They are medical conditions not often spoken about, yet impact millions of women each day—bladder and pelvic floor disorders. And while it is true these conditions become more common with advancing age, bladder and pelvic floor health issues can also affect women in their 20s, 30s, and 40s. Fortunately for all women, there are solutions and enhanced treatment options that can help restore function and improve quality of life.
NYU Winthrop Hospital is home to two of only a handful of board-certified urogynecology specialists in the area—George Lazarou, MD, chief of gynecology and director of urogynecology and pelvic reconstructive surgery, and Bogdan A. Grigorescu, MD, associate director of the Division of Urogynecology and Pelvic Reconstructive Surgery—who are regarded experts in treating women with pelvic floor disorders.
We recently sat down with Dr. Grigorescu to discuss some of the common conditions that women face and the treatment options that are available to them at NYU Winthrop.
What are the most common forms of urinary incontinence and what causes them?
Incontinence is caused by bladder abnormalities or urethral sphincter weakness. Stress incontinence, or leakage during periods of abdominal pressure such as coughing, sneezing, lifting or straining, is due to urethral sphincter weakness for which the most common causes are multiple childbirths or prolonged labor. This form of incontinence is very common in younger women. Urge incontinence, or leakage which follows an irresistible urge to pass urine, is caused by bladder muscle spasms. This condition is called overactive bladder syndrome. The overwhelming urgency to use the bathroom may be caused by spasms of the bladder muscles.
What is pelvic organ prolapse?
Pelvic organ prolapse occurs when a pelvic organ, such as the bladder, drops from its normal location and pushes the walls of the vagina. This can happen when the muscles that hold the pelvic organs in place weaken or stretch as a result of childbirth or surgery.
Many women will experience some form of pelvic organ prolapse during their lifetime. It can be uncomfortable or painful; it can effect one’s quality of life by restricting normal activities—for example, uncomfortable sitting—and more than one pelvic organ can prolapse at the same time. Organs that can be involved in a pelvic prolapse include the bladder—the most common—the urethra, uterus, vagina, small bowel, and rectum.
How are pelvic floor conditions diagnosed?
A physical examination is the first step to diagnosing a pelvic floor condition. Other tests of bladder function may include an in-office multichannel urodynamics test to confirm the type of urinary incontinence. For patients who smoke, or have a long history of smoking, we may recommend in-office or outpatient cystoscopy, which is visualizing the inside of the bladder with a camera, to rule out bladder abnormalities.
What are some of the risk factors for these pelvic floor conditions?
Some of the risk factors for pelvic floor conditions include having delivered multiple children vaginally; having a traumatic vaginal delivery; heavy lifting; being overweight; lung conditions such as chronic obstructive pulmonary disease (COPD); as well as genetic factors.
Is there a way to prevent incontinence?
Kegel exercises, also referred to as pelvic floor exercises, can help to relax the bladder muscles and strengthen the pelvic floor. Performing 30 to 50 Kegels each day is a good routine to get into to reduce or prevent urinary leakage problems. After pregnancy and delivery, we recommend pelvic floor strengthening with daily Kegels. Also, remaining at a healthy weight and minimizing risk factors such as smoking, which can cause coughing and in turn, lead to stress incontinence, are some ways to reduce one’s risk.
What are some of the treatment options for incontinence?
At NYU Winthrop, we work to develop a care plan that is tailored to each patient’s needs. There are a range of treatment options for incontinence including conservative treatments such as Kegel exercises, medications, and bladder training techniques to prolong the intervals at which one uses the bathroom. Outpatient procedures for patients who did not respond to conservative treatments may include bladder Botox® injections for those struggling with urge incontinence. These injections, which involve injecting Botox® into the bladder, can be performed every 8 to 10 months in the office or in the hospital’s Ambulatory Surgery Unit.
Other treatment options include bladder neuromodulation. This technique, which can be performed in the office or as an outpatient procedure, utilizes mild electrical pulses to stimulate the nerve that controls the bladder and other muscles that control urinary function.
For stress incontinence, if Kegels are ineffective, minimally invasive surgery is approximately 90 percent effective as a long-term treatment. The procedure involves passing a thin strip of safe and effective U.S. Food and Drug Administration (FDA)-approved mesh, or sling, through small incisions on the outside of the body, which are then passed beneath the bottom of the urethra, increasing support to the pelvic organs where the tissue is weakened. The mesh grows with the tissue to support the urethra and improve bladder control.
What types of treatment options does NYU Winthrop offer for prolapse?
NYU Winthrop is a leader in minimally invasive robotic surgery utilizing the daVinci® Surgical System. With this advanced surgical system, which provides unprecedented visualization of the surgical field along with highly flexible surgical tools, we are able to perform hysterectomy, or removal of the uterus, and sacrocolpopexy, a surgical technique, for vaginal or uterine prolapse. Because robotic surgery is minimally invasive, patients experience less scarring and postoperative pain and can usually return to normal activities within a few short days. Laparoscopic and traditional abdominal, or open, surgeries are also treatment options.
It is best for women to finish having children prior to surgery since the birthing process could reverse the desired outcomes of surgery.