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Incontinent? Minimally Invasive Surgery Can Significantly Improve Quality of Life

Mary was an otherwise healthy 61-year-old woman who found herself confronted with a problem common to women her age. She had to urinate often, and she was unable to control occasional leakage, known as stress incontinence.

The situation posed a challenge to her active lifestyle, so Mary (not her real name) was referred to Catrina C. Crisp, MD, MSc, a urogynecologist with Cincinnati Urogynecology Associates. After a thorough exam, Dr. Crisp diagnosed prolapse.

This condition occurs when the muscles and tissues that make up the pelvic floor become weak or injured. The tissues form something like a hammock across the pelvis and, in women, hold the uterus, bladder, bowel and other pelvic organs in place so that they can work properly. Childbirth, injury, being overweight and sometimes just getting older can cause the weakness, and as a result those internal organs slip out of place and lose function.

“She had a relatively large prolapse, graded at stage 4, which is the highest grade,” Dr. Crisp says. Surgery was Mary’s best option. thanks to new minimally invasive techniques using the da Vinci robotic surgical system, these operations are now performed more quickly and with fewer complications than in the past.

During the operation, Dr. Crisp sutures the vagina to a ligament located just above the tailbone to hold it in proper position. “We also create a sling to treat the incontinence,” she says. “It looks like a shoestring that goes under the urethra and provides a backboard, so when the urethra moves from stress it bumps up against this sling and closes, blocking leakage.”

In some cases she also performs a hysterectomy – for one of two reasons. “There may be a medical reason such as excessive bleeding, or because it helps make the repair more durable,” she says. “Mary is postmenopausal, so we did it for better success.”

Prolapse operations typically take three to three-and-a-half hours, and most patients stay overnight in the hospital, though some can go home the same day. Patients can drive within three to five days, Dr. Crisp says, but should avoid heavy lifting for six weeks. “Most people have no significant pain and require just oral pain medications for discomfort,” she notes. “They can do most daily activities right away, but it is recommended that they stay out of work for six weeks, maybe less for non-strenuous types of jobs.”

Dr. Crisp reports that Mary did very well with her surgery and recuperation. Some patients follow surgery with physical therapy to improve strength and control of the pelvic muscles, but Mary didn’t need it. “She had excellent resolution of prolapse and incontinence.”

National Institutes of Health
Tags Women's Health

Last Updated: September 08, 2015