By Heather van Raalte, M.D. Princeton HealthCare System
Most women can talk openly about many difficult topics, such as relationship trouble, career challenges, and family matters. However, discussing a bladder problem can be challenging, leading many women with bladder problems to suffer in silence for years before seeking help.
It is important for women to discuss concerns about incontinence and other issues affecting bladder health with their physician. Some of the most common bladder problems may be symptoms of an underlying condition called pelvic organ prolapse that — once discussed and diagnosed — can be easily managed and overcome.
Pelvic organ prolapse occurs when pelvic organs such as the uterus, bladder and bowel fall out of position and collapse into the vagina. This happens when the pelvic muscles and connective tissues that hold the organs in place are weakened or injured, most often through childbirth.
An estimated 50 percent of women between the ages of 50 and 79 suffer from prolapse, according to the American Urogynecologic Society, and bladder problems are often the first sign of the condition.
These problems include:
• Recurrent urinary tract infections. One in five women will experience a urinary tract infection at least once in her lifetime. These infections are caused by bacteria entering the urethra and traveling to the bladder, where they take hold.
Symptoms of urinary tract infections include a burning feeling when urinating; frequent or intense urges to urinate; lower back or abdominal pain; discolored or odd- smelling urine, and fever or chills.
Doctors will typically prescribe antibiotics to treat a urinary tract infection.
However, recurrent infections may be a sign that the bladder is not emptying properly. In these cases, further evaluation is necessary to determine if the bladder is out of place because of prolapse.
• Stress incontinence. Urinary incontinence — or loss of bladder control — affects up to 50 percent of women. Stress incontinence is one of the most common forms of the disorder and occurs when urine leaks out after you laugh, sneeze, cough or otherwise “stress” your bladder.
When your pelvic and sphincter muscles that control urine flow are strong, they can handle the extra pressure those actions place on your bladder, but when they’re weak, the stress pushes urine out.
• Urinary urgency and frequency (overactive bladder). Urinary urgency and frequency is a relatively common condition that typically develops with age. People with overactive bladder may feel that their bladder is about to burst, but they pass little urine.
This can become problematic because when the bladder is continually being emptied with small voids, it fails to flush out completely and can become a breeding ground for bacteria and infection.
In some mild cases, these problems can be treated with simple dietary or lifestyle changes. For instance, limiting coffee and high-acid foods may help control incontinence. Kegel exercises and Pilates can also help by strengthening the pelvic muscles.
In other cases when prolapse is moderate to severe, doctors may recommend treatment with a pessary, a plastic device similar to a diaphragm that is fitted into the vagina to help hold the bladder, uterus and bowel in place.
In addition, surgery is becoming an increasingly popular treatment option for women with pelvic organ prolapse. At University Medical Center at Princeton, doctors are using the da Vinci Surgical System to perform minimally invasive, robotic-assisted surgery to treat prolapse.
Called a sacrocolpopexy, the procedure uses a mesh sling to hold the vagina in the correct position and treat prolapse. Sacrocolpopexy has traditionally been performed as an open surgery requiring large incisions in the lower abdomen.
With the da Vinci system, the procedure can be performed laparoscopically through tiny, one- to two-centimeter incisions. For most women, this minimally invasive approach offers numerous potential benefits over traditional open surgery, including significantly less pain; less blood loss and need for transfusion; less risk of infection; less scarring; shorter hospital stay; shorter recovery time, and quicker return to normal activities.
If your doctor recommends sacrocolpopexy to treat prolapse, talk with him or her about whether you are a candidate for da Vinci surgery.
To help prevent prolapse and keep your bladder healthy, consider these tips from the American Urogynecologic Society:
• Maintain a normal weight or lose weight if overweight. Overweight women have a greater risk for developing incontinence.
• Eat a diet with plenty of fiber and fluid to help avoid constipation and chronic straining, which can weaken the muscles and connective tissue that make up the pelvic floor. Fluid also helps keep your bladder and urinary tract clean.
• Don’t smoke.
• Avoid repetitive strenuous activities.
• Learn and perform pelvic floor muscle exercises (Kegel) regularly.
To find a urogynecologist affiliated with Princeton HealthCare System, call 888-742-7496 or visit www.princetonhcs.org.
Heather van Raalte, M.D., is fellowship-trained in urogynecology and a member of the medical staff at University Medical Center at Princeton.
