Urinary Incontinence and Pelvic Organ Prolapse

An estimated 15 million to 20 million people in the United States have bladder control problems. The condition affects men and women, although it is nearly twice as common in women.

One of the most prevalent medical problems we see in our patients is urinary incontinence (UI). Involuntary loss of urine is reportedly experienced by more than 95 percent of women at some time during their reproductive and post-menopausal years.

If you are affected by loss of bladder control, remember these two most important truths:

  • You are not alone.
  • Many treatment options are available.

Symptoms of pelvic floor dysfunction may include:

  • Incontinence: Loss of bladder or bowel control, leakage of urine or feces.
  • Prolapse: descent of pelvic organs, causing a bulge and/or pressure in the pelvis region brought on by a "dropped uterus, bladder, vagina or rectum.
  • Emptying Disorders: Difficulty urinating or moving bowels.
  • Pelvic (or Bladder) Pain: Discomfort, burning or other uncomfortable pelvic symptoms, including urethral pain.
  • Overactive Bladder: Frequent need to urinate, bladder pressure, urgency, urgency incontinence or difficulty holding back a full bladder.

Treatment Options

A variety of treatment options may be recommended to cure of relieve symptoms of prolapse, urinary or fecal incontinence and other pelvic floor problems. Conservative (nonsurgical) options include medications, pelvic exercises, behavioral and/or dietary modifications and use of vaginal devices (pessaries). Biofeedback and electric stimulation are newer treatments that may be recommended.

One of the following safe and effective surgical procedures may be recommended:

Prolift for Prolapsed Pelvic Organs. Pelvic organ prolapse occurs in women when the muscles and tissues that hold the pelvic organs in place begin to weaken. Subsequently, the uterus, bladder and rectum may press against the vaginal walls, causing them to protrude into the vagina. Symptoms include back or pelvic area pain as well as urine leakage or difficulty in starting to urinate. Pelvic organ prolapse also can cause bowel problems, including constipation, or a sensation of vaginal bulging or heaviness. Women who have had multiple vaginal births are at greatest risk for pelvic organ prolapse, which occurs in some form (cystocele, rectocele and/or uterine prolapse) in half of women older than 50.

For women with moderate to severe symptoms, a new surgical technique uses the Gynecare Prolift Pelvic Floor Repair System to restore the prolapsed organ or organs to a correct position. GHS urogynecologist Jeffrey B. Garris, M.D., FACOG, FACS, was the first physician in the United States to receive certified training on the system, and he has performed more Prolift repairs than any other urogynecologist in the Upstate.

  • TVT Secur for Stress UI. GHS also offers a minimally invasive surgical treatment for stress urinary incontinence (UI), a condition that afflicts up to half of U.S. women on occasion and 10 percent frequently. Stress UI is the unintentional loss of urine during periods of bladder pressure or stress. It occurs with coughing, sneezing, standing and lifting, among other circumstances, and is the most common type of incontinence.

Tension-free vaginal tape (TVT) surgery, also known as suburethral sling surgery, has become the most popular operation to treat moderate to severe stress UI during the past decade. The latest modification of TVT is called TVT Secur.

  • InterStim for Urge UI. For patients who suffer from incontinence when they have the urge to urinate, GHS offers InterStim Therapy, among other treatment options. Described as a pacemaker for the bladder, InterStim Therapy works by sacral neuromodulation.

Developed by Medtronic Inc. and FDA-approved since 1997, InterStim Therapy has been in the mainstream for several years. Dr. Garris is a national InterStim preceptor and one of very few physicians in the Upstate offering this therapy.