Download Bladder and Pelvic Health

Bladder and Pelvic Health
A Woman’s Guide to
Symptoms • Tests • Conditions • Treatments
937-277-8988 • 1-888-808-1016
Dayton Center
• Englewood Center • Huber Heights Center • Trotwood Satellite
Table of Contents
About Bladder and Pelvic Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Making a Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Common Conditions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Treatment Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
“This side view of a normal female
pelvis shows the bladder, uterus and
rectum in place and well supported.
When pelvic organs slip out of place
due to weakened pelvic muscles, the
result can be discomfort, pain and
embarrassing incontinence.”
-William J. Rush, MD
Bladder and
pelvic health is
an increasingly
important issue
for women.
About Bladder
and Pelvic Health
A Message from William J. Rush, MD
Since its inception more than ten years ago, Lifestages—
Samaritan Centers For Women has been dedicated to
offering the highest quality healthcare and to setting the
regional standard for recognizing and responding to
women’s unique health challenges.
We know that bladder and pelvic health is becoming
an increasingly important issue for women. Over a
lifetime, three out of four women report some degree
of urinary leakage and one out of three may experience
pelvic organ slippage (prolapse). As common as these
conditions are, women often don’t talk about them –
even to their doctors. Eventually, however, their situation
becomes unmanageable – interfering with daily life,
damaging self-esteem and causing physical pain.
Recognizing bladder and pelvic health as a growing issue
among women, Lifestages and its long-time partner
Good Samaritan Hospital established the Women’s
Center For Bladder & Pelvic Health. The center, which
combines the expertise of Lifestages medical team with
the resources of a full-service hospital, makes it easy
for women to seek care in a supportive, professional,
comfortable setting. We offer our patients:
• Physicians, nurses and technicians with advanced
training in women’s bladder and pelvic health
• A multidisciplinary approach including physical
therapy and nutrition counseling
• The latest diagnostic technology
• Multiple treatment options
No woman should suffer needlessly with bladder or
pelvic health problems or be embarrassed to seek help.
It is our hope to end the taboo that has surrounded
these conditions and to bring relief and peace of mind
to many women who otherwise might suffer in silence.
-- William J. Rush, MD
Director
Women’s Center for Bladder and Pelvic Health
1
Making
Making a
a Diagnosis
Diagnosis
Your
Your initial
initial visit
visit to
to the
the Women’s
Women’s Center
Center For
For Bladder
Bladder && Pelvic
Pelvic Health
Health will
will include
include
aa review
of
your
medical
history
and
medications,
a
physical
examination,
review of your medical history and medications, a physical examination, and
and aa
conversation
conversation with
with your
your physician
physician about
about your
your symptoms.
symptoms .
Depending
Depending on
on what
what isis learned
learned during
during this
this visit,
visit, your
your physician
physician may
may order
order further
further
testing
testing such
such as
as aa urodynamic
urodynamic study,
study, aa cystoscopy
cystoscopy –– or
or both
both –– proceeded
proceeded by
by aa one-toone-tothree-day
bladder
diary.
three-day bladder diary .
Bladder
Bladder Diary
Diary
Your
Your physician
physician will
will give
give you
you aa form
form to
to use
use to
to
Kegel Excercises
complete
complete aa bladder
bladder diary
diary for
for one
one or
or three
three days.
days . You
You
Kegel Exercises Strengthen Pelvic Muscles
will
record
all
fluid
intake
and
output
(including
you
need additional
help identifying
and exercising your
ordingwhenyouwakeupinthemorningandcontinuefor24hours.
will record all fluid intakeIfpelvic
and
output
(including
muscles, we have a physical therapist who is trained
parateentryeachtimeyouvoid,leakorhaveanythingtodrink.
to evaluate
your muscle
strength and
help you learn
leakage)
for
the
prescribed
time
period,
including
leakage) for the prescribed
time period, including
voids(mLmeasurements)usingthehat.Ifyouarenotathome,use
how to perform Kegel exercises. Ask your physician for
ingscaletomeasuretheamountofurinevoided:1=small,2=medium,
information.
what
leakage
what you
you were
were doing
doing when
when
leakage occurred
occurred and
and
Find Your Pelvic Muscles
uidintakeinounces.
whether
or
not
you
felt
an
urge
to
urinate.
• Trytostopyoururinarystream.Ifyousucceed,youhave
whether or not you felt an
urge to urinate .
6.Whenrecordingaleak,usethefollowingscale:
identified the right muscles to exercise.
ageforday three of a three-day diary.Thethreedaysyouchoose
vetobeinarow;however,eachdaymustbeafull24hoursduring
convenient for you to measure every void.
1=drops/damp,2=wet/soaked,3=bladderemptied.
Indicate your activity during the leak and if you had an
urgetovoid(yesorno;strongornot).
ActivityDuringLeak
WasThereAnUrge?
cutalongthislineforone-dayonlydiary
s:
• Exercisingthemusclesaroundtherectumwillalsostrengthen
those around the vagina and under the bladder. Squeeze the
muscles that would prevent gas from escaping from your
rectum.
Bladder
Diary
One- to Three-Days
• Donottightenyourstomachandbackmusclesorsqueeze
your legs together as you isolate and contract your pelvic
muscles.
Kegel Exercise Routine
• Beginyourroutinelyingdown.Asyougetstronger,youcan
exercise while sitting or standing.
• Pullinandholdapelvicmusclesqueezefor5seconds;relax
for5seconds.
• Do10setsofrepetitionsthreetimesaday.
• Increaseyourholdby1secondeachweekuntilyouare
contractingfor10seconds.
• Restandbreathebetweencontractions.
Source: American Urogynecologic Society
www.augs.org/Portals/0/Kegel_Exercises.pdf
www.lifestagescenters.com
937-277-8988•888-808-1016
Dayton Center
2200 Philadelphia Dr Ste 101
Dayton, OH 45406
Englewood Center
9000 North Main St Ste 232
Dayton, OH 45415
22
Huber Heights Center
6251 Good Samaritan Way
Ste 130
Huber Heights, OH 45424
Trotwood Satellite
3038 North Olive Road
Trotwood, OH 45426
www.lifestagescenters.com
937-277-8988•888-808-1016
Three out of four women
report some degree of
urinary leakage.
Urodynamic Testing
A certified technician will conduct a series of tests to evaluate how your bladder
and urethra are functioning – including how well your bladder fills with, stores and
empties urine (cystometry), the rate of urine flow (uroflowmetry) and how well your
urethra closes (urethral pressure study). The technician will also assess the strength
and function of the muscles that control urination (electromyography and pressure
flow study). Urodynamic testing is performed in a private exam room in the Lifestages
office. No sedation or medication is required. The tests take about 45 minutes. Your
physician will interpret the results.
Drink two glasses of water one hour prior to your appointment so that your bladder is
comfortably full and arrive about 15 minutes prior to your test. The technician will help
you position yourself in a special chair and will drape you for comfort and privacy.
You will be asked to empty your bladder; a collection device will measure the volume
of urine. The technician will insert thin, flexible catheters into your urethra and vagina
and will fill your bladder with water through one of the catheters. She will ask you
to tell her when you feel the urge to urinate. She may ask you to cough or strain. If
leaking occurs, the sensors in the catheters will record the pressure at the point where
the leakage occurs. Finally, you will empty your bladder with the catheters in place
to measure pressure. The technician will then remove both catheters. You will have a
follow-up appointment within the next week at which time your Lifestages physician
will review your results with you and develop your plan of care.
3
Cystoscopy
Your physician performs a cystoscopy to examine the inside of your bladder and
urethra. The procedure is performed in a private exam room in the Lifestages office.
No sedation or medication is required. A nurse will help you position yourself in a
special chair and will drape you for comfort and privacy. She will cleanse the opening
to the urethra and insert a small amount of numbing gel.
When your physician enters the room, you will be ready for the procedure. He/she will
insert a small, lighted camera through your urethra and into your bladder. You will be
able to see images taken by the camera on a television screen and your physician will
explain what you see. When the procedure is over – about five minutes – you will be
given privacy to dress and then will meet your Lifestages physician in a consultation
room to review your results and develop your plan of care. You will receive medication
to relieve any bladder discomfort and to help prevent infection.
What to Do at Home
After Urodynamic Testing or a Cystoscopy
• Some women may need to take it easy for the rest of the
day; others may proceed with activity as tolerated.
• Drink plenty of water to flush out your bladder. Avoid
alcohol, caffeine and carbonation for 24 hours.
• Take your medication for bladder discomfort and to
prevent infection.
• Soak in a warm tub in the unlikely event of pelvic
discomfort.
• Some patients have some mild urinary discomfort during
the first 24 hours after a cystoscopy. If these symptoms
persist beyond 24 hours or if you have any of the
following symptoms of a urinary tract infection, please call
the Lifestages office at 937-277-8988:
• Fever or chills
• Blood in urine
• Painful urination
• Low back pain
• Frequent or urgent urination
• Difficulty emptying the bladder
4
Common Conditions
Pelvic Organ Prolapse
As muscles are weakened with normal
aging and childbirth, pelvic organs may
slip or protrude into the vagina. Pelvic
organ prolapse also may be caused
by obesity, chronic cough and chronic
constipation with straining.
Pelvic Organ Prolapse Symptoms
• Pressure in the vagina or pelvis
• Feeling very full in the lower
belly
• Decreased pain or pressure
when lying down
• A lump at the opening of the
vagina
• Feeling a pull or stretch in the
groin or lower back
• Recurrent urinary tract infections
• Incontinence or a need to
urinate frequently
• Painful intercourse
• Bowel-related problems such as
constipation
Cystocele
The bladder drops into the vagina.
Rectocele
The rectum bulges into the vagina.
Uterine Prolapse
The uterus drops into the vagina.
5
Urinary Incontinence
Usually, a woman can hold urine in her bladder until she is ready to “go.” It may
seem like a simple thing to do, but actually requires a number of functioning systems
– strong pelvic muscles, a healthy bladder, a strong urethra that opens and closes
properly, and brain and nerve control over the whole process. If one or more of these
systems isn’t working properly, an involuntary loss of urine – urinary incontinence
(UI) – can occur. UI can be light or heavy, regular or occasional. It can interfere
with activities of daily life, work and travel. The emotional impact of UI – due to
embarrassment and loss of self-esteem – can be devastating. UI has several triggers:
• Stress incontinence is leaking associated with coughing, sneezing, jumping, heavy
lifting and exercise. It can occur when the urethra is not well supported and cannot
close properly, thus allowing urine to leak. This failure to completely shut off
the flow of urine happens when muscles around the urethra are weak or when
weak pelvic floor muscles allow the bladder and urethra to shift from their proper
position. Physical changes resulting from pregnancy, childbirth, hysterectomy and
menopause can contribute to stress incontinence.
• Urge incontinence involves a sudden strong urge to urinate caused by bladder
spasms, followed by an uncontrolled loss of urine. People with urge incontinence
may need to urinate often, especially during the night. Urge incontinence, also
called overactive bladder, can worsen with anxiety. Urinary tract infections, bladder
irritants, the slippage of pelvic organs (prolapse), bowel problems and some
medications may cause urge incontinence. When stress incontinence and urge
incontinence occur at the same time, the condition is called mixed incontinence.
• Overflow incontinence happens when the bladder fills normally but does not empty
properly. In this case, urine flow is usually weak and may be a constant dribble. If
the pelvic organs have slipped out of place (prolapse), they may be blocking the
normal flow of urine. In some cases, however, the bladder muscle may not contract
normally or there may be no sensation to empty the bladder. People with nerve
damage from diabetes, stroke or spinal injuries sometimes suffer from overflow
incontinence. Some prescription medications can cause this condition as well.
Urinary Incontinence at a Glance
6
You May Have This
Type of Incontinence . . .
If You . . .
Stress
Leak or lose urine during physical movement
Urge
Leak or lose urine at unexpected times
Mixed
Have both stress and urge incontinence
Overflow
Leak small amounts of urine unexpectedly
Painful Bladder Syndrome
This chronic syndrome is also called interstitial cystitis. It is thought to be an
inflammation of the bladder wall. The exact cause is unknown and the severity of
symptoms can fluctuate and may even disappear for periods of time. Painful bladder
syndrome is sometimes confused with overactive bladder because the patient
may experience frequency and urgency. A woman with painful bladder syndrome,
however, may have a greater need to empty her bladder repeatedly during the night
than does a woman with overactive bladder.
Painful Bladder Syndrome Symptoms
• Pain, pressure, discomfort or a burning sensation that may increase as bladder
fills and is alleviated temporarily by urinating
• Lower abdominal pain that sometimes extends to the lower back
• Pain in the vagina, urethra and rectum
• A frequent need to urinate, especially at night
One out of three women
may experience pelvic
organ prolapse.
7
Treatment Options
Your physician will discuss treatment recommendations with you. These
recommendations will depend on the nature of your condition, its severity, its
underlying cause and your general health. The medical team at the Women’s Center
For Bladder & Pelvic Health are trained in all the latest treatments and take a minimally
invasive approach whenever possible.
May be used to treat:
Pelvic organ prolapse
Urinary incontinence
Painful bladder syndrome (including urgency and frequency)
8
No woman should
suffer needlessly with
bladder or pelvic
health problems.
Non-Surgical
Medication and physical therapy are among the non-surgical treatments your
physician might recommend. Some of these approaches may be combined with
surgical repair.
Medication
Several medications are available to treat the symptoms of urge incontinence or
overactive bladder. Low-dose topical estrogen may rejuvenate tissue in the vaginal
and urethral area. Your physician may also prescribe anti-inflammatory drugs,
antidepressants and antihistamines to relieve pain and other symptoms. In some cases,
your physician may place medication directly into the bladder to help relieve symptoms.
Nutrition Counseling
Diet plays an integral role in bladder health.
For example, avoiding irritants such as coffee,
tea, citrus and carbonation and drinking the
optimal amount of fluids are two important
considerations. The center’s registered dietitian
will assess your diet and advise you on how to
make healthy food choices.
“What you eat and drink can have an impact
on the healthy functioning of your bladder. We
help you identify your food sensitivities and
develop a realistic eating plan that promotes
bladder health.”
– Shannon Lingg, RD, LD
Registered Dietitian
Women’s Center For Bladder & Pelvic Health
Bladder Retraining
Urinating at regularly scheduled times may help re-establish bladder control.
9
Pessary
A pessary is a silicone support device that is inserted
into the vagina to support pelvic organs. Pessaries come
in various shapes and sizes and, with regular inspection
and cleaning, can be used for many years. If your
physician recommends a pessary, it will be professionally
fit to your body.
Strengthening Pelvic Floor Muscles
Strengthening your pelvic floor muscles may be all you need to relieve your
symptoms. If you have a surgical procedure, strengthening the pelvic floor muscles
will be an important part of your rehabilitation and critical to the long-term success of
your surgery.
Kegel Exercises. These exercises help strengthen pelvic floor muscles. Once the proper
technique is learned, they can be done virtually any time and anywhere. You will be
instructed on how to tighten and release your pelvic floor muscles (as if stopping the
flow of urine). Kegel exercises are repeated several times a day.
“Techniques and procedures such as pelvic floor
exercise, biofeedback and electrical stimulation
are proven non-invasive ways to treat bladder
problems. They help by strengthening the
muscles surrounding the bladder and by
improving bladder control. We work with you
one-on-one to teach you these therapies.”
– Wendy O’Shea, PT
Physical Therapist
Women’s Center For Bladder & Pelvic Health
10
Biofeedback. If you have trouble performing Kegel exercises properly, your physician
may recommend biofeedback to help you identify your pelvic floor muscles. A small
tampon-like sensor placed into the vagina or rectum will link you to a computer and
screen. You will see an image showing the tightening and releasing of your pelvic
muscles on the computer screen. By associating your action with the image, you will
learn how to identify and control the proper muscles.
Electrical Stimulation (E-Stim). Your physician may recommend E-Stim if neither Kegel
exercises nor biofeedback work well for you. A mild, painless stimulus is delivered to
the pelvic floor muscles through a small tampon-like sensor placed in the vagina or
rectum. This stimulus causes the pelvic floor muscles to contract and become stronger.
Surgical
The type of surgery your physician recommends depends on your condition and the
repair needed. Sometimes a patient will need more than one procedure during a
single surgery.
Cystocele Repair*
This surgical repair, which is performed through an
incision in the vagina, is used when the bladder has
fallen into the vagina. Stitches are placed between
the bladder and vagina to reposition the bladder and
add support.
Rectocele Repair*
This surgical repair, also performed through the
vagina, is used when the rectum is bulging into the
vagina. Stitches placed between the vaginal wall
and the rectum help reposition the rectum and add
support.
Cystocele or Rectocele Repair with Mesh*
When the tissues supporting the bladder or rectum
are too weak to repair, a specially designed supportive
mesh, similar to a hammock, may be used to
reinforce the repair.
11
Sling Procedure (TVT)*
A special mesh material (tension-free vaginal tape) is
attached to strong tissues and muscles within the pelvis
and placed underneath the urethra to provide support
and help it close properly. This outpatient procedure
requires a small incision in the vagina and either just
above the pubic area or near the creases of the thighs.
Sacral Nerve Modulation (InterStim)
A small, pacemaker-like device, surgically implanted
in the lower back, sends mild, painless stimulation
to the sacral nerve, which controls the bladder and
surrounding muscles. This stimulation may decrease
or eliminate urgency and frequency symptoms,
incontinence and urinary retention. (The patient uses a
portable test device prior to surgery to ensure she will
benefit from this therapy.)
*© ETHICON, Inc. All images reproduced with permission.
12
Sling procedure with tensionfree vaginal tape.
Glossary
Bladder – a muscular sac in the lower abdomen where urine collects before
being voided
Catheter – a small hollow tube used to drain urine from the bladder
Cystoscope – a small camera used to look inside the urethra and bladder
Incontinence – the inability to control the release of urine from the bladder
Pelvic floor – a group of muscles that provides support for the bladder, intestines
and uterus
Prolapse – the falling down of an organ, such as the uterus or bladder, from its
normal position
Rectum – the last section of the digestive tract, extending from the colon to the
anus, where waste is stored before elimination from the body; located behind
the vagina
Urethra – the tube through which urine is released from the bladder; located in
front of the vagina
Vagina – a tube-shaped tract leading from the uterus to the vulva; located
between the urethra and the rectum
13
www.lifestagescenters.com
937-277-8988 or toll–free 888-808-1016
Dayton Center
2200 Philadelphia Dr Ste 101
Dayton, OH 45406
Englewood Center
9000 North Main St Ste 232
Dayton, OH 45415
Huber Heights Center
6251 Good Samaritan Way Ste 130
Huber Heights, OH 45424
Trotwood Satellite
Trotwood Family Physicians
3038 North Olive Road
Trotwood, OH 45426
www.goodsamdayton.org/bladder