Urology

You have been referred to the Urogynecology Clinic for urinary incontinence and/or pelvic organ prolapse. A referral is required by family physician or nurse practitioner to be seen in the clinic. 

Urinary incontinence is the “involuntary loss of urine” which can result in a social or hygienic (cleanliness) problem. There are different categories or types of urinary incontinence, which are recognized or classified by some of the following signs or symptoms:

Stress incontinence 
This condition is described as the involuntary leaking of urine when a person is laughing, coughing, sneezing, straining or participating in any physical activities.

Urge incontinence 
This condition is described as a person’s awareness or strong need to void and yet has great difficulty in preventing the bladder from emptying before they are able to reach the toilet.

Overflow incontinence 
This condition is described as the involuntary loss of urine that is associated with an overdistended (overfull) bladder.

Functional incontinence 
This condition is described as urinary leakage that occurs with a person’s inability to go to the toilet due to physical or cognitive problems, psychological unwillingness or environmental barriers (stairs, dimly light hallways).

In order to help your doctor to determine what type of incontinence you may have, it is important to keep a record (bladder diary) on: how much you drink, how many times you void and/ or how many accidents you may have during the day. 

When you arrive for your appointment in the Urogynecology clinic you can expect an interview with a physician or a nurse continence advisor. They will be asking you questions about your health status and/or your quality of life. Some questions may include information about past surgeries, medications, lifestyle patterns, and medical conditions. In most cases a physical examination of the vagina and pelvic floor may also be required in order to provide the health-care team with a complete picture of your problem. 

In order to help your doctor to determine what type of incontinence you may have, it is important to keep a record (bladder diary) on: how much you drink, how many times you void and/or how many accidents you may have during the day. 

The treatment available for urinary incontinence is very specific to the type of urinary incontinence a person is diagnosed with. In some cases it is not unusual to have more than one type of urinary incontinence occurring at the same time.

Various types of treatment include:

Private conservative management counselling 
This counseling is given by nurse continence advisors who provide information and education regarding fluid intake, dietary changes, bladder drill training, Kegel teaching, and pessary care.

Pessaries 
These are pink, medical silicone devices that are worn in the vaginal canal and provide support to the bladder neck to assist with leaking or help to lift things up which maybe falling down. (See the next section for more information).

Periurethral bulking agents 
This type of treatment requires injections of a special medication into the urethra which helps it to bulk up forming a soft, puffy, water tight seal required for helping to keep an individual dry.

Medications 
Your physician will decide whether or not your condition warrants the necessity of using any of the many different types of medications now available on the market for the different types of urinary incontinence.

Surgery 
There are many different types of incontinence surgeries. Some of them include: Burch colposuspension procedure, TVT (Tension-free Vaginal Tape) and RPU (Retropubic Urethropexy). For certain individuals or conditions surgery is a good option and only you and your doctor can determine which is the best for you to enhance or promote your quality of life. 

When the tissues and muscles that support the pelvic organs become damaged, stretched, or weak the pelvic organs tend to move or “fall” out of their normal place within the pelvis.

There are several different types of pelvic organ prolapse:

Cystocele (bladder) 
This type of prolapse is the bulging of the bladder through the top wall of the vagina. If you were to think of your pelvic floor as a room in a house, it could be said that the ceiling to your room was sagging.

Rectocele (rectum) 
This type of prolapse occurs when the rectum bulges into the vagina. Thinking back to the room in a house, this type of prolapse could be compared to the floor in the room buckling upwards.

Uterine prolapse (cervix) 
This prolapse is diagnosed when the uterus drops into the vagina. It can drop just slightly or quite a lot. In severe cases the cervix (opening of the uterus) may stick out of the vagina (has a dimple effect) causing discomfort when walking or when having sexual intercourse.

Vaginal vault (vaginal walls) 
This prolapse occurs when the sides of the vaginal walls fall or in some cases the vagina tries to turn itself inside out not unlike a sock.

Enterocele 
This rare type of prolapse occurs from a bulging (hernia) of the small bowel into the vagina.

Some symptoms which are common with pelvic organ prolapse include:

• A feeling of something hanging out.
• Never feeling empty after voiding or having a bowel movement.
• Unable to empty your bladder or your bowels due to an obstruction.
• Increased urinary tract infections.
• Urgency.
• Low back pain.

Many women have pelvic organ prolapse and find that it does not negatively affects their quality of life. If you are some one in this category these are some helpful hints on how you can maintain and promote good pelvic floor health.

• Drink plenty of fluids to ensure your stools are soft helping to prevent straining and constipation.
• Eat a well-balanced diet.
• Ensure tissues are healthy and well lubricated with natural lubricants or hormone base creams.
• No heavy lifting.
• Do Kegel exercises daily.
• Don’t be afraid to manually empty your bladder or rectum if needed.
• Consider a pessary.
• See your doctor to discuss surgery options. 

Pessaries have been around for many centuries and have been made with many different types of materials. These include: rocks, gold, silver, glass and rubber to name a few. Today the pessary is made out of medical grade silicone (a type of plastic) which gives the wearer a product that lasts longer, doesn’t hold odour, cleans well, and is non-allergic. There are many styles and sizes of pessaries which are used for the conservative treatment of urinary incontinence or pelvic organ prolapse.

The care of a pessary for most women is as simple as caring for your contact lenses. It requires removal regularly for short periods of time and cleansing it with dishwashing soap. Using certain vaginal creams will also help keep the vagina well lubricated and healthy: an environment that the pessary needs to do its job properly.

Your doctor or nurse continence advisor will be able to decide if you would be a good candidate for a pessary after performing a thorough vaginal examination. 

• Eliminate bladder irritants from your diet
  Caffeine products (coffee, tea, chocolate, pop) are considered chemical irritants for the bladder and can aggravate or produce symptoms of urgency for some people.
  
  Eliminate smoking and alcohol from your lifestyle. Nicotine and alcohol are other chemical irritants that can also aggravate the bladder.
  
  Spicy foods for some people can also have an irritating effect so monitor your diet and consider eliminating foods which cause you with a sense of urgency.
   
• Increase your water intake
  Ensuring that your water intake is between 6-8 glasses (8 ounce) of water per day helps to promote the flushing out of bacteria in the urine and maintain soft bowel movements which are also important for good pelvic floor health.
  
  Keep in mind that you should stop drinking two to three hours before bed to allow the kidneys a chance to filter the fluids to the bladder helping to stop you from getting up during the night.
  
  Introducing cranberry or blueberry juice (one four-ounce glass) daily in your diet also helps to deter bacterial growth which may make you more prone to urinary tract infections.
   
• Promote a healthy lifestyle by exercising on a routine basis
  It has been widely publicized that routine exercise and maintaining an ideal weight helps to decrease and eliminate different types of health problems. This also applies to urinary incontinence and prolapse. Being overweight can put increased pressure on the bladder and the pelvic floor.
   
• Practice good pelvic floor health
  • Performing proper Kegel exercises on a daily basis tones the pelvic floor muscles which helps keeps the urethra (the doorway to your bladder) closed.
  • Trying to keep sexually active for as long as possible to keep blood flow circulating to the tissues in the perineum.
  • Using lubrication or hormonal creams (with your physician’s advice) to keep the area moist, well lubricated and healthy.
  • Avoid using soaps, bubble baths and perfumes from your perineal hygiene.
  • Do not douche unless prescribed by a health-care professional.
  • If you need to wear pads or panty liners ensure the products that you are buying are designed for urine collection and not blood.
  • Maintain good bowel habits by drinking fluids, keeping active, and eating a well-balanced diet.