Freedom From Bladder and Pelvic Floor Problems

Many women are hesitant or even embarrassed to talk about bladder or pelvic floor problems. Instead of seeking advice or help from their physician, they suffer in silence. Millions of women have urogynecologic disorders, also known as bladder or pelvic floor disorders. Common problems include, urinary or bowel incontinence, urgency and/or frequency and pelvic organ prolapse. These conditions often affect a woman’s quality of life and her self-esteem. However, women do not need to suffer as there are new and enhanced treatments available.

What are bladder and pelvic floor disorders?
Lily Arya, MD, a urogynecologist at the University of Pennsylvania Health System, defines problems with the bladder, rectum or reproductive pelvic organs as bladder or pelvic floor disorders. She states, “Two of the most common conditions we see are pelvic organ prolapse, and urinary incontinence.”

Pelvic organ prolapse is associated with discomfort during sexual intercourse, incontinence of stool or urine, difficult urination, and low back or abdominal pain. Urinary incontinence is associated with poor bladder control. Leakage is common when you sneeze, laugh, run, jump or cough.

Both pelvic organ prolapse and urinary incontinence can be caused by several factors; weakened or stretched supportive tissues that damage nerves controlling bladder function, childbirth, genetics, medications, menopause or reduced estrogen levels and age. Because symptoms of urinary incontinence are not always due to pelvic organ prolapse, accurate diagnosis is very important.

Who is affected by bladder and pelvic floor disorders?
Dr. Arya states, “Bladder and pelvic floor health disorders can affect women at any age. However, over fifty percent of women over age forty have some form of pelvic organ prolapse. Forty percent of women between age 40 and 50 experience urinary incontinence, this number increases to 70 to 80 percent for women over age 70.” She continues, “The condition may be caused or aggravated by childbirth, but it can also occur in women who have never experienced childbirth.”

What can I expect during an evaluation?
If you suspect that you have a bladder or pelvic floor problem, talk to your gynecologist about your symptoms. The gynecologist will advise if you should seek further assistance from a urogynecologist, a physician specializing in bladder and pelvic floor disorders. The urogynecologist will perform a thorough evaluation to diagnose the problem.

An evaluation may include:

• History and physical examination
• Urine examination
• Examination of urethra and bladder (cystoscopy)
• Measurement of bladder function
• Electrodiagnostic testing (EMG) of the pelvic floor

What treatments are available today?
Treatment should be based on the nature and severity of an individual patient’s problem. Various forms of treatment include:

• Behavioral therapy - This includes pelvic muscle rehabilitation, bladder training programs, fluid and dietary modification.
• Devices and medications - Pessaries, a support device placed in the vagina, and other devices can be used to treat some conditions as a safe alternative to surgery. Medications are also available to treat a variety of urogynecologic problems.
• Surgery - This includes minimally invasive surgery, laparoscopic surgery, and pelvic reconstructive surgery.
  Sacral nerve stimulation is the latest minimally invasive surgery available for people with urinary incontinence (i.e. urge incontinence or urgency-frequency). This surgery uses a small implanted medical devise to send mild electrical pulses to the sacral nerve. The sacral nerve controls the bladder and surrounding muscles that manage urinary function. Sacral nerve stimulation may eliminate or reduce certain bladder control symptoms.

Dr. Arya advises, “Ignoring the problem will not make it disappear nor should the problem be accepted as “a part of getting older.” There is a physical reason that pelvic and bladder conditions occur. 85 to 90 percent of these conditions can be successfully treated through dietary changes, exercise, bio-feedback therapy, medication or surgery. The first step is to talk to your physician about your symptoms.”

	Need an appointment? Request one online 24 hours/day, 7 days/week or call 800-789-PENN (7366) to speak to a referral counselor.