Maude Carmel, M.D. Answers Questions On: Female Urology

Pelvic organ prolapse happens when the ligaments that support the vagina weaken so much that the bladder, uterus and/or rectum herniate through the vagina.

Pelvic organ prolapse is very common as women get older. Risk factors include aging, pregnancies, vaginal deliveries, obesity, family history, and chronic constipation. Patients may develop a feeling of a mass or bulge coming out of the vagina, a feeling of pressure, trouble urinating, or discomfort with intercourse.

Treating it is really a matter of how bothersome the prolapse is for the patient.

Patients who are bothered by prolapse may opt for a pessary, a specially fitted plastic “doughnut” that we insert into the vagina to support it. While some patients are very satisfied with using a pessary, most patients will prefer a more definitive treatment. Surgery is the most common way we treat pelvic organ prolapse.

We offer a number of surgical approaches and techniques for pelvic organ prolapse, including vaginal, abdominal and minimally invasive/Robotic approaches. The approach and technique we choose depends on which part(s) of the vagina is prolapsing and how severe it is. After patients recover from surgery, they see improvement right away.

Sacral neuromodulation is a treatment we use for urinary urgency, frequency, urgency incontinence, and urinary retention when medication hasn’t worked. The therapy was also recently approved for the treatment of fecal incontinence.

The device is like a pacemaker for the bladder. We place a small electrode around the tailbone through a very small incision in the back that stimulates one of the nerves that innervates the bladder. We test this electrode with an external battery for about 2 weeks. If the patient has significant improvement after this test period, we connect the electrode to a permanent battery which is buried in the buttock. The entire device is then all internal.

The device can either “calm” the bladder in patients with urinary frequency, urgency ,and urgency incontinence or stimulate the bladder for those who have trouble urinating on their own (urinary retention).

Today’s batteries are much smaller than they were originally, making them more comfortable for patients. They usually last three to five years, depending on how much a patient uses the device, and replacing them takes about 20 minutes under local anesthesia.

The variety of new drugs to treat patients with urinary problems is a big advance. For example, for many years there were only a few medications for problems like urgency, frequency, and urgency incontinence. In the past few years, several new drugs have been developed to treat this problem – drugs that are better tolerated and that have fewer side effects.

The biggest advances are probably the treatment options for patients who are not responding to these drugs. The injection of Botulinum toxin in the bladder was recently approved for the treatment of neurogenic and non neurogenic overactive bladder. Neuromodulation is also an excellent alternative. The device has changed a lot since it was first approved, making it much more comfortable for the patient and making its implantation much easier.