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Ask the Doctor at Saint John’s: New Incontinence Treatment Holds Up Q: What’s the main cause of prolapse and incontinence, and
what I’m trained as a gynecologist, and my particular interest is midlife
urogynecological problems concerning prolapse of the pelvic organs. These
conditions involve dropping of the uterus and bladder, and relate to incontinence
and urinary loss. One of the main ways a woman’s pelvic floor can be damaged is through childbirth. The stretching that results from pressure on specific organs can eventually lead to less support for them. If the distortion caused by the baby’s head passing through occurs for too long, vascular and nerve injury can result. If the process occurs too fast, muscle tears can result. There’s been an evolution of thought as to the best way to deal
with this problem. When I first started practicing, the idea was to avoid
cesarean delivery at all costs. It was viewed as expensive and painful.
We eventually determined, however, that cesarean delivery was sometimes
being rejected out of hand when it should have been the method of choice.
Cesarean delivery, properly used when the In prolapse, the uterus and cervix slide. If there’s relatively insignificant repositioning, the woman may feel nothing. It’s not a problem that needs fixing. A lower bulge from greater sliding, however, creates a “bulky” sensation in the patient. Corrective action may be called for. What can be done? Before the uterus has completely fallen, Kegel exercises can sometimes strengthen the pelvic floor. But many women with prolapse have significant nerve damage. This negates the benefit of muscular strengthening. Fortunately, we are able to perform a one to three hour reconstructive operation that usually takes care of everything in one fell swoop. It’s done vaginally, and the patient’s up and around in two weeks. When incontinence first occurs after 50, the cause is usually not childbirth but neurological. The good news is that a variety of options including medications, biofeedback and other treatments can often be effective. Dr. Rosenman is Chair of the Credentials Committee at Saint John’s Health Center. A gynecologist in private practice in Santa Monica, she is president of the American Urogynecologic Society. For more information about Dr. Rosenman or other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC. Want to learn about a variety of health and lifestyle issues? Watch
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