Latest Treatments for a Leaky Bladder None
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1 Latest Treatments for a Leaky Bladder None Financial Disclosures Jeremiah McNamara, MD, OBGYN Boulder Women s Care Boulder Women s Care Agenda: Prolapse & Urinary Incontinence The Pelvic Floor The Big Issue: Pelvic Floor Dysfunction The Big Problems: Prolapse Urinary Issues Others: Bowel issues, Pain For each: How does it present? Who is at risk? Treatments Lifestyle Conservative Procedures
2 Pelvic Floor (Dysfunction) The Pelvic Floor A range of issues that arise out of weakness, spasm, or discoordination of the structures that make up the Pelvic Floor A complex association of muscles, the connective tissues that anchor them to the bony pelvis, and the organs that they support physically, and assist functionally. INCIDENCE & IMPACT Affects 1 in 4 women 50% of women over 50 live every day with one or more of these problems Most Common: Stress urinary incontinence 1 in 3 of those women with urinary incontinence have some degree of bowel dysfunction 60% of nursing home occupants suffer from daily fecal and/or urinary incontinence As much as 20% lifetime risk of needing surgery for prolapse or incontinence Surgical repair of prolapse is the most common surgery performed in women older than 70 Thousands of dollars per year spent on pads and other products. $300 million on ambulatory care in It is VERY common. Many are suffering silently with it. Well I mean I ve had these symptoms for years but didn t really know there was anything to do about them I enjoy sex with my partner, but truth be told it is a little painful most of the time, has been that way for years. I get it I had had a couple kids I assumed that some amount of leaking was just part of the deal
3 Prolapse Bladder Issues PFD Bowel Issues Pain Pelvic Floor Dysfunction Prolapse Bladder Issues Prolapse Bladder Issues PFD PFD Bowel Issues Pain Bowel Issues Pain
4 1 1. Cystocele 2. Uterine Prolapse Rectocele 4. Combination PFD: Pelvic Organ Prolapse Risk Factors Pregnancies, Age, Obesity, Chronic constipation VD > Cesarean (size of babies not necessarily correlated, cesarean not completely protective) BMI >25 = two-fold higher risk (weight loss = amazing improvement) Hysterectomy = Historically - Increased risk of apical/vault prolapse Presentation Bulge (vaginal fullness/pressure) Organ system dysfunction Cystocele: Incontinence or Urgency, Double voiding, Splinting, Weak/changing stream, Feeling of needing to pee during intercourse Rectocele: Obstructed/painful BM s, Splinting, Stool trapping, Accidental Bowel leakage, Feeling of needing to have BM during intercourse Low back or pelvic pain 1 2
5 Prolapse Bladder Issues PFD Bowel Issues Pain w/ Stress Incontinence? Pelvic Floor Dysfunction PFD: Bladder Issues Urinary Incontinence Prolapse Bowel Issues PFD Bladder Issues Pain Urinary Retention Recurrent UTI s Painful bladder * With or Without underlying prolapse
6 Stress vs. Urge PFD: Stress Urinary Incontinence PFD: Stress Urinary Incontinence Risk Factors Pregnancies (VD>CD), but just carrying pregnancy implicated Age (Effects of menopause as well as cognitive impairment) Overuse of Bladder irritants Obesity Presentation Leaking with cough, sneeze, laugh, position changes, activity Unexpected, insensible loss of urine Unusual symptoms: Uncontrollable loss of urine, Enuresis, or Incontinence with sexual intercourse
7 PFD: Urgency / Urge Incontinence PFD: Urgency / Incontinence Treatments Risk Factors Lifestyle: Smoking, Bladder irritants Prolapse, or H/o bladder/prolapse interventions Family history (Twin studies: 35-55% genetic, only 1.5% for SUI) Recurrent UTI s Presentation Frequency ( OAB ) Bladder pain/bladder spasm, Chronic pelvic pain related to voiding, Urgency, Urge accidents
8 Treatments Treatments: Prolapse Treatments: Prolapse Treatments: Prolapse Lifestyle Correction of Risk Factors Weight loss & Increased physical activity Addressing constipation Quitting smoking Pelvic Physical Therapy Strengthen pelvic support Improve bowel and bladder function Address PFD-related pain
9 Pelvic Physical Therapy Pelvic Physical Therapy Treatments: Prolapse Treatments: Prolapse Pessary
10 Treatments: Prolapse Treatments: Prolapse Procedures Does not always involve hysterectomy Does not mean removing ovaries All Vaginal Surgery no belly incisions Treatments: Urgency Treatments: Urgency
11 Treatments: Urgency Treatments: Urgency Lifestyle Correction of Risk Factors Voiding Diary Avoiding Irritants Timed Voiding Pelvic Physical Therapy Biofeedback Treatments: Urgency Treatments: Urgency Medications Reduce bladder spasm and reactivity Anticholinergics Oxybutynin, Detrol, etc. Side effects: Dry mouth, dry eyes
12 Treatments: Stress Leaking Treatments: Stress Leaking Treatments: Stress Leaking Pelvic Physical Therapy Lifestyle Correction of Risk Factors Obesity: Weight reduction Quitting smoking Addressing constipation Voiding Diary & Avoiding irritants Pelvic Physical Therapy PF strengthening (Support AND Sphincters)
13 Treatments: Stress Leaking Treatments: Stress Leaking Pessary Treatments: Stress Leaking
14 Incontinence Slings Same day surgery Single 1cm incision upper vagina Thin strip of permanent mesh Benefits: 71-97% cure rate at one year Maintained at 5 yrs Risks: Injury to bladder or urethra during operation (1-5%) Post-op urinary retention (1-2%) & Urgency (15%) Mesh erosion ( %) Incontinence Slings 81 trials, 12,113 women Conclusion Prolapse Bowel Issues PFD Bladder Issues Pain PFD is very common, and very undertreated. There are very effective changes you can make on your own. If you need surgery, there are options with short recovery and good success. Do your Kegels!
15 Thanks! Sources: Memorial Union Terrace, Madison, WI American UroGyn Society (augs.org) Uptodate.com Voices for PFD (voicesforpfd.com) The International Pelvic Pain Society (pelvicpain.org) The University of Michigan Bowel Control Program (medicine.umich.edu/dept/michigan-bowelcontrol-program) The American Physical Therapy Association (apta.org) Ultrasound Post-Void Residual, Michael Zwank, youtube.com The Poise Impressa, Kimberly-Clark Worldwide, Inc. (poise.com/products/impressa) Netter Atlas of Human Anatomy, 6e: Copyright Elsevier Inc. (netterimages.com) THANK YOU! Jeremiah McNamara, MD, OBGYN Boulder Women s Care JMcNamara@bch.org Boulder Women s Care
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