Female Support Problems

Dr. Jay Greenberg, FACOG, FACS

     As women age, urinary incontinence becomes more common. For some women, laughing, coughing, sneezing or exercising can cause an embarrassing leakage known as stress incontinence.

     “Stress incontinence is really under-reported because women just don’t want to talk about it,” says gynecologist Jay Greenberg, M.D., FACOG, FACS of Meritus Health Women’s Health Center at Professional Court.

Stress incontinence occurs when the pelvic muscles cannot prevent urine from flowing—especially when pressure is placed on the bladder. Vaginal childbirth can contribute to the muscle-weakening as well as smoking, being overweight and lifting heavy objects. Doctors often prescribe physical therapy to strengthen the pelvic floor muscles that support the bladder.

When conservative measures don’t help, surgery may be an option for stress incontinence. A “sling” uses a woman’s own tissue or synthetic mesh to create a hammock around the bladder neck and the tube that carries urine from the bladder (urethra). Dr. Greenberg uses a tension-free sling made from mesh to support the bladder and prevent urine loss. The minimally invasive procedure requires very few stitches and is done in an outpatient setting.

Pelvic organ prolapse (POP), a related but more serious condition, occurs when the bladder, urethra, uterus or rectal wall bulge into the vagina. The condition is common in older women, especially those who have had multiple vaginal deliveries, perform strenuous physical labor or are overweight.

Women experiencing POP complain of pelvic pressure (feeling as though something is falling out), stress incontinence, constipation and painful intercourse.

For milder forms of POP, physicians recommend physical therapy, but sometimes surgery is the only option when a woman’s comfort and lifestyle become intolerable.

Sacral colpopexy, the gold standard for addressing POP, involves attaching one end of a synthetic mesh material to the top of the vagina and the other end to the upper part of the tail bone (sacrum).

“The mesh acts like suspenders for the pelvic floor organs and recreates the natural anatomic support,” explains Dr. Greenberg.

With more than 100 procedures performed, Dr. Greenberg uses an abdominal incision similar to C-section to reposition fallen pelvic organs. Recovery involves a hospital stay of two to three days and six weeks of recuperation.

“Sacral colpopexy gives women excellent support and they can return to an active lifestyle,” says Dr. Greenberg.

As women in the baby boom era age, this once rarely discussed problem will become a priority in their health. If you’re plagued by symptoms of stress incontinence or pelvic organ prolapse, don't be embarrassed to talk your doctor about ways to overcome this troublesome problem.

By: Anne Gill