Jeanne Faulkner 10/2007
Seems like it was yesterday we skulked down the market's feminine hygiene aisle tucking tampons under cereal boxes so "no one would know." Soon we became comfortable and didn't give a hoot who saw our whopping pack of pads. "The darn thing has wings" became part of our joke-bank. For 19 million Americans though, (80% of whom are women), the new joke is: Have you ever laughed so hard tears ran down your legs? Now we're skulking around the market buying incontinence supplies.
Nineteen million Americans suffer from incontinence - medical speak for "wetting your pants." That's roughly the same as the entire population of New York. Why does it happen? Frequently it's due to pelvic organ prolapse (POP) - lack of structural support to pelvic organs, including the bladder. Under normal conditions pelvic tissues support the uterus, bladder, urethra, intestines, rectum and vagina. With age, childbirth or injury, these tissues may weaken and fail to do their job. When that happens, pelvic organs slip down and press against (and sometimes out of ) the vagina.
Incontinence is one of the most frequent complaints women bring to their gynecologist. There are many different types; the most common being stress incontinence which occurs with coughing, sneezing, laughing and lifting. Urge incontinence is caused by an overactive bladder, giving you that "got to go" impulse where you feel like you'll spring a leak on the way to the bathroom.
There's more than one kind of prolapse too. Here's a survey of some of the most common:
Cystocele: The bladder drops from its normal position into the space occupied by the vagina.
Prolapse of the uterus: A group of ligaments at the top of the vagina weaken, causing the uterus to fall and the walls of the vagina to weaken. The condition has several stages -- from first degree when the uterus drops into the upper portion of the vagina, to fourth degree when it protrudes outside of the vagina.
Rectocele: Sometimes called a posterior wall prolapse, the rectum bulges into the vagina making it difficult to have a bowel movement.
Enterocele: Vaginal vault prolapse sometimes occurs after hysterectomy when the top of the vagina loses support and drops. It's frequently associated with the small intestine dropping through its supporting tissue and into the vagina.
Countless women suffer from pelvic organ prolapse (POP). According to the National Institutes of Health (NIH), with advanced POP, vaginal protrusion may block the flow of urine, prevent the bladder from emptying completely and lead to urinary tract infections. In other cases, POP causes stress incontinence, difficulty with bowel movements and sexual activity. Oscar Polo, an OB/GYN at Women's Health Today says, "I'm surprised how many women think it's a normal part of having children or aging even when it affects their quality of life. Women don't have to live with this."
Though POP and incontinence may be interrelated, every woman is unique and diagnosing her specific issues is key to successful treatment. Dr. Polo says, "I draw my treatment plan from my patients' experiences and symptoms. It's very customized care. During an office consultation we sort out what organs are prolapsing, what type of incontinence she's experiencing and provide reassurance. Then we decide together on the best treatment options." Patients sometimes feel frightened that "thing" that's bulging out is something scary – like cancer. Others feel like they're the only one with a problem like this. For some women, reassurance is all the treatment they need.
There are a wide range of "fixes" for incontinence and POP. Some are as simple as physical therapy or a prescription. According to studies at the Mayo Clinic, one in 11 women requires surgery for POP in her lifetime. One third of these will need additional surgeries to correct recurrent prolapses. It's not uncommon that patients require treatment for more than one type of prolapse at a time.
Some surgeries require no over-night stay and patients can expect to be up and around within a few days. Others require a couple days hospitalization and several weeks for recovery. Pain management is always an important part of surgery and recovery and tailored to the patient's needs. A serious talk with your physician will map out an individualized surgical treatment plan.
Finding the right solution to a very personal problem requires the skill, trust and confidence of a good physician. Incontinence and POP are no laughing matter when it affects your daily life. Here at Women's Health Today, we can make it better so you can safely laugh (sneeze or cough) again.