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- I have a prolapse of the vaginal wall. Is there any other safe way to bring it back up into place again without using mesh of any kind? I was supposed to have surgery using mesh, but have decided against it.
- My daughter (age 7) doesn't wet her bed; she pees her pants multiple times during the day... Her pelvic region is RED and sore. Bladder was tested in July; no infection... Should I schedule an appointment with a pediatric urologist...
- I am up every hour to urinate. I am very tired from getting up so often.
- For the past 2 ½ months I have been experiencing problems with bladder pressure and urinary frequency around the time that I ovulate - I have short menstrual cycles (24-26 days) so this has been a consistent problem for...
- I was supposed to have pelvic mesh surgery three years ago and cancelled due to the bad publicity and lawsuits associated with the mesh. How prevalent are complications with this procedure?
- I am 56 and have to run to the bathroom before I leave to go anywhere and then again as soon as I get where I am going. I try to avoid drinking anything while I am out, but still have to go...
- How to tell if you have a prolapsed uterus or cervix?
- I frequent the bathroom too regularly, sometimes four times in an hour, just can't seem to empty the bladder....
- I have a dropped bladder which protrudes about half size of an egg. I am 87 years old and in very good health.
I have a prolapse of the vaginal wall. Is there any other safe way to bring it back up into place again without using mesh of any kind? I was supposed to have surgery using mesh, but have decided against it.
A. We understand how concerned patients are about the use of mesh in vaginal repairs. The TV and radio spots create a lot of worry for our patients. However, be reassured that there are many non-mesh surgical repairs as well as nonsurgical treatments available for the management of vaginal prolapse. Each approach is different and offers different risks, success rates and postoperative experiences. Fixing prolapse is not an emergency and you have plenty of time to find the right doctor who can help you find the right treatment for you. We recommend seeing someone with advanced training in urogynecology who can discuss your options in detail and help you find the right procedure for you.
Q. My daughter (age 7) doesn't wet her bed; she pees her pants multiple times during the day. She states when she laughs, gets scared pee comes out. Her pelvic region is RED and sore. Bladder was tested in July; no infection. Any idea of what this might be? Should I schedule an appointment with a pediatric urologist? My insurance company said I don't need a primary MD referral.
A. We're sorry your daughter is having so much trouble with continence. This sounds like a condition some providers call giggle incontinence and it's not uncommon among prepubertal children. A pediatric urologist may be able to offer a more thorough opinion and we have a well respected pediatric urologist starting at UMass Memorial Medical Center full time in mid-November. You can make an appointment by calling 508-856-5821.
Q. I am up every hour to urinate. I am very tired from getting up so often.
A. Getting up often at night to void is a common and very frustrating problem. Sometimes it's due to overactive bladder and bladder problems. If the bladder is causing this problem, then we would expect you to have similar problems with urgency and frequent void during the day as well as night. In this case, a urogynecologist or urologist specializing in female incontinence could offer effective solutions.
However, if you only have trouble with frequency at night and when you void at night you usually void large volumes of urine, then it's more likely that you have a condition called nocturnal polyuria. In patients with this condition, the kidneys make a lot of urine at night causing the bladder to fill quickly. Once the bladder is full, it's normal and expected that one would wake to empty the bladder. In this situation, the bladder is responding appropriately to the amount of urine that the kidneys make. This is more of a medical or kidney issue rather than a bladder issue and is best managed by an internal medicine physician.
For the past 2 ½ months I have been experiencing problems with bladder pressure and urinary frequency around the time that I ovulate - I have short menstrual cycles (24-26 days) so this has been a consistent problem for about four cycles now. The first time that it occurred I suspected a urinary tract infection so went to the doctor, had a urinalysis and was sent home with antibiotics. Within five days I felt better so didn't think much of it. The same symptoms occurred the very next month around the same time, I figured the UTI came back and took the same measures and again felt better within a few days (I am not clear if the doctor ever did an actual culture). When it came back yet another 23 days later, I began to suspect that something more was going on - I was also in a situation where I had a temporary lapse in health insurance so I decided to wait a few days. Sure enough the problem cleared within five days without any antibiotic this time.
I am once again experiencing the problem and a check at my calendar shows that it is at the exact same point in my cycle as the three other instances. My main symptoms are an intense bladder pressure anytime it is even slightly full. I am able to void without any burning or discomfort and I am producing urine each time I try to go and feel a temporary sense of relief, but the minute I drink even a cup worth of fluid the pressure comes back and I have the intense need to urinate again. Sometimes toward the end when my symptoms seem to be going away I will experience difficulty initiating urination for about a day or so and then the symptoms are gone. I have also noticed that during this time, my bowel movements are also not as they normally are and I tend to be on the constipated side. Some other details about my medical history that could be relevant:
A. You have done a great job detailing your symptoms and associated factors. It's not clear what's causing these symptoms but given that they are intermittent and correlate very well with your menstrual cycles, it's likely related to your cycles. Given your history of endometriosis and that endometriosis responds to hormonal cycles, the most likely explanation is endometriosis. Infections are possible but your history is more suggestive of a hormonally responsive condition rather than recurrent infection. It's unlikely that your history of abnormal pap smears, prior LEEPs or cerclage with early delivery are playing a role in these symptoms. We recommend further evaluation by either a urogynecologist or a regular gynecologist with experience evaluating and managing endometriosis.
Q. I was supposed to have pelvic mesh surgery three years ago and cancelled due to the bad publicity and lawsuits associated with the mesh. How prevalent are complications with this procedure?
A. Thank you for raising a very important and controversial issue. In 2011 the FDA issued a warning about the use of transvaginal mesh repairs, and it's this warning that led to all of the lawsuits and television commercials. Transvaginal mesh repairs are performed by making incisions in the vagina and placing permanent mesh through the vaginal wall to treat pelvic organ prolapse. Over two to four years prior to the FDA warning, it had received a significant number of reports of complications from vaginal mesh. Based on those reports and a board of experts, the FDA recommended that these products be used with caution and appropriate counseling. The FDA didn't recall or recommend recall of the transvaginal mesh products. In addition, the FDA specifically recommended a vaginal mesh procedure called sacral colpopexy as the gold standard for prolapse repair. The FDA is reviewing midurethral sling procedures separately. Given our greater than 20 years of positive experience with midurethral slings all over the world, it's very unlikely the FDA will recommend any restrictions the sling
It's important to note that most women who received transvaginal mesh did very well. They suffered no complications and had complete resolution of their prolapse. However, a significant number of women had trouble with pain and mesh erosion, prompting the FDA warning. The rate of complication varies but many report rates up to 10%. At UMass Memorial Medical Center, we don't offer transvaginal mesh to our patients but have extensive experience with sacral colpopexy (performed laparoscopically or open) as well as with repairs that don't use any mesh at all. We encourage you to meet with experts in urogynecology to be sure you get accurate information on this issue
Question: I am teased a lot by family about wearing Depends and laugh it off, but I am 56 and have to run to the bathroom before I leave to go anywhere and then again as soon as I get where I am going. I try to avoid drinking anything while I am out, but still have to go. Is this something I should worry about?
You are describing urge urinary incontinence and this is a very common symptom. There are many causes of urge incontinence and most of them are very treatable, often without medications or surgery. It is rare that urge incontinence is caused by a serious problem like cancer. However, if you are wearing depends, that indicates you are leaking a great deal of urine and would benefit from an evaluation. We would encourage you to see an expert in urinary incontinence as there are treatments available to make this much better, if not cure the problem.
Question: how to tell if you have a prolapsed uterus or cervix?
Uterovaginal prolapse is very common. Most women have some descent of the vagina and uterus when they bear down or push, particularly if they have delivered children. If a woman's uterus or cervix drop a little bit in the vagina, it is usually completely asymptomatic and we typically reassure her that she is normal and needs nothing done. Prolapse does not tend to cause symptoms or problems unless the vaginal wall or cervix drop to the vaginal opening where a woman can then feel a bulge. Most women realize that they have prolapse when they feel something dropping to the vaginal opening. The bulge is usually worse with activity and prolonged standing and gets better with laying down. It usually does not hurt but can be uncomfortable or cause pressure.
When a woman feels something prolapsing it can be difficult for her to tell if the bulge she feels is the cervix or vagina. We would encourage anyone feeling a bulge to see a trained urogynecologist for evaluation and counseling on her many options
Q. I frequent the bathroom too regularly, sometimes four times in an hour, just can't seem to empty the bladder. I have bought this concern to my gynecologist years back and she just noted it. As years have passed I now notice something coming through the hole of the vagina which has been there for quite awhile. I have been going to the gynecologist on regular basis and she never finds this odd. After all things I have been hearing about a prolapse bladder and now my sister had the same symptoms I have and today they diagnosed her with a prolapsed bladder. Should I go and get this checked out by a specialist before it becomes a painful condition like my sister is going through now? Or do I wait until it becomes worse and who would I see for a specialist in this field?
A. The symptoms you're describing are very common. It's hard to tell if your urinary symptoms are being caused by your prolapse. It's likely that they're related and the treatment of your prolapse may improve your bladder emptying. Alternatively, the bladder symptoms may be unrelated to your prolapse and an evaluation by a specialist would be very helpful.
There isn't a rush to see someone but we encourage you to be seen sooner than later. In general prolapse tends to gradually progress and become more symptomatic. We encourage you to get good information so that you have plenty of time to consider the best treatment for you.
If your symptoms are due to prolapse, you have several surgical and nonsurgical options. We strongly encourage you to see a specialist for these symptoms. Urogynecologists are specifically trained to manage these problems and we recommend seeing a fellowship trained urogynecologist for an evaluation and counseling on your management options.
Q. I have a dropped bladder which protrudes about half size of an egg. I am 87 years old and in very good health.
A. It sounds to us that you may have vaginal prolapse and that you're asking about management options for this problem. As you can tell from the questions from other women, this is a very common condition. For our patients with prolapse we recommend that they make treatment decisions based on how much the prolapse limits her daily activities and on how much each treatment option can improve her quality of life. Some women are very bothered by their prolapse and treatment usually makes their lives much better. Other women aren't bothered by the bulge at all and in those cases, we generally don't do anything but follow the patients over time to see how they do.
At 87 years and good health you have many options including surgical and nonsurgical treatments. 87 is not too old for surgery but we obviously are cautious before recommending surgery for our senior patients. There are several minimally invasive procedures that our 80 and 90 year old patients have selected and they have done very well. Some of these may be reasonable for you to consider. Alternatively, many of our patients are successfully treated with nonsurgical treatments such as pessaries. We have many patients who have used them for decades with great effect. There are some patients for whom a pessary will not work well but it's almost always reasonable to try one.
We recommend seeing a specialist who is trained to care for patients in their 80s with vaginal prolapse and fully exploring your options. The urogynecologists at UMass Memorial have extensive experience with patients similar to you and we would welcome the opportunity to help you decide on a method that best works for you.
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