Pelvic Organ Prolapse (POP) is a common condition affecting women globally. This occurs when the pelvic floor muscles and tissues weaken due to various bodily stresses, causing organs such as the bladder, uterus, or rectum to shift from their normal positions and descend into the vagina.

One of the most common consequences of POP is urinary incontinence, a condition where control over bladder function is compromised, leading to involuntary urine leakage. As this condition poses a risk of landing you in an embarrassing situation, managing pelvic organ prolapse with urinary incontinence can be tough.

Studies indicate that about 80% of women with POP develop urinary incontinence. Though common, experiencing the condition can be overwhelming. Thus, understanding the relationship between pelvic organ prolapse and urinary incontinence, the risk factors, and the associated symptoms is crucial for effectively addressing and managing the condition. This article sheds light on managing urinary incontinence with prolapse and improving the overall quality of life.

Understanding Pelvic Organ Prolapse and Urinary Incontinence

Stresses like pregnancy, especially at an older age, multiple childbirths, giving birth to a large baby can weaken the muscles supporting the pelvic organs. As a result, without strong supporting pelvic muscles and tissues, the pelvic organs descend from their original position and slip into the vaginal canal.

Pelvic organ prolapse can be of various types depending on the organ involved. When the bladder slips down and bulges into the vagina, it is called cystocele or bladder prolapse. Rectocele is the term used for the condition where the rectum descends from its original position. Uterine prolapse is characterized by dropping of the uterus and protruding into the vaginal canal. 

The descent of the pelvic organs can put pressure on the bladder, comprising bladder control. This can lead to bladder problems like the involuntary urine leakage or urinary incontinence. Excessive pressure on the uterus due to increased weight, pregnancy, chronic cough, and constipation can exacerbate the situation. Seeking medical guidance is crucial for early intervention and faster recovery.

Medical Evaluation and Diagnosis

Though a common condition, urinary incontinence often goes unreported. It is essential to seek timely medical advice to receive a comprehensive diagnosis and a personalized treatment plan. A skilled healthcare professional will be able to assess the specific issues you are facing and your current health status to provide tailored pelvic organ prolapse incontinence solutions.

While evaluating your condition, your healthcare provider will ask about your medical history, where he will ask you about the symptoms you are facing, any previous health conditions, and any medications you are currently taking. They will also suggest taking certain diagnostic tests such as urinalysis, urodynamic studies, and pelvic examinations to identify underlying causes and determine the most effective treatment approach.

Treatment Options for Urinary Incontinence

The treatment of urinary incontinence depends upon its underlying cause and the degree of severity. Mild and moderate cases can be managed by lifestyle modifications like ceasing alcohol and caffeine intake, quitting smoking, maintaining a healthy weight, and managing chronic cough and constipation.

Kegels is one of the pelvic floor exercises for incontinence relief. This exercise helps enhance the strength of the muscles supporting the bladder, leading to improved bladder control and reduced events of urinary incontinence. Certain medications, such as anticholinergics, also helps address bladder control symptoms. 

Doctors may suggest surgical treatment for advanced stages of urinary incontinence, such as:

• Sling procedure: It is a minimally invasive surgical method where a synthetic mesh tape is positioned beneath the urethra to provide support and prevent the leakage of urine.

• Bladder neck suspension: This technique encompasses elevating and suturing the bladder neck, and urethra to the pubic bone, offering support to treat stress incontinence.

• Colposuspension: This surgical intervention entails elevating the vagina by placing stiches at the sides of the urethra and attaching them to supportive ligaments.

Lifestyle Modifications for Managing Urinary Incontinence

Modifying your lifestyle can help in the efficient management of urinary incontinence. Consumption of adequate fiber-rich foods can be of great help to prevent constipation and straining. Fluid management strategies, such as timed hydration and avoiding bladder irritants, can help control urinary incontinence. Additionally, integrating pelvic floor exercises into daily routines can help improve pelvic muscle strength, promoting bladder control. Adapting these lifestyle changes will help you address urinary incontinence and promote overall well-being.

Pelvic Floor Rehabilitation

Pelvic floor rehabilitation involves targeted exercises and techniques to strengthen the pelvic floor muscles and, in turn, improve urinary incontinence. Kegels, the most advised pelvic floor exercise, involves intermittently contracting and relaxing the pelvic floor muscles to improve muscle tone. Another rehabilitation technique involves bladder training. It involves resisting the urge to urinate and scheduling regular bathroom visits to train the bladder, diminishing involuntary urine leakage, and gradually extending the time between trips to the bathroom.

On consultation, your healthcare professional will provide tailored physical therapy regimens, considering your specific needs and challenges. Practicing them can help you regain control and mitigate the impact of urinary incontinence on your daily life.

Adapting Daily Activities

Incorporating various activities in your daily routine can help you cope with urinary incontinence with ease. At home, you can think of implementing a bathroom routine and using absorbent products. In the workplace, discreet planning for restroom breaks and ergonomic seating can help confidently manage the condition. When going out, you can carry the necessary supplies discreetly to be prepared. Supportive products like absorbent pads and specialized undergarments can enhance comfort and confidence and enable you to live an active lifestyle.

Conclusion

Urinary incontinence is more common than you think. Though it may feel embarrassing, consulting with your healthcare professional can help in early intervention and better management of the condition. Coping strategies for prolapse-related incontinence include adopting lifestyle modifications, fluid management, and incorporating pelvic floor exercises. Surgical options for advanced cases are also available when deemed necessary. By taking a proactive approach and seeking timely expert guidance, you can effectively address urinary incontinence and enhance your health and overall well-being.

Supervising Doctor of This Article

Koichi Nagao, MD PhD

Professor, Department of Urology, Toho University Faculty of Medicine
Director of Urinary tract reconstruction center, Toho University Omori Medical Center
Director of Reproduction Center, Toho University Omori Medical Center

Professor Nagao specializes in plastic surgery in the field of reproductive medicine. He completed eight years of plastic surgery training at Showa University before majoring in urology at Toho University. With his meticulous surgical techniques and careful examinations that combines urology and plastic surgery, Professor Nagao became a Board Certified Specialist with multiple associations including the Japanese Urological Association, the Japan Society for Reproductive Medicine, and the Japanese Society for Sexual Medicine.