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Answer to your Health Question

Question (07/12/2012):

Title: Repair or not repair a cystocele and uterine prolapse.

I was diagnosed with Grade 2 Cystocele and Rectocele grade 1-2 uterine prolapse.

I have no sensation of heaviness, bulge etc.

I also was diagnosed with stress and urgency incontinence.

I saw 2 different board certified urogynecologists.

Both recommend the sling.

One wants to use mesh to repair the prolapses but the other said if it is not symptomatic, leave it alone.

He said if I have problems in the future, he would use my own tissue--not mesh.

Both would give me medication for urgency/frequency.

Do you have any opinion about which approach (leaving prolapse alone- or repairing it?

Amy

Answer:

Dear Amy,

Some women with urine leakage can regain control by losing weight, cutting caffeine or doing special pelvic muscle exercises called Kegel exercises, exercises to strengthen the pelvic floor muscles. Kegel exercises may also help relieve some symptoms of a cystocele (a type of pelvic organ prolapsed).

In a severe-grade 2-cystocele, the bladder sinks far enough to reach the opening of the vagina.

A mechanical support device called a pessary (plastic or rubber ring inserted into the vagina to support the bladder) helps some women.

Treatment options range from no treatment for a mild cystocele to surgery for a serious cystocele.

If a cystocele is not bothersome, the doctor may only recommend avoiding heavy lifting or straining that could cause the cystocele to worsen.

If symptoms are moderately bothersome, the doctor may recommend a pessary- a device placed in the vagina to hold the bladder in place.

Pessaries come in a variety of shapes and sizes to allow the doctor to find the most comfortable fit for the patient. Pessaries must be removed regularly to avoid infection or ulcers.

The pessary is most often used for prolapse of the uterus (uterus droops or sags into the vaginal canal because the muscles and ligaments that should support it are weak).

A pessary can help if you have a cystocele (when your bladder droops down into your vagina) or if you have a rectocele (when the wall of your rectum bulges into the bottom of your vagina).

A pessary can also help many women who have stress urinary incontinence (the leaking of urine when you cough, strain or exercise).

The pessary has to be fit just right in orderfor it work correctly and be comfortable.

Many vaginal pessaries can be worn during intercourse.

Pessaries remain an excellent alternative to surgical repair for pelvic organ prolapse and stress urinary incontinence.

The Uresta® pessary is indicated for use in adult women over 18 years of age who experience involuntary urine loss with physical activity (stress incontinence), but is not indicated for urge incontinence (also known as overactive bladder) that is caused by bladder contractions (detrusor instability). It is treated with bladder re-training, elimination of caffeine and standard anticholinergic medications.

Treatment of a cystocele depends on how severe the cystocele is and whether there are any related conditions, such as a uterus that slips into the vaginal canal (prolapsed uterus).

Mild cases - those with few or no obvious symptoms - typically don't require treatment. The patient could opt for a wait-and-see approach, with occasional visits to the doctor to see if the prolapse is worsening, along with self-care measures, such as exercises that strengthen pelvic floor muscles.

Many women use pessaries as a temporary alternative to surgery, and some use them when surgery is too risky.

If there are noticeable, uncomfortable symptoms, the cystocele may require surgery.

You may find more information related to your question at:

Cystocele repair


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