What patients are saying
“From scheduling and checking in to seeing Dr. Arendt, I was very happy with my visit. I was a new patient and didn’t know what to expect and was nervous because of my condition. All the staff was very nice. I felt comfortable and look forward to continuing my care with Dr. Kathryn Arendt.”
Dr. Jacoby “is gentle and understanding.” She is a “dedicated and wonderful surgeon. Highly recommend.”
“Most patient and caring doctor experience I have had. Totally listened to my concerns about my prolapse and helped me with ideas of how to avoid surgery for now. I’d highly recommend Dr. LaCombe if you are on the fence about surgery.”
“Dr. Miller has been wonderful in helping my daughter and myself with our female and urology issues. I highly recommend her.”
Pelvic Organ Prolapse (POP)
One-third of all women have pelvic organ prolapse, or POP. However, the condition remains little known by the public. As a result, many suffer silently for years before seeking medical help. The good news is that very effective treatment options are available to you from experienced board-certified urogynecologists and female urologists.
What is Pelvic Organ Prolapse (POP)?
The pelvic organs include the cervix, uterus, vagina, small bowel, rectum and bladder. A group of muscles called the pelvic floor hold these organs in place in a hammock-like structure, or sling. If these muscles are damaged, torn or stretched or weaken, the organs may descend, moving downward or even outward. Patients describe a feeling of a bulge or fullness. Prolapse is not a medically urgent condition, but it can cause uncomfortable pelvic symptoms and even obstructive urinary and bowel symptoms, in addition to sexual dysfunction. POP is diagnosed by a pelvic exam.
What causes Pelvic Organ Prolapse (POP)?
Factors causing POP include:
- Genetics, including family members who have had POP
- Pregnancy and vaginal childbirth, although many women who have multiple children will not experience POP
- Race, with Caucasian women more likely to develop POP
- Intensive heavy lifting
- Obesity, with obese women up to 75% more likely to develop POP
- Menopause and aging
- Chronic constipation
Pelvic Organ Prolapse (POP) Symptoms
Many times, POP doesn’t produce symptoms. However, the most common are:
- Pelvic or vaginal pressure
- A feeling that “something is falling out”
- Vaginal cramping, pain or low back pain
- Difficulty emptying the bladder or rectum
- Painful intercourse
Types of Vaginal Prolapse
The three main types of vaginal prolapse are:
Anterior Vagina Wall Prolapse (often referred to as a cystocele or mislabeled as a bladder prolapse)
This is a defect in the vaginal wall that can change the position of the bladder. It occurs at the anterior, or front, and apical, or top of the vagina. If the vaginal tissues weaken, the bladder can sit lower on the vagina. It can result in vaginal bulging and difficulty in emptying the bladder, which can potentially lead to bladder infections, frequent urination and urgent loss of bladder control.
Posterior Wall Prolapse (Rectocele or Enterocele)
If the support tissue between the vagina and the rectum is damaged, stretched or detached, the rectum and small or large intestine can put pressure on the vaginal wall. This can lead to vaginal bulging and difficulty with bowel evacuation.
Apical or Uterine Prolapse
The uterus is suspended by strong ligaments called the uterosacral ligaments. If they become over-stretched and elongated, the uterus can sit lower in the vaginal canal. The same ligaments are responsible for suspending the top of the vagina in women who have had hysterectomy. It can prolapse if those ligaments lose suspension, a condition called vaginal vault prolapse. Classic symptoms for uterine or vaginal vault prolapse include vaginal bulging or protrusion, difficulty with bowel or bladder emptying, and/ or pelvic or low back pressure that worsens with increased activity or as the day progresses.
Pelvic Organ Prolapse (POP) Treatment Options
Treatments are determined by the severity and symptoms. They can include:
- Watchful waiting: Intervention is not necessary for everyone. Some patients prefer to take a wait-and-see approach.
- Pelvic floor strengthening and coordination.
- Vaginal suspension devices known as pessaries, which are medical-grade silicone vaginal inserts.
- Low-dose vaginal estrogen.
- A variety of minimally-invasive techniques, including repairs that are exclusively vaginal and abdominal repairs that may be approached laparoscopically or with robotic technology. Minimally invasive approaches allow for smaller incisions, a quicker recovery time, and faster return to daily activities.
When is it appropriate to consider surgery?
Our goal is to encourage, educate, guide and empower our patients to participate in choosing their preferred care. Some women may select non-surgical therapies. For others, surgery may be preferential if the pelvic prolapse is affecting quality of life and causing significant discomfort. Each woman’s situation is unique, which is why we work closely and attentively with you in choosing the best path forward.
Labiaplasty is a procedure that reduces the size and can improve the symmetry of the labia minora or majora, which are part of the vulva. This procedure is not common, but it can be performed by our urogynecologists if needed or desired.
Half of American women 65 and above and over 40 percent of those ages 50-64 experience some sort of urinary incontinence. The condition refers to involuntarily losing control of the bladder and urine leakage, an issue that affects women much more often than men. The severity varies from person to person, ranging from small infrequent bladder leakage to sudden urges to urinate. It can be very embarrassing and disruptive.
Most people can gain control of their bladder again through simple lifestyle changes. For those with more severe conditions, treatment depends on the type of urinary incontinence. There are three types: stress incontinence, overactive bladder and overflow incontinence.
Stress incontinence refers to leakage from increased abdominal pressures, such as coughing, sneezing, lifting or bending over. Activities including running, tennis, yoga and simple day-to-day movements like stepping off a curb or walking down stairs can also cause pressure resulting in leakage.
How does stress urinary incontinence cause bladder leakage?
Stress urinary bladder leakage is commonly caused by weakness of the pelvic ligaments supporting the urethra, which is the ‘tube’ that exits the bladder during normal urination. In addition, The hormone estrogen can also play a role in tissue weakness and stress urinary incontinence once the ovaries are no longer producing it.
What are ways to prevent stress incontinence?
Lifestyle changes can help:
- Smoking cessation, to minimize coughing and collagen damage that occurs in smokers
- Losing weight: Reducing weight by just 5-percent can improve urinary incontinence in overweight women.
- Managing constipation
- Modifying high-impact activities.
What are treatment options for stress incontinence?
- Physical therapy to improve strength and coordination of the muscles and ligaments, which can be both a preventive and treatment measure.
- Muscle strengthening by direct nerve stimulation devices.
- Vaginal devices that support the urethra by physical compression, such as an incontinence pessary or the over-the-counter device “Impressa.”
- Bulking agents that plump tissue tone, narrowing the urethra to make it “less leaky.”
- Mid-urethral slings, a minimally-invasive vaginal procedure.
If you are experiencing any of the symptoms of stress urinary incontinence, please see your physician for a diagnosis and treatment plan.
Overactive bladder refers to the bladder contracting when it isn’t supposed to, causing the sudden strong urge to urinate. Sometimes the feeling is so overwhelming that patients experience leakage before getting to the restroom. The bladder contractions can be caused by the nervous system or irritation in the bladder. While this condition is generally known as overactive bladder, it is sometimes also called urge incontinence.
Causes of Overactive Bladder:
- Aging, which is the most common cause
- Urinary tract infections
- Inflammation or irritation
- Cancer of the bladder
- Bladder stones
- Obstruction of the bladder by a tumor or urinary stones
- Neurological disorders, which may include multiple sclerosis (MS), Parkinson’s disease, stroke, brain tumor, diabetes and spinal injury. Each of these can cause incontinence by interfering with the nerves that control the bladder.
Treatment options for overactive bladder
Behavioral modifications: This involves changing your habits and training your bladder to improve function, which may include timed voiding, double voiding, and scheduled bathroom breaks. This can also encompass avoiding dietary irritants such as caffeinated beverages, acidic beverages, alcohol and spicy food. Retraining overactive or uncoordinated pelvic muscles may help, as well.
Medications: Two new medications in the beta 3 agonist class are effective for overactive bladder. They are an advance from the anticholinergic medications for overactive bladder that are no longer recommended for long-term use in women over 70, due to evidence they can lead to dementia and cognitive deficits. The two new beta 3 agonists do not produce those side effects.
Percutaneous Tibial Nerve Stimulation (PTNS): Percutaneous tibial nerve stimulation is a nonsurgical treatment delivered by a slim acupuncture-type needle placed near the ankle, where the tibial nerve is located. When the tibial nerve is stimulated, impulses travel to the nerve roots in the spine to block abnormal signals from the bladder and prevent bladder spasms. This treatment requires 12 weekly sessions
Bladder Botox injection: Botox blocks the ability of some nerves to communicate with bladder or sphincter muscles. It is similar to Botox injections to facial muscles. While Botox bladder treatment is temporary, it is very effective. The injection typically lasts about eight months to one year, at which time the procedure can be repeated.
InterStim and Axonics implant devices: These improve the communication pathway between the brain and the bladder by stimulating nerve roots that control bladder and bowel function. A small neuro-stimulator, similar to a pacemaker, is placed under the skin through a minimally invasive procedure that uses a small incision in the upper buttock. In addition, a thin lead is threaded along the nerve root of the sacrum. Patients utilize a remote control to turn their device up, down or off. The stimulation reduces “noise” from the overactive bladder and relieves the feeling of urgency. It can resolve accidental bladder and bowel leaks. This FDA- approved therapy, which is reversible, has been used with hundreds of thousands of people over several decades and studies show high levels of patient success and satisfaction. If you are experiencing any of the symptoms of urinary incontinence, please see your physician for a diagnosis and treatment plan.
Overflow incontinence is the opposite of overactive bladder, occurring when the bladder loses its sense of urgency. In some cases, we call this underactive bladder. The patient doesn’t know that their bladder is full and needs to be emptied. At this point, urine overflows involuntarily, resulting in incontinence.
Causes of overflow incontinence:
- Weak bladder muscles
- Nerve injury that affects the bladder
- Diseases that affect the nerves including diabetes, Parkinson’s disease, multiple sclerosis and spina bifida
- Pelvic prolapse of the uterus or bladder
Treatments for overflow incontinence include:
- Percutaneous Tibial Nerve Stimulation ( PTNS): Percutaneous tibial nerve stimulation is a nonsurgical treatment delivered by a slim acupuncture-type needle placed near the ankle, where the tibial nerve is located. When the tibial nerve is stimulated, impulses travel to the nerve roots in the spine to block abnormal signals from the bladder and prevent bladder spasms. This treatment requires 12 weekly sessions.