Urogynecology Expert Forum
prolapse, to have surgery or not?
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Questions in the Urogynecology forum are answered by Bruce Crawford, MD, J. Kyle Mathews, MD, and other medical professionals and experts. Topics covered include overactive bladders, bladder pain, fallen/drooping bladder, bowel urgency, bowel prolapse, cystitis, incontinence, pain with intercourse, rectal prolapse, surgery, urinary urgency, and uterine prolapse.

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prolapse, to have surgery or not?

i have been examined by my gynocologist and he seems to think I haven't fallen far enough to need surgery.  At first he tried to tell me i had OAB but after treatment he realizes that's not the case.   Is surgery the only alternative for Stress incontenience? or is there other alternatives, does your bladder have to be down so far before they will do surgery or is the leakage enough to warrant the action?
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Fallen bladder does not equal incontinence. first we need to clarify your symptoms. If your symptoms are mostly unintended urine leakage, then you need to be evaluated to see if you have stress incontinence (generally surgical problem), or Urge incontinence (AKA overactive bladder- which is mostly a medical problem). In addition, if you have prolapse (a bulging of the vaginal walls that you can SEE when you look between your thighs), then that may also cause symptoms of overactive bladder (urinary urgency and frequency).

If your doctor is unsure, you should locate a urogynecologist, who can properly diagnose the above conditions, and offer you an appropriate solution. To answer your question, Stress incontinence (cough-laugh-lift-leak) is best cured surgically for the long term, but many women get relief from special pessaries (incontinence pessaries), or sometimes from Kegel exercises. Both pessaries and Kegels have a 25% long term cure rate. Surgery for stress incontinence has a 80-90% lomng term cure rate.

Dr. Hoyte.
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