Incontinence & Pelvic Organ Prolapse


Urinary incontinence is defined as loss of urine that is involuntary and is severe enough to constitute a social or hygienic problem. Incontinence affects all ages and it gets more common as women get older.

Even though the majority of women do not complain or discuss incontinence, it is thought that it could affect up to 55% of women. Another study showed that only one third of women who have incontinence discuss their symptoms with their doctor.

Pelvic Organ Prolapse

This refers to the herniation of pelvic organs into or beyond the vagina. The organs that can fall into the vagina are the uterus, bladder, rectum and intestines. Occasionally, in women that have had a hysterectomy, the apex of the vagina could descend into the vagina or protrude through the vagina. These different prolapses have varying levels of severity and it is possible to have all of them together in the same patient.

Many women start to experience prolapse of pelvic organs with advancing age, with the majority of women having symptoms after the age of 40. The risk of prolapse increases with the number of children birthed. The risk in women who have four children increases about ten times over women who did not give birth. Other risk factors include women who have chronic constipation, women with jobs that involve heavy lifting, and menopausal women.

Women who have a prolapse may notice symptoms related to pressure such as a bulge, or they may have some urinary or bowel related issues. Some women may have sexual difficulties. The severity of symptoms does not always correlate with how advanced a prolapse is and many times the bulge or protrusion is more pronounced in the evening after a day of physical activities.

Many women will have no symptoms and in these women, treatment may not be necessary.

It is always appropriate to consider less invasive means of treatment with your provider before surgery is considered. The usual alternatives to surgery are pelvic floor exercises and physical therapy. Pessaries may be a good option and are worth considering. Avoiding constipation and maintaining a healthy weight can also help.

Pelvic floor exercises (Kegel exercises) have also been shown to be most effective when supervised by a physical therapist.