Prolapse & Incontinence

Incontinence & Prolapse


Incontinence


      One third of women over the age of 35 years will suffer embarrassing urinary loss (urinary incontinence).

Symptoms include:

      • Loss of urine with daily activities such as laughing, coughing, exercise,
      • Increase in the urinary frequency (day and night), and urgency (sudden urge to pass urine) and
      • Difficulties in voiding.

The different types of urinary incontinence are stress, urge and overflow incontinence. These often occur together (mixed incontinence) in the same woman making it difficult to make an accurate diagnosis clinically. This may be further compounded with the presence of prolapse (a lump or bulge protruding through the vagina).

Urodynamics

Urodynamic assessment is a highly specialised investigation, to accurately diagnose their problem.

Once the correct diagnosis is made, a specific management plan can be developed. Correct diagnosis by urodynamic assessment and subsequent treatment will result in a significant improvement for most people.

Prolapse


Pelvic organ prolapse (POP) refers to herniation of pelvic organs to or beyond the vaginal introitus. This is a common condition that affects women in their daily life including exercise and sexual function. With the aging population, the prevalence and impact of POP is likely to expand.

Risk factors for POP include, multiple childbirths, advancing age, obesity, lack of estrogen following menopause and hysterectomy.

The most common symptom of POP is the “feeling of a bulge” or something falling out of the vagina. Women also complain of pelvic heaviness or pressure, sexual dysfunction, urinary retention and /or difficult defecation.

Treatment options include expectant management, conservative and surgical therapy. Conservative therapies include the use of Pelvic floor muscle exercise, local estrogen therapy and the use of vaginal ring pessaries.

Reconstructive surgery consists of a combination of re-suspending the vaginal apex and anterior and posterior vaginal wall. Due to a higher rate of vaginal mesh related complications; the focus is now changing to its use via the laparoscopic route. Sacro-colpopexy is a method to fix the prolapse abdominally using mesh, this is still regarded as the gold standard to fix apical prolapse and is now technically even easier with robotic assisted surgery.

Mesh vs Native tissue:


Prolapse repair of the anterior and posterior vaginal component can be done using native tissue ( the patient’s own tissue) or using a synthetic mesh. The use of vaginal mesh potentially has higher success rates when used in the anterior compartment and apical prolapse of the vagina.

This is, however, associated with higher complication rates than the traditional native tissue repair.

Decision to use vaginal mesh is controversial and its use is only indicated in few select scenarios. Use of mesh in abdominal procedures and for mid urethral tape placement is still standard in Australia.

Contact us today to discuss your options.

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