Female Incontinence & Vaginal Prolaspe
When an organ becomes displaced, or slips down in the body, it is referred to as a prolapse. Your physician has diagnosed you with a pelvic organ prolapse if part of the vagina has become weakened or displaced.
Women affected by pelvic prolapse sometimes refer to their “dropped bladder” or “fallen uterus.” In the medical profession, these conditions are referred to in more technical terms – such as “cystocele”, “uterine prolapse” or “rectocele”, which will be explained in this brochure.
Symptoms of pelvic prolapse can include pressure or discomfort in the vaginal or pelvic area, often made worse with physical activities such as prolonged standing, jogging or bicycling. For other women, diminished comfort and control in the bladder and/or the bowels can be an indicator of a worsening prolapse condition.
Vaginal prolapse can be treated in several ways, depending on the exact nature of the prolapse and its severity. You and your physician may discuss:
This patient guide will help discuss the various types of prolapse, and the surgical procedures that may help to improve your prolapse.
Pelvic prolapse repairs can be performed in a few basic ways:
(1) through vaginal incisions, (2) through traditional abdominal incision, or (3) through a laparoscopic approach. In recent years, general trends have favored vaginal repair techniques – as they often provide excellent outcomes.
Surgical repairs for prolapse sometimes involve the placement of ‘mesh’ or ‘graft’ materials, to reinforce areas of weakened tissues. This is especially common with the repair of more advanced prolapse conditions, or cases where a previous operation has failed.
Cystocele: The Bulging Bladder: is often referred to as a dropped bladder, and it is one of the most common prolapses within the vagina among women following pregnancy and childbirth. A cystocele forms when the normally flat upper vaginal wall loses its support and sinks downward. This allows the bladder, which is located right above the upper vaginal wall, to drop right along with it. When a cystocele becomes advanced, the bulge may become visible outside the vaginal opening. The visible tissue is the weakened vaginal wall; the bladder is right behind the skin but cannot be seen. The symptoms caused by cystoceles can include vaginal bulging or pressure, slowing of the urinary stream, overactive bladder symptoms, and an inability to fully empty the bladder.
Enterocele The Female Hernia: When the intestines bulge downward into the upper vagina, then you have an enterocele. It’s the last of the pelvic bulges you should know about, and the most difficult to conceptualize. Among all types of female prolapse, enteroceles share the most similarities with hernias that can develop in the abdominal and groin areas of both women and men: both involve bulging of the intestines into weakened supports nearby. In a man, hernias bulge through the abdominal wall; in a woman, enteroceles bulge into the top of the vagina. The symptoms are often vague, including a bearing down pressure in the pelvis and vagina, and perhaps a lower backache. They often exist alongside vaginal vault prolapse in women who have had a hysterectomy.
Rectum: is the mirror image of a
cystocele. Cystoceles result
from a weak upper vaginal
wall, allowing the bladder
to bulge downward, while
rectoceles result from a
weak lower vaginal wall,
allowing the rectum to bulge upward. This creates an extra pouch
in the normally straight rectal tube.
Prolapse: If you have already had a
hysterectomy, the top of the
vagina (called the vault or
apex) should be attached to
supportive ligaments on
either side of the pelvis.
These attachments prevent
the top of the vagina from
bulging outward beneath the constant pressure of the abdominal
contents. However if these attachments weaken and the vaginal
apex drops, a bulge may form near the vaginal opening. This is
called vaginal vault prolapse, a condition that only happens to
women who have had a hysterectomy, and one that can cause
severe pressure and bulging symptoms. Similar to cystoceles,
The first condition is called hypermobility, (“hyper” means too
much and “mobility” refers to movement) which is a common
condition resulting from childbirth, previous pelvic surgery or
hormonal changes. Hypermobility occurs when the normal
pelvic floor muscles can no longer provide the necessary support
A minimally invasive sling procedure using a mid-urethral sling system is designed to provide a ribbon of support under the urethra to prevent it from dropping during physical activity. The dropping of your urethra out of the correct anatomical position may be what causes your incontinence. Providing support that mimics the normal anatomy should prevent urine from leaking or reduce the amount of leakage.
Your sling procedure with a mid-urethral sling system will take an estimated 30-45 minutes. Dr. Sunkavally will determine the type of anesthesia you will have during the procedure. Once the anesthesia takes effect, Dr. Sunkavally will begin the procedure. A small incision will be made in the vaginal area and two small incisions will be made through the skin in the groin area. Next, the synthetic mesh is placed. When it is placed, it will extend from one skin incision, in towards the vagina, around the urethra and back out though the second skin incision. This creates a “hammock” of support around the urethra. Dr. Sunkavally will adjust the mesh tension so that the leakage of urine is reduced. When Dr. Sunkavally is satisfied with the position of the mesh, he or she will close and bandage the small incisions in the groin area and the top of the vaginal canal.
Many surgical options have been developed for the correction of SUI due to hypermobility and/or ISD. Boston Scientific offers many different minimally invasive procedures, the difference being in the placement of the “anchoring” location of the mesh material. Dr. Sunkavally will recommend which anchoring location is right for you.
The sling system is designed to add support to the urethra and stabilize it as well. With the sling system in place, normal urinary function may be restored.
To help with the healing process, a catheter may be placed into your bladder. The catheter will be connected to a drainage bag, which will collect your urine. The catheter will be removed within a short period of time. After the procedure is complete, specialized nurses will monitor you. You will probably be discharged within 24 hours.
Before your discharge from the hospital, Dr. Sunkavally and nurse will provide you information on what to expect and how to care for yourself during your recovery time. Below are a few things included in these instructions:
The Coaptite Injectable Implant is a material that is used to bulk or fill out the tissues surrounding the urethra to provide additional support during physical activity. The Coaptite Implant is made of round particles made of calcium hydroxylapatite, which is a natural component of your teeth and bones, in a water-based gel.
Stress Urinary Incontinence is the involuntary loss of urine during physical activity such as coughing, laughing or sneezing. The round muscle (sphincter) used to keep urine in the bladder can become weak and urine leaks out during these activities (See Figure 1). This type of incontinence is treated both surgically and non-surgically. Bulking with the Coaptite Injectable Implant increases the resistance of the urethra to urine leakage.
This brochure is to help you make a decision as to
whether or not to have a urethral bulking procedure
with the Coaptite Injectable Implant. Over 13 million
adults have Stress Urinary Incontinence in the United
States, 85% of these adults being women. Coaptite
Implant treatment is only one way to treat Stress Urinary
Incontinence. Your physician will provide you with
recommended options for treating your incontinence
and help you make the right treatment decision.
You should not have the procedure at this time if you have inflammation of the bladder (cystitis) or the urethra (urethritis) or other infections. Tell Dr. Sunkavally if you have pain when you urinate or if you urinate often because these may be signs of a urinary tract infection. After your infection is treated, using the Coaptite Injectable Implant treatment can be considered.
In the clinical study, 158 patients were treated with the Coaptite Injectable Implant and followed for 12 months after the initial treatment. The adverse events reported included:
Most of these adverse events listed above happened within 24 hours and went away within 30 days.
The Coaptite Injectable Implant did not stay in place where it was injected. As a result, two patients experienced a serious adverse event. One required corrective surgery and the other did not. See the Warning Section to the left for more information.
You may require more than one treatment to achieve dryness or satisfactory improvement, or the Coaptite Implant may not help at all.
It is unknown how long Coaptite Implant treatment will last. So far it has been shown to last at least one year. Over time, the calcium hydroxylapatite (CaHA) particles should break down and be taken up by the body. Some data shows that the CaHA particles can still be there after 3 years, but everyone is different and they may not be there as long for you.
There are also other ways to treat your problem. They can be non-surgical, including strengthening exercises for the pelvic muscles to improve support of the bladder and urethra, and biofeedback to assist in retraining the pelvic muscles. Drugs, as well as treatment with other bulking agents can help. Surgical procedures can repair and reposition organs, restore support to weakened pelvic muscles, or implant an artificial urinary sphincter. You should discuss these treatment options with Dr. Sunkavally.
The Coaptite Injectable Implant may benefit you because it may help you become dry or lessen the amount of urinary leakage. The Coaptite Implant is made of round particles of CaHA in a water-based gel. The body takes up the gel. The particles remain to act as a space filling bulk, causing the closing of the urethra.
In the study, 83 out of 131 (63%) of patients were improved at 12 months following treatment with the Coaptite Injectable Implant. Fifty-one out of 131 (34%) of the patients were dry. A majority of the patients (82 out of 131) (62%) had more than one injection of the Coaptite Implant. Thirteen of 131(10%) patients got worse after one year. For 35 patients (27%), we do not know if they improved, remained the same, or got worse.
The procedure will take place in a doctor's office, an
outpatient surgery center or in an operating room. The