Questions and answers

I had to wait a long time to see you. Why?

Urogynecology is an important specialty in Women’s Health that covers and treats many common conditions, but there aren’t as many specialists in this area as you may think. Long wait lists come from a shortage of specialists and high demand for their services.

General gynecologists and some Urologists also provide care for similar conditions and we all work together to help women with pelvic floor disorders. Some cases are more complex and require specialist consultation and some do not.

Has my bladder dropped ? Is that why I am leaking?

Urinary incontinence and pelvic organ prolapse are common pelvic floor disorders but its important to distinguish between them. They can occur together in the same person or women may have one or the other.

Prolapse (“dropped bladder”) does not necessarily cause incontinence, and there are different kinds of incontinence. Many people discuss their “fallen bladder” which is a term we do not use as it doesn’t describe what is actually happening. Furthermore, having prolapse of the anterior vaginal wall (called a cystocele) does not always cause incontinence in itself.

Stress incontinence is loss of urine with any activity that increases abdominal pressure, such as laughing, coughing, sneezing, lifting, jumping, walking, jogging or even sudden movements for some women. This is caused by a relative weakness of the supports to the urethra itself and not the anterior vaginal wall which has the bladder behind it.

Understanding why someone has urinary incontinence requires a history, examination and sometimes further testing. A physical exam can also determine whether prolapse of the vaginal walls is present independently. But having prolapse does not mean you will necessarily have incontinence and if you have urinary incontinence you may not have vaginal prolapse at all.

My mother had surgery for prolapse, does that mean I will get it to? Is prolapse genetic or hereditary?

The short answer is maybe.

There is no known gene responsible for prolapse alone, but it very possible that more than one woman within a family can have it simply because it is a common condition. Studies show that 11-19% of women will have a surgery for pelvic organ prolapse and/or urinary incontinence by age 80.

Another possibility is that there may be inherited features of the strength or weakness of our tissues that run in families that make it more likely. Women are 2.5-times more likely to develop pelvic organ prolapse if there is a history of prolapse in their first degree relatives.

There are genetic conditions called Connective Tissue Diseases (CTDs) that can affect the strength of the collagen and proteins in our muscles and ligaments. People with CTDs are more likely to develop pelvic organ prolapse. However, women with CTD’s only make up a small proportion of those with prolapse.

I don’t want to take medication for my urinary incontinence, I just want to have this “fixed” and have a surgery instead.

There are a few different types or causes of urinary incontinence and not all types of can be improved or treated with surgery. Stress urinary incontinence (SUI) is the only type of incontinence where surgery is commonly performed.

A history, physical exam and possibly more testing can help to determine which kind of urinary incontinence you have.

Overactive bladder is a common cause of urinary incontinence and typically also involves symptoms of urgency, frequency and getting up at night multiple times to void. The first line treatment is lifestyle and habit changes and perhaps pelvic physiotherapy. Medications are used for the management of overactive bladder and surgery is not the next step medication doesn’t help. Surgery for stress urinary incontinence does not help overactive bladder, and in fact it can make the symptoms worse.

Some women have mixed incontinence, or have more than one cause. The treatment plan involves a careful evaluation and individualized discussion about options, benefits and risks.

So in summary, treating incontinence does not necessarily start with medication and then proceed to surgery next as many people perceive.