Women’s health care has come a long way, particularly for Baby Boomers who experience age-related problems that affect their quality of life.
In the past, conditions such as incontinence and pelvic organ prolapse might have been addressed by gynecologists or urologists, but today doctors who specialize in female pelvic medicine can provide a variety of effective treatments, from physical therapy to minimally invasive surgery.
Incontinence – causes and cures
Women are more likely to suffer from incontinence, and their chance of developing it increases with age. But not all incontinence is age-related.
“Stress incontinence” refers to a condition where a person leaks urine while coughing, lifting a heavy object, laughing hard or sneezing. For women, having given birth vaginally can be a contributing factor, and weakened pelvic muscles are the culprit. “It’s due to a loss of support at the neck of bladder or urethra,” explains Patricia A. Wallace, M.D., a board-certified gynecologist and female pelvic medicine and reconstructive surgeon at Mission Hospital.
Remedies include doing Kegel exercises—consciously contracting and releasing muscles used to control urine flow. “The baseline treatment is pelvic floor strengthening,” says Dr. Wallace. “A trained therapist can show women how to do these exercises, and other strength exercises of the core muscles.”
Other treatments include a pessary ring which a doctor inserts into the vagina to give support under the bladder neck, says Dr. Wallace. “A new tampon called Impressa can be used — this puts a bolster under the urethra bladder area,” she adds.
A surgical sling is another treatment. “A doctor puts a strap of mesh under the urethra to give it support,” says Dr. Wallace, explaining that this is done with a patient under general anesthesia. “It’s the gold standard for stress incontinence,” she says.
“Urgency incontinence” is an age-related condition where a person’s bladder becomes hyperactive or spastic. Since the brain isn’t able to control the bladder spasms, the person might accidently leak urine at any time, Dr. Wallace explains. “Urgency incontinence can also be caused by MS, Parkinson’s disease or spinal cord injuries. It is not directly related to childbirth,” she says. Medications that relax the bladder muscles, and acupuncture that treats the nerves of the bladder are other nonsurgical treatments, she adds.
Another option is sacral nerve stimulation, in which a small device is implanted near the sacrum to regulate the nerve signals between the bladder and the brain.
Pelvic organ prolapse treatment
Prolapse (or dropping down) of the bladder, vagina or uterus is the result of weakening connective tissue around those organs. Having multiple vaginal childbirths or chronic constipation can cause it. A telltale sign of this condition is when a woman feels pressure or a bulging sensation in her pelvic area.
Inserting a pessary ring to hold the organs in place is one simple treatment. But to repair severe prolapse, doctors often opt to surgically place mesh patches in the pelvic area in order support the organ walls.
Mission Hospital is fortunate to have a Da Vinci Robot, a machine that provides surgeons three-dimensional views for precision, small-incision operating.
Dr. Wallace is certified as a Da Vinci robotic-assisted surgeon. “For prolapse surgery, the robotic approach allows me to get into smaller deeper spaces than if I had an open incision,” she says. The upside for patients? Less pain, shorter hospital stays and less blood loss than with other kinds of surgeries, Dr. Wallace says.