I am an OB/GYN who has been in practice now for 20 years in Seattle. My early training had a strong emphasis on vaginal reconstructive surgery, but I was always frustrated with our poor success rate in repair of pelvic prolapsed and urinary incontinence. As my practice has evolved I have continued to focus on urinary incontinence and new techniques for treating pelvic prolapse. In the recent years there have been some very exciting new changes.
Urinary incontinence in women
Many women are bothered by urinary incontinence. Recent studies have shown that this is worse if you have had a vaginal delivery, but some of women have either wide pelvic openings or poor tissue elasticity that can lead to this without ever having had a vaginal delivery. This is an embarrassing problem and can be very inconvenient, with many women carrying a change of clothes or wearing daily pads. In the elderly this can lead to slips or falls and even broken hips. For women who have had children, this may keep them from exercising or playing with their children for fear of leakage. Many women suffer in silence because this is too embarrassing to share even with their doctors.
Today we have several excellent ways of treating urinary incontinence. Physical therapy, which ranges from “super Kegel’s”, to bio feedback, is an excellent place to start. Many women get significant relief with this. Pessaries, which are silicon donuts that fit in the vagina, may allow a woman to exercise, and go through her daily routine. These can be to be removed at night. Some women even use tampons just to support the vagina during exercise.
For those done with childbearing there are surgical options. We do not recommend these if you are planning on more vaginal deliveries as the next delivery may cause more pelvic damage and undo the surgical correction.
The most successful surgery is the mid urethral sling. This was initially marketed in Europe in the early 1990’s and rapidly became a success here in the US. Prior surgeries had a 60% success rate, with the vaginal tape; the success rate was 90%. While there are changes with aging, the 10 year data is still quite good.
Unfortunately, we have not found a cure for gravity and general “sagging” of tissues (loss of tissue elasticity that comes with age). This is a factor in possible need for other procedures as a woman ages. Initially authorities in the area condemned using “mesh” as a dangerous technique, but as the technique and the mesh has evolved it has become the standard of care. No surgery is perfect, but this is an excellent procedure that can really give a woman her life back.