Urinary incontinence refers to the loss of urine under conditions which are not socially or medically desirable. There are several types of incontinence generally referred to as urge, overflow and stress incontinence. Urge incontinence refers to incontinence occurring when the person feels the urge to urinate however loses urine prior to reaching a socially appropriate facility. The loss of urine may be a small amount or a large amount. Overflow incontinence is similar however occurs when the bladder is full and the person loses urine secondary to this overfilling. Stress incontinence refers to loss of urine with “stress” phenomenon. For instance, with laughing, coughing, sneezing or any other maneuver which increases intra-abdominal pressure. Examples are various types of exercising or sports or even rising from a sitting position to a standing position. All of these types of incontinence may be very disturbing to the patient. Fortunately they are amenable to either medical or surgical therapy in many cases.
Pelvic prolapse refers to descent of the female genetalia toward the vaginal
opening or introitus. Prolapse may include the uterus and cervix and or the
base of the bladder or the anterior surface of the rectum. Symptoms of
uterine and cervical prolapse may include pressure in the pelvis, pain with
intercourse or in some cases protrusion of the genetalia through the vaginal
opening. Symptoms of bladder prolapse may include incomplete emptying
of the bladder, pelvic pressure and in many cases incontinence of urine. Symptoms
of prolapse of the rectum or posterior vagina are similar with patients demonstrating
pressure and pain with bowel movements, constipation among others.
Prolapse is very common especially among postmenopausal women who have had vaginal childbirth. The symptoms of prolapse may be successfully corrected in many cases with straight forward surgical procedures.
Chronic interstitial cystitis is a condition not commonly recognized in the past. Symptoms include urinary urgency, frequency and painful urination which are commonly experienced by patients with urinary tract infections. The overlap in symptoms and lack of specific findings on examination and inspection of a urine specimen lead to incorrect diagnosis and treatment. Today, physicians are much more aware of the symptoms and are able to correctly identify the process with relatively simple tests. Many patients with interstitial cystitis present with complaints of chronic pelvic pain. Secondary to the many potential causes of pain in the low pelvis the diagnosis may be less obvious in these cases. However, the diagnosis may still be identified in these persons and appropriate therapy given. Therapy may consist of procedures performed at the time of a cystoscopy ( a procedure wherein the physician looks into the bladder with a telescope), oral medications, and physical therapy training. Overall the treatments are much better than in the past allowing patients to lead normal lives.