hgazette.com, Haverhill, MA

July 25, 2013

Many suffer with incontinence, but help is available

Women affected most by stress incontinence

Melinda Birdsall

---- — Editor’s note: The Gazette occasionally publishes columns written by local doctors. One appears here.

Millions of adults in the United States suffer with some form of urinary incontinence, but women suffer most from the type called stress incontinence, which causes urine to leak when they laugh, cough, sneeze or exercise.

It’s usually women over 40 who develop this condition because it is generally caused by childbirth, hysterectomy or menopause.

Incontinence of any type can cause emotional distress and depression, so it’s unfortunate that, due to embarrassment, up to 40 percent of women affected won’t seek medical help.

There is no need to feel embarrassed. Incontinence is a medical condition which with medical and/or surgical intervention, can generally be helped.

The muscles, ligaments, and skin in and around a woman’s vaginal tract act as a support structure to hold pelvic organs in place. Childbirth, hysterectomy and menopause can cause those support structures to weaken, resulting in a condition called pelvic organ prolapse. This means that the bladder, urethra, uterus, vagina, rectum, or small bowel have fallen out of their normal positions.

Without medical treatment or surgery, they can prolapse further, so it’s best to have a conversation with your doctor sooner rather than later.

Pelvic organ prolapse can cause discomfort and pressure, affect sexual function, and affect bodily functions such as urination and bowel function.

Types of pelvic organ prolapse include:

Prolapse of the bladder, which happens when the front wall of the vagina prolapses. The bladder may prolapse into the vagina which can cause the urethra to prolapse as well. Urine leakage during coughing, sneezing or exercise is a common symptom.

Prolapse of the rectum, which happens when the back wall of the vagina weakens and the rectal wall pushes against the vaginal wall, creating a bulge which may become noticeable during bowel movements.

Herniated small bowel happens due to weakening of the upper vaginal supports following a hysterectomy when the front and back walls of the vagina separate, allowing the intestines to push against the vaginal skin.

Prolapsed uterus is caused by the weakening of ligaments at the top of the vagina, which causes the uterus to fall. Depending on the degree of weakness, the uterus can fall into the upper portion of the vagina, lower part of the vagina, the vaginal opening or protrude outside the body.

Vaginal prolapse occurs following removal of the uterus (hysterectomy) which provides support for the top of the vagina. The top of the vagina falls toward the vaginal opening causing the walls of the vagina to weaken. The top of the vagina may eventually protrude out of the body through the vaginal opening.

If you have symptoms of pelvic organ prolapse, it’s important to have a conversation with either your primary care doctor or gynecologist. Depending on the severity of symptoms, your doctor may offer suggestions that range from simply monitoring the intake of fluids and using panty liners or pads, to Kegel exercises to strengthen pelvic floor muscles, medications, and if necessary, surgery.

Gynecologist Melinda Birdsall, MD, the 2013 winner of the National Richard Ireland Award, is on staff at Merrimack Valley Hospital, and specializes in pelvic reconstructive incontinence surgery.