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A Sustainable Approach to Incontinence and Prolapse

Take the long view of your health because the “quick fix” often turns out not to be so quick and not to be a fix.

Incontinence and prolapse surgery is a prime example of a “quick fix” that is neither. Pelvic reconstructive surgery is major surgery with high post-op recurrence rates (ranging from 5-60%), and a questionable risk:benefit ratio. Complications run the gamut of usual suspects—infection, bleeding, damage to related structures—to mesh exposure (up to 30% if mesh is used), fistulas (tracts communicating from one organ to the other, e.g. bladder to vagina), and other issues.

The most effective and least risky approaches to incontinence and prolapse also happen to be the least invasive, least expensive.

You can reduce urine leakage by 50% with as little as an 8% weight loss. You can reduce the size of the genital hiatus (thereby reducing prolapse) by 20% in just 2 weeks by doing Kegels with a pessary.

The conservative measures are worth your time and effort because you may get as good or better, longer-lasting results with these than with the “quick fix” of surgery.

  • What’s your experience with incontinence? prolapse?
  • Did you know 25% of women leak gas for at least a short time after their first delivery?
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{ 4 comments… add one }

  • Yvonne May 27, 2011, 1:47 am

    Hi, I am 65 yrs. old and have a severe bladder proplapse. I am not emptying properly, which I believe is a big cause of kidney stones. I am due to get my bladder lifted at X hospital on June 17th…Dr. X is using “mesh”…. I am really worried after reading articles on this system. Would I be better getting the sling? My sister had a sling inserted many years ago. She is now 75 and has not had any problems. Are the risks very high for the mesh? My doctor said he has had an 85% sucess rate. What do you think? I am concerned…..

    Thank you, YM

    • Shelley Binkley May 30, 2011, 5:39 pm

      Hi Y, It is possible the mesh you doctor is planning to use is the same thing as a sling. Sometimes they are both referred to as “mesh” or “sling”. Usually a mesh sling is positioned under the mid-point of the urethra to provide continence when a person is leaking urine. A bladder support mesh goes under the bladder, between the bladder and the vagina, to elevate the bladder when it is falling out or “prolapsed”. Often these two procedures are done together. Any surgery is not without complications. The risks of these procedures include bleeding, infection, damage to the bladder, urethra, or upper urinary tract, erosion of the mesh through the vaginal wall, and other problems. The three-year success rate is quoted as 85%, but the ten-year success rate may not be as high. We don’t have much data on ten year success rates, and the limited data we have, indicate the ten-year success rates may be only about 60-70%. You should speak to your doctor if you have concerns or questions. Thank you for reading the blog and for sharing your information, which I know will be valuable to many other women. Please let me know if I can answer any additional questions or if you have other comments.

  • Donna December 15, 2013, 10:35 pm

    Hi-I’m 57 yrs old-have a history of endometriosis having had a total abdominal hysterectomy at 19 yrs of age. Now having stress incontinence for the past ten yrs but worsening. Had 3 abdominal surgeries (bikini cut) in 1973, 1974, 1975-first for grapefruit sized ovarian cyst, then removal of tube and ovary, then 3rd for the uterus and remaining tube and ovary removal resulting in surgical menopause-been on estrogen x 38 yrs. Had urodynamics testing which showed stress incontinence worsening from 8 yrs ago same test. It also showed I was having rectal spasms-sent to f/u with GI and had defocography MRI which showed pelvic floor problems-grade 1 pelvic hiatal enlargement (7.5cm), pelvic floor descends 3.9cm-mild grade 1 pelvic floor descent; minimal urinary bladder cystocele; rectal prolapse with the anus and rectum descending to ~3.9cm below the pelvic hiatus-grade 2 moderate amt of rectal prolapse; also “appears to be a small anterior rectocele formation”.Mild to moderate pelvic floor relaxation with pelvic hiatal enlargement, pelvic floor descent.
    MY PROBLEM is rectal pain and pressure very uncomfortable-feels like my rectum is going to fall out, pelvic cramping (feels like I did 200 situps), I think my adhesions have reattached-seems like they need to snip them every ~10 yrs and it’s been ~8yrs now but they said there’s no way to know if they’re back unless you do the laproscopic urgery. My urologist wants to do a sling.GYN confirmed I don’t need cystocele repair, waiting til the end of the month to see colorectal surgeon. Kinda nervous about the test results and prognosis-wish I knew what to do for the pain in my bottom. Thank you for your time.

    • Shelley Binkley December 16, 2013, 7:08 am

      Hi Donna,

      It sounds like a complicated problem and your doctors are on top of the situation. I recommend you follow up with them. Adhesions can be troublesome and if symptomatic, often need surgical removal. Endometriosis does sometimes recur after a hysterectomy. It can recur in scar tissue and other areas of the pelvis and abdomen.

      Thank you for reading the blog and commenting.

      -Dr. B

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