Women's Pelvic Health Prolapse and Urinary Incontinence by kellena91

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									     Women’s Pelvic Health:
Prolapse and Urinary Incontinence
  Glencoe Regional Health Services
  Glencoe Regional Health Services

                    Presented by:
                 John Mark Johnson
                      OB/GYN
                    April 22, 2008

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                             Acknowledgment
The following slides and information are courtesy of:
                  American Medical Systems Inc.
                  Minnetonka, Minnesota
                  www.AmericanMedicalSystems.com
GRHS would like to thank them for providing these educational materials for
this health talk.

                              Important Notice
The information contained in this document is for informational purposes only.
It is not intended to diagnose or treat specific patients and should not be used
as a substitute for the medical care and advice of your health care provider. In
addition, this document may contain references to specific products and/or
medications. Such references, whether by brand name or generically, are
provided for informational purposes only and do constitute endorsement,
recommendation, or approval by GRHS or its medical providers. Always
consult a medical professional if you have concerns regarding your health. If
you are experiencing a medical emergency, dial 911.



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Urinary Incontinence




 Loss of voluntary bladder control
   resulting in urinary leakage
          A Common Problem




     1 out of every 3 women over age 45 has some
              type of urinary incontinence*

13 million US women over age 45 suffer from Stress Urinary
                     Incontinence

              1 out of 2 women over age 65
            Anatomy Review




• Bladder stores the urine
• Sphincter muscle holds the urine in the bladder
• Urethra is the tube in which urine is passed out of
  the body
Different Types of Incontinence


             • Urge-Experiencing the
               overwhelming need to urinate,
               even if you just went and/or
               being unable to hold it long
               enough to reach a bathroom

             • Stress-Urine loss during
               exercise, coughing, sneezing,
               laughing, or any body
               movement which puts pressure
               on the bladder

             • Mixed-Combination of both urge
               and stress
        Urge Incontinence




Occurs when nerve passages from the
  bladder to the brain are damaged,
causing a sudden bladder contraction
          Urge Incontinence Treatments


• Goal: To improve bladder instability

   – Lifestyle changes

   – Behavior modifications

   – Medications

   – Neural Stimulation
         Stress Incontinence

Occurs when pelvic muscles have been damaged



                    Damage can be caused by:
                    •Pregnancy and childbirth
                    •Radiation
                    •Trauma
                    •Prior surgery
                    •Muscle damage
                    •Hormonal changes
        Stress Incontinence Treatments


• Goal: To strengthen or aide the pelvic muscles that have
  been damaged.

    –   Pelvic floor exercises
    –   Pessary devices
    –   Bulking agents
    –   Surgery
    –   Minimally invasive procedures

*There is currently no medication available to treat Stress
   Urinary Incontinence (SUI)
         Mixed Incontinence

    A combination of both urge and stress




Often treated with both surgery and drug therapy
Stress Incontinence Treatments: Slings


• There are different types of surgical
  sling procedures that are:
   – Minimally invasive

       – Outpatient procedure

       – Designed to reduce recovery time

       – Effective: Results >90%1




1. Davila et al., Multicenter experience with Monarc transobturator sling to treat stress urinary
incontinence. Int Urogyn J Sept 2006
            Slings for Stress Incontinence




• Considered minimally invasive surgery
• A sling or hammock shape material is placed below the
  urethra
• Long term data shows success of over 90%1



1. Davila et al., Multicenter experience with Monarc transobturator sling to treat stress urinary
incontinence. Int Urogyn J Sept 2006
   Slings for Stress Incontinence


– Minimally invasive

– Incisions are very small

– Procedural pain is minimal

– An outpatient procedure

– Designed to reduce recovery time

– Patients can resume normal, non-strenuous
  activities shortly after procedure
                      What to Expect After


          – Your recovery will be determined by your doctor

          – You may be able to return home in just a few hours
            after the procedure is complete

          – For approximatly four to six weeks you should avoid
            sexual intercourse, heavy lifting and exercise




Data on file at AMS
                          Risks and Precautions

  Sling procedures require surgery and are not recommended for everyone,
  especially if you:


•Are pregnant

•Have blood coagulation disorders

•Have a compromised immune system

•Have renal insufficiency

•Have upper urinary tract obstruction


Inflammation and irritation may occur after surgery.

Future pregnancies may cause you to become incontinent again

Although rare, some of the most severe risks associated with sling procedures are infection, erosion and vessel
or urethra perforation. Some of the most common risks include urinary tract infections, urge symptoms and
difficulty with urination. You should talk with your doctor about benefits and risks before moving forward with any
  Data on option.
treatmentfile at AMS
Steps to a Solution




    – You don’t have to live with this

    – Don’t tolerate wearing pads or using
      other coping mechanisms

    – Talk with your doctor or healthcare
      professional
            Next Steps




Patient Evaluation-History

– Physical exam

– Laboratory testing
Pelvic Organ Prolapse




 A weakening of the supporting tissues or
       muscles of the pelvic floor
               A Common Problem




 More than 30 million US women over age 45 suffer from pelvic
                        organ prolapse

1 out of 2 Women over age 45 suffer from some type of prolapse

   Only 15% of women affected by prolapse seek treatment
Common Causes of Prolapse




  •Menopause

  •Pregnancy and Childbirth

  •Prior Surgery

  •Obesity

  •Aging
      Common Symptoms of Prolapse



•A bulge or lump in the vagina

•A pulling or stretching feeling in the groin area

•Difficult or painful sexual intercourse

•Urinary or fecal incontinence

•Difficulty with bowel movements

•Delayed or slow urinary stream
Anatomy Review
               Types of Prolapse



Cystocele                Bladder falls into the vagina

Enterocele               Small bowel falls into the vagina

Rectocele                Rectum falls into the vagina

Uterine Prolapse         Uterus falls into the vagina

Vaginal Vault Prolapse   Vaginal vault occurs when the upper
                         portion of the vagina (the apex)
                         descends into the vaginal canal.
Types of Prolapse
    Pelvic Organ Prolapse Solutions



• Conservative Therapies
   – Strengthening the pelvic floor
      • Kegel Exercises
      • Vaginal Cone Weights
   – Supporting the pelvic floor
      • Pessaries
• Surgical Solutions
   – Mesh Repair Kits
New Surgical Solutions: Mesh Repair Kits



• Prolapse repair systems return prolapsed organs to a more
  normal anatomical position and strengthen structures around
  the vagina to maintain support. They are designed to:

   – Offer a minimally invasive solution

   – Minimize tissue trauma

   – Restore normal anatomy with a faster recovery than open
     abdominal approaches

   – Minimize pain compared to more invasive procedures

   – Provide a solution that is long lasting
 New Surgical Solutions: Mesh Repair Kits



  • Efficacy >90%2


  • High patient satisfaction




Although there is a low rate of complications the most common are:

    •Pain
    •Infection
    •Pain or discomfort with intercourse

 2. Garuder-Burmester et al, “Follow-up After Polypropylene Mesh Repair of Anterior and Posterior
 Compartments in Patients with Recurrent Prolapse” IntUrogyn J, 2007
                      What to Expect After




          – Your hospital stay and recovery will be determined
            by your doctor

          – Incisions will be small and should heal quickly

          – For approximately four to six weeks you should
            avoid sexual intercourse, heavy lifting and exercise

Data on file at AMS
                         Risks and Precautions

  Surgical procedures to correct prolapse are not recommended for everyone,
  especially if you:




•Are pregnant or plan to become pregnant in the future

•Have blood coagulation disorders

•Have a compromised immune system




After the prolapse procedure you may notice some incontinence that had been hidden before the surgery. As
with most surgical procedures, inflammation and infection may occur that may require additional medical
treatment. You should talk with your doctor about benefits and risks before moving forward with any treatment
option.

 Data on file at AMS
                     Today is the Day!



•   You do not have to suffer from
    incontinence or prolapse

•   Many treatments are available

•   New advancements offer minimally
    invasive procedures

•   You can have an improved quality of life
    and return to your normal activities
    within a short time.
Question & Answers

								
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