activities altogether.

When symptoms begin affecting your quality of life, it’s time to see a specialist in the pelvic floor.

Pelvic floor conditions are common

About half of women report at least one pelvic floor condition like those mentioned earlier. And up to one in five women will undergo surgery for prolapse or incontinence in their lifetime.

The most common risk factors for these conditions are childbirth, increasing age and being post-menopausal. Other risk factors include obesity, chronic cough or constipation, family history, and genetic conditions that make vaginal supports weaker.

Treatments that can help

The good news: There are a variety of surgical and non-surgical options to treat pelvic organ prolapse and/or urinary incontinence. These include diet and lifestyle modifications for bladder control issues, seeing a specialized physical therapist, and being fit with a pessary (a silicone dish that sits in the vagina to give support to the vaginal walls and urethra, for prolapse and stress incontinence).

If you have an overactive bladder and urgency urinary incontinence, treatments include:

• Medication
• Botox injections in the bladder
• Nerve stimulation, either in the leg or the tailbone

For pelvic organ prolapse, surgical options include procedures through the vagina or abdomen that use stitches and one’s own tissue or mesh to re-support the walls of the vagina that have become weakened and prolapsed.

For stress urinary incontinence, options include:

• A midurethral sling, which is a lightweight piece of mesh that is placed in the operating room to support the urethra and reduce the likelihood of leaking
• Injecting a material into the walls of the urethra to make it less likely that you’ll leak from stressors like coughing, laughing or sneezing
• Other surgical procedures that use stitches and your own tissue to treat this type of leakage

Some patients, upon learning of all treatment options, decide that they’d like to wait to pursue specific treatment. We call that “expectant management,” and it’s an acceptable choice, too — these conditions affect quality of life, and it’s up to you whether and how to treat them.

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What to expect

The goal with all of these treatments is to improve or resolve the symptoms affecting your quality of life, whether that’s urinary incontinence or prolapse. For incontinence, we’re hoping to significantly reduce leakage or overactive bladder symptoms or even eliminate the symptoms entirely. For prolapse, the goal is to relieve bulge symptoms and restore normal, healthy anatomy. By reducing or eliminating these symptoms, many people notice improved confidence and better sexual satisfaction.

Prolapse surgery recovery

Recovery for pelvic organ prolapse surgery can take six weeks, though patients will likely notice an immediate improvement in their bulge symptoms.

Stress urinary incontinence surgery recovery

It can take six weeks for urination to completely normalize as everything heals after surgery to treat stress urinary incontinence, but many patients notice improvement in their leakage symptoms almost immediately.

Outpatient procedures

Several in-office procedures require little recovery time, and patients see a difference very quickly.

Botox injections in the bladder muscle may improve symptoms as soon as the first week. Urethral bulking (injecting an agent to narrow the urethra) can improve symptoms the day of the procedure. With a bladder nerve stimulator, which is placed in the lower back through the tailbone, results can be seen as soon as the day of the procedure. If you’ve been fitted for a silicone pessary, you’ll likely notice improvements in bulge or incontinence symptoms as soon as it’s placed.

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Urogynecologic surgery

Recovery after urogynecologic surgery is typically six weeks, though it may be less, depending on how complex the individual’s surgery is. Restrictions during that time are to avoid heavy lifting or putting anything in the vagina (using tampons, having intercourse, etc.). Pain often can be managed with over-the-counter medication like acetaminophen (Tylenol) or ibuprofen.

The bottom line

While vaginal prolapse and/or urinary incontinence might feel private, embarrassing and isolating, it’s important to know that there are professional health care providers who are specialists in these conditions. They’ll make you feel comfortable discussing concerns and help develop an individualized treatment plan to care for your specific symptoms so that you can get back to enjoying the things you like to do.