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Common Urogynecologic Problems after Pregnancies/Deliveries

Health News


By Dr. Paul A. White

Board-Certified OB-GYN specializing in Urogynecology Procedures

Adventist Health / Community Care – Reedley Women’s Health

CENTRAL VALLEY – The arrival of a new baby is a joyful occasion, but the delivery can be difficult on the mother’s body, leading to pain and discomfort. Fortunately, lifestyle changes and medical advances in urogynecology can bring relief. Common problems and treatments include:

1) Stress Incontinence

This is one of the most common problems after even one vaginal delivery. This is when women leak urine with movements such as a cough, sneeze, laugh, lift or jog, leading some to wear a pad every day.

Activities that can help:

Weight loss - Studies have shown that weight gain is the most significant contributor to severity and frequency of stress urinary incontinence.

Kegels - Squeezing exercises for the vagina can also help; 200 squeezes a day is recommended.

Bladder training - Allowing the bladder to overfill will exacerbate incontinence.

2) Overactive Bladder (OAB) and Urge Incontinence

This is another common bladder issue, more related to aging and previous surgery than deliveries, although obstetrics injuries will contribute. This is when the woman has sudden urges (some very painful) and must get to bathroom immediately or she will leak uncontrollably. These women will be the ones who know exactly where every bathroom is wherever they go. People with OAB will have frequent urges to use the restroom and will often have to go more often than every two hours and get up at night more than twice.

Treatments:

Avoid bladder irritants - These may include red wine, spicy food, coffee, chocolate, smoking and acid juices.

Bladder training - Urinate no more frequently than every two hours. Avoid late-night drinks, and don’t allow the bladder to overfill.

Medications:

Neuralmodulation – therapeutic alteration of activity either through stimulation or medication, both of which are introduced by implanted devices.

Physical therapy

Botox

3) Cystocele (Bladder/Anterior Wall Prolapse):

This is the feeling of a bulge from the vagina. It may range from being barely perceptible to having a complete prolapsed bladder that has to be reduced for the woman to function.

This is most common in women who have had one or more babies and even more so in those who have also had a hysterectomy. Sometimes this can cause some urinary retention and bladder infections, and the exposed portion can get sores and cause pain during intercourse.

Treatments:

Kegels and weight loss

Pessary - A rubber/Silastic object made to fit the individual’s vagina and symptoms.

Surgery: Bladder suspension with and without mesh or other material.

Vault suspensions (suspending top of vagina to durable pelvic structures)

4) Uterine Prolapse: when the cervix is noticeable well below its normal station and/or

even is visible within/without vagina.

This can lead to a feeling of chronic fatigue and pressure, pain during intercourse and sores on the exposed area of the prolapse.

Treatments:

Pessary

Surgery - Hysterectomy with vault suspension

Sacro-uteropexy - attaching uterus to sacrum with mesh (not performed often).

5) Rectocele (posterior wall vaginal prolapse)

This is the out-pouching of the back wall of the vagina, on the rectal side. This is also more common in women with previous vaginal delivery and/or obstetric injury. It can fill with stool, and the woman may have to put her fingers on it to press out the stool.

Treatments:

Pessary

Kegels
Surgery - Rectocele repair with or without mesh or other material and with or without vaginal roof suspension.

6) Stool/Bowel Incontinence:

The woman leaks some fecal material and has poor control of solids and gases. This is commonly seen after vaginal births, especially deliveries that caused larger posterior tears and episiotomies.

Treatments:

Dietary changes

Stool bulking agents

Kegels

Surgical reconstruction of affected area

Urogynecology problems can be very uncomfortable, but there is hope and help for women who suffer from these problems. To contact Dr. White, call (559)-637-2455 or visit www.ReedleyWomensHealth.com