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Director of the Center for Urogynecology of Saint Barnabas
Medical Center
When it comes to a variety of female pelvic disorders, many
women needlessly suffer in silence, says Jeffrey Segal, M.D.,
Director of the Center for Urogynecology of Saint Barnabas
Medical Center.
 "Very often patients are too embarrassed to discuss
their symptoms with a physician, and they may not be aware
that treatment options exist for them. They may also think
these disorders are a normal part of the aging process, but
they are not," Dr. Segal relates. "All aspects of
quality of life can be impacted, including emotional, social,
physical, and sexual well-being, which in turn negatively
affects interpersonal relationships. By properly diagnosing
and treating these disorders, the goal is to return the patient
to the previous lifestyle she enjoyed."
At the Center for Urogynecology of Saint Barnabas Medical
Center, these are some of the most commonly treated conditions:
Stress incontinence is a leakage
of varying amounts of urine associated with laughing, coughing,
exercise and performing household chores. Risk factors include
obesity, smoking, increased age, and vaginal delivery. Depending
on how stress urinary incontinence is defined, anywhere from
4 to 35 percent of adult women are affected.
The spectrum of the severity is wide, ranging from minor
leakage brought on by activity to continuous leakage which
may be due to a faulty urethra. Dr. Segal recommends starting
with conservative treatments, including Kegals (pelvic floor
muscle exercises), biofeedback techniques to help patients
better identify pelvic floor muscles and estrogen replacement
creams for menopausal women.
The most effective treatment option, however, still remains
surgery. Although there are over 100 procedures used to treat
stress incontinence, Dr. Segal often performs minimally invasive
outpatient surgeries that can be done under local anesthesia
and result in shorter recovery times. Over 85 percent of women
who undergo Tension-free Vaginal Tape (TVT) surgery are successfully
treated. Another option for some patients, particularly those
with a poorly functioning urethra, is an office procedure
in which collagen is injected through the urethra to create
a bulking effect of the bladder neck.
This condition involves a need to get
to the bathroom quickly to avoid an accident. In addition
to feelings of urgency, those with an overactive bladder make
frequent trips to the bathroom, even at night. About 40 percent
of people with this condition also experience wetting accidents
due to not getting to the bathroom on time. Overactive bladder
occurs when the bladder muscle involuntarily contracts more
often than normal. Risk factors include age, neurological
impairment (such as Parkinson’s disease or spinal cord
injury), menopause, previous surgery of the bladder neck and
pelvic organ prolapse.
The overactive bladder can be successfully treated with
non-surgical approaches, including fluid management, pelvic
floor rehabilitation and bladder re-training which helps to
extend the amount of time between trips to the bathroom. Medications
may also be prescribed to help the bladder relax and reduce
the frequency and intensity of contractions. While dry mouth
and constipation are two possible side effects from medication,
newer medications may have reduced side effects.
Pelvic Organ Prolapse occurs when
the pelvic organ, which may include the uterus, bladder, rectum
or vagina either drops or descends. Risk factors include vaginal
childbirth, decreased estrogen, increasing age, connective
tissue disorder and constipation. Symptoms may include a feeling
of pressure in the vagina, difficulty in emptying the bladder
or rectum and difficulty or pain with intercourse. As an alternative
to surgery, a pessary – a small ring that supports the
vagina -- may be a useful tool for relieving symptoms. Surgical
treatment of pelvic organ prolapse involves reconstruction
of the vaginal supportive tissues. Dr. Segal commonly performs
the surgery through the vagina, eliminating the need for an
abdominal incision.
The inability to control feces can be
a devastating problem for patients who are embarrassed and
often unable to speak about it even to physicians. Conservative
treatments include medications that bulk the stool, anti-diarrhea
medications and the use of pelvic floor muscle exercises and
biofeedback. Patients with fecal incontinence who are found
to have a damaged anal sphincter may require surgery, says
Dr. Segal, which can include overlapping anal spincteroplasty.
Up to 10 percent of women visit a gynecologist
for treatment of chronic pelvic pain which may be attributed
to a variety of conditions, including irritable bowel syndrome,
fibromyalgia, endometriosis and interstitial cystitis. Women,
who suffer from interstitial cystitis, or IC, often have to
urinate urgently and frequently and experience pain in the
bladder, pelvis or lower abdomen. Although the cause is unknown,
it is associated with inflammation and damage to the lining
of the bladder.
Dr. Segal recommends a treatment approach that combines
patient education, diet modification (avoidance of citric
fruits, caffeine, chocolate, spicy foods and alcohol) and
medications. Before any treatment, the cause of the pain must
be determined and any underlying condition must be addressed,
says Dr. Segal.
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