Few people want to talk about incontinence, the loss of bladder or bowel control. But it is a reality that affects 25 million Americans of all ages and both sexes.
Options are available to treat it.
Uterine or vaginal prolapse is a common problem that occurs when a woman’s pelvic floor muscles and ligaments stretch and weaken. When prolapse, or bulging, occurs, these muscles provide inadequate support for the bladder, rectum or uterus, which drop into the vaginal canal. This causes urinary incontinence, or an inability to control one’s urine. It can also lead to symptoms of vaginal bulge/swelling, vaginal pain or discomfort, problems with sexual relations and bowel movements.
“Many women are too embarrassed to even report this to their doctor,” said Gregory Tyler, M.D., an obstetrician/gynecologist who sees patients at Marshfield Clinic Marshfield Center. “Instead they just live with it.”
Dr. Tyler emphasized that uterine prolapse is a natural consequence in many women. A combination of factors can lead to it, including vaginal childbirths, the effects of gravity, loss of estrogen, poor tissue strength and reduced tone of pelvic floor muscles. He first tries to treat these conditions conservatively with a supportive device such as a vaginal pessary, Kegel exercises to strengthen the pelvic floor muscles, weight reduction or treatment of chronic straining maneuvers.
“If these approaches do not work, I perform minimally invasive surgical correction procedures through the vagina or through small incisions on the abdomen,” he said. “I can often repair the prolapse using their native tissue or synthetic mesh, in carefully selected women, to hold up the descending organs. “This minimally invasive approach provides much faster recovery than the more traditional large abdominal incision surgery.”
The U.S. Food and Drug Administration (FDA) recently issued a warning against synthetic mesh because of problems with mesh erosion. Patients have asked about this warning, he said. It affects meshes other than those he uses as a sling to treat female urinary incontinence or the sling used to support the vagina, which is inserted through tiny incisions on the abdomen.
Synthetic mesh for vaginal prolapse repairs still has a place, he emphasized, for a very select group of women. These include women who have had a repair using their own natural tissue that has failed, and women who suffer chronic medical conditions and are not surgically fit for recurrent surgeries. He said it’s also important that mesh procedures be done only by surgeons well trained and certified in using them.
“It’s a shame that many older women who have had hysterectomies in their past are reluctant to seek help for vaginal prolapse or urinary incontinence,” he said. “They think nothing can be done, or they’ve heard something bad about the synthetic mesh. I want them to know that we do have good treatment options available even without the mesh, which will help most women improve their quality of life.”