Bladder Control

Prolapse

Signs and Symptoms
Diagnosis
Treatment

Treatment

Behavioral therapy, pessaries or vaginal inserts and surgery are the three treatment options for this problem.

• Behavioral treatments are simple, self-directed, have no side effects and are often used in conjunction with other treatments. They have been effective for many women with certain types of incontinence.
  
  1. Bladder Training: Bladder training is an important form of behavior therapy that can be effective in treating urinary incontinence.
     

     The goals are to increase the interval between each time you urinate and to increase the amount of fluids your bladder can hold. This training can help diminish the sense of urgency and leakage.

     Bladder training requires a fixed schedule be established, whether or not the urge to urinate is present. If urge occurs before the assigned interval, urge suppression techniques, such as relaxation and Kegel exercises, should be used. As success is achieved the interval is lengthened in 15 to 30 minute increments until it is possible to remain comfortable for 3 or 4 hours. This goal can be adjusted to suit each woman's needs and desires.

     Keeping a diary of your bladder activity is very important. This helps your health care provider determine when to start the training and to monitor your progress throughout your program.

  2. Pelvic muscle exercises: Pelvic muscle exercises, also known as Kegels, can help improve incontinence and prevent it from worsening. They can help you suppress the urge to urinate. The exercises strengthen and tone the muscles that support the pelvic organs. These muscles contract and relax under your command to control the opening and closing of the bladder. When these muscles are weak, urine leakage may occur. To achieve the best results, imagine yourself as an athlete in training. You need to build strength AND endurance of your muscles. This requires commitment and regular exercise. Correct technique also is very important.
  3. Biofeedback: Biofeedback takes information about something happening in the body and presents it in a way that we can see or hear and understand. Getting on a scale to check your weight or having your blood pressure taken are very simple examples of biofeedback. Biofeedback can be used to measure any body response such as heart rate or muscle contraction and relaxation. The measurement can be displayed on a computer screen or heard as a tone and used to learn about a subtle body function.
     

     Biofeedback has been effective in treating urinary incontinence. It can help you learn to control and strengthen your pelvic floor muscles and play an important role in bladder control.

     Because you cannot see the pelvic floor muscles, you may find it difficult to locate them. Perhaps you are uncertain if you are doing the exercises correctly. This is where biofeedback can help. Biofeedback therapy uses computer graphs and audible tones to show you the muscles you are exercising. It also allows the therapist to measure your muscle strengthen and individualize your exercise program. It is a teaching tool to help you learn to control and strengthen the pelvic floor area.

  4. Urge Suppression: Urge suppression is a way to help control the sudden urge to urinate so that going to the bathroom is not an emergency. Running to the bathroom is the worst thing you can do as it actually causes bladder irritability to increase and interfere with your ability to concentrate on controlling your bladder.

     When the urgency strikes, an "urge suppression" technique can help maintain control. Your goal is to maintain bladder control until you reach a toilet. A normally functioning bladder can wait until the appropriate opportunity to empty, an unstable bladder can not.

• Vaginal inserts or pessaries are frequently used to treat bladder and pelvic support problems. A pessary is a vaginal insert, similar to a contraceptive diaphragm, which is placed into the vagina to support the uterus as well as bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease leakage. The type and size of the insert is fitted to address your problem and your body. A properly fitted pessary is not noticeable when in place.
• Surgery for pelvic support problems attempts to restore the normal anatomic position of the prolapsed areas and to improve symptoms that may be caused by the prolapse. The choice of surgical procedure is individualized. Factors that may influence this choice include examination findings, previous surgery, age, other medical illnesses and patient/physician preference.

  The surgery typically includes repair of tears in the fascia or suspension of the prolapsed tissues to stronger structures in the pelvis. In some cases, a graft may be used to help strengthen the area. The surgery may be performed through a vaginal or abdominal incision or a combination of both.

  One of the goals of surgery for pelvic organ prolapse is to repair all of the defects that are present in order to prevent the need for surgery in the future. Therefore, many women will require a combination of these procedures.

  1. Vaginal procedures are done through an incision in the vagina. Some of the common vaginal procedures are:
     
     • Anterior repairs to help strengthen the front wall of vagina overlying the bladder.
     • Posterior repairs to correct tears that may exist in the back wall of vagina -- the area directly above the rectum. This type of surgery may involve the use of a graft (taking a piece of tissue from another part of the body) to help strengthen the area.
     • Vaginal vault suspension procedures, which use sutures (stitches) to attach the top of the vagina to stronger structures in the pelvic region.
     • Perineorrhaphy, which involves reconstruction of the area between the vagina and rectum.
     • Colpocleisis, which includes partial or complete closure of the vagina.
  2. Abdominal Procedures are done through an incision in the abdomen. Some of the common procedures are:
     
     • Abdominal sacrocolpopexy suspends the top of the vagina to a strong ligament on the front part of the sacrum, or lower back bone, using a piece of tissue, muscle or ligament from another part of the body.
     • Paravaginal defect repair repairs places where the vagina has torn away from its attachment to the tissue that connects to the pelvic bone.

Reviewed by health care specialists at UCSF Medical Center.
Last updated May 8, 2007