CHAPTER 1 - The Nuts and
Bolts of the Female Pelvis: Normal Anatomy and Physiology
CHAPTER 2 -
What Can Go Wrong? Pelvic-Floor Problems: Symptoms and Solutions
CHAPTER 3 - Picking a Doctor:
Gynecology versus Urology: Who Treats Bladder Problems?
CHAPTER 4 -
Stress Urinary Incontinence
CHAPTER 5 -
Urinary Urge Incontinence: Overactive Bladder Syndrome
CHAPTER 6 -
The Golden Years: Incontinence in the Elderly
CHAPTER 7 -
Pelvic Floor Prolapse
CHAPTER 8 -
Urinary Tract Infection
CHAPTER 9 -
Interstitial Cystitis and Pelvic Pain Syndrome
CHAPTER 10 -
Menopause, Hormones, and the development of Female Pelvic Problems
CHAPTER 11 -
Anesthesia for Surgery and a Crash Course in Pain Medications
CHAPTER 12 -
A Visit to the Urologists Office: Definitions and Explanations of the Diagnostic
Procedures
CHAPTER 13 -
Safety in Numbers: The Epidemiology of Urinary Incontinence
The Basics
CHAPTER 1
The Nuts and Bolts of the Female Pelvis: Normal Anatomy and Physiology
Summary:
"This chapter discusses the normal anatomy of the urinary tract. It lays
the foundation for understanding what can go wrong By knowing what is normal,
it will help the reader understand why her problem presents the way it does and
why the treatment will work."
CHAPTER 2
What Can Go Wrong? Pelvic-Floor Problems: Symptoms and Solutions
Summary
"This chapter offers an overview of the urinary tract disorders from which
women can suffer. Some women have straightforward problems that are easily addressed
in a few visits, while other women have multiple issues that need time and patience
to sort out. Urinary tract infections, pelvic pain conditions, incontinence,
and pelvic floor prolapse are interrelated entities. After all, they all share
the same organs of origin, all of which lie close together and are interconnected.
Often, treatment of one problem will unmask another. At other times, multiple
problems are treated with a single intervention: Whatever the problem, patience
and thoughtful evaluation will uncover solutions that are both efficacious and
agreeable."
CHAPTER 3
Picking a Doctor: Gynecology versus Urology: Who Treats Bladder Problems?
Summary
"Although the choices seem overwhelming, the truth is that it all comes
down to the person sitting across the desk from you and how you relate to her.
The more confident you are in the information that you are getting from your
doctor, the more you can trust him or her. You don’t have to like her,
but you do have to trust her. The best way of assessing your physician is intuition,
but intuition bolstered by understanding her background and training for your
particular medical problem."
Urinary Leakage And Incontinence
CHAPTER 4
Stress Urinary Incontinence
Summary
"Stress urinary incontinence occurs when a woman leaks while coughing, laughing,
sneezing or lifting heavy items. Unlike urge incontinence, stress incontinence
results from a problem with the support structures of the urethra, not with the
bladder itself. Weakness of the muscles on which the urethra sits results in
movement of the urethra with activity, and, consequently, leakage. The treatment
involves reinforcing, or replacing, this support, usually through a surgical
procedure. Medication, exercise therapy, and injectable agents can be tried first,
but as of now, the only real cure for stress urinary incontinence is surgery.
On the bright side, with proper diagnosis, the management of stress incontinence
is extremely successful."
CHAPTER 5
Urinary Urge Incontinence: Overactive Bladder Syndrome
Summary
“The most effective treatment for frequency, urgency, and urge incontinence
is a combined approach using both behavior modification and medication. Behavior
modification includes reduction in fluids, urinating when the urge presents,
and exercise therapy. Many medications are available if behavioral modifications
are not enough. Usually, a combination approach which included both changes in
fluid intake and medication should work in nearly every woman with this condition.
Women are often embarrassed that they are not getting better, or they think it
is their fault. They think they “just can’t control themselves.” That
is by no means the case. This is a physical condition that should be treated
that way. Your doctor is there to help you get better. Be honest, and be persistent.”
CHAPTER 6
The Golden Years: Incontinence in the Elderly
Summary
“Urinary incontinence is common in the elderly woman, but not acceptable.
With effective treatments available for nearly every situation, women and their
families need to inform their physicians of this depressing, debilitating, and
embarrassing problem. Urinary leakage in the elderly can cause terrible problems
that go beyond the inconvenience of soiled clothes and bed sheets. Infections,
pressure sores, limitations to physical activity, and falls that result as you
try to get to the bathroom in time to prevent an accident will all lead to an
early demise. Careful evaluation and thoughtful treatment can save you and your
caregivers from difficult and painful consequences of urinary incontinence. Medication
and surgery are not the only options out there. Many less-invasive interventions
can be attempted, many of which will cure you without any painful testing or
expensive procedures. Communication between you and your doctor will ensure that
good results are achieved. A little persistence and a lot of patience will produce
effective results for almost all elderly women with urinary incontinence.”
Dropped Organs: Pelvic Floor Prolapse
CHAPTER 7
Pelvic Floor Prolapse
Summary
“Pelvic organ prolapse is a complicated problem for both women and their
doctors. For women, the shame, embarrassment, and belief that nothing can be
done prevent them from seeking treatment. Physicians often don’t recognize
a prolapse when they examine a patient, or they don’t know where to send
patients when they do. Gynecologists and urologists with special training in
the management of prolapse are sprouting up all over the country. As we all get
older, our bodies change, often resulting in problems that interfere with a healthy
lifestyle. Treatment of these debilitating conditions will help women return
to social and physical activities that are essential for us, regardless of our
age. No one is too old or too young to have pelvic-floor prolapse and its associated
urinary issues. Nor is anyone too old or too young to seek treatment. Both surgical
and nonsurgical choices are available and nearly all evaluation and management
is covered by conventional insurance. See a physician, get examined, gather information,
and then make an informed decision regarding your own condition. You will be
surprised at how much this small step will change your life!”
The Painful Bladder
CHAPTER 8
Urinary Tract Infection
Summary
“Urinary tract infections (UTIs) are by no means a problem exclusive to
healthy, sexually active women. Children and men certainly suffer the wrath of
bacterial invasion into the normally sterile urine. However, women have a propensity
to develop infections in the urine more so than men because of their unique anatomy.
Those of you who are plagued with infections know how frustrating and painful
they can be, especially when treatment is delayed because antibiotics are not
accessible. Although the cause of recurring infections is not understood, management
is possible. It is important to know when to seek professional help because a
more serious problem exists. Urinary tract infections should not control or ruin
a productive life. Over time, our understanding of the causes of UTIs will evolve.
Once we know why they occur, prevention and cure will be imminent.”
CHAPTER 9
Interstitial Cystitis and Pelvic Pain Syndrome
Summary
“Pelvic pain syndromes are terrible for patients to live with and frustrating
for physicians to treat. Little is understood about these diseases, so treatment
can be elusive. The relationship between urethral syndrome, interstitial cystitis,
and endometriosis, and irritable bowel syndrome cannot be proven, but they seem
interrelated in their symptoms and management. Researchers continue to pursue
an understanding of all four syndromes, which should only lead to better treatments
and, ultimately, to cure.”
Related Issues
CHAPTER 10
Menopause, Hormones, and the development of Female Pelvic Problems
Summary
“The role of hormones in urinary tract disorders remains confusing, even
for those of us in the business of providing care and counsel to patient. On
an individual basis, educated decisions can be made between you and your doctor,
depending on the nature of the menopausal symptoms that you need to treat. Hormone
depletion causes changes in the urinary tract, especially the urethra. Visible
changes to the vaginal canal correspond to the symptoms that many of you may
experience from low estrogen, including dryness, itching, and burning in the
vagina and the urethral area. Vaginal applications of estrogen will help these
symptoms while causing very few side effects. Systemic estrogen has a less clearly
defined role in the treatment of urinary tract disorder in the postmenopausal
woman. In terms of urinary leakage, estrogen therapy alone will not treat the
problem. However, combination therapy of vaginal estrogen and a bladder medication
may alleviate symptoms more than either would alone.”
CHAPTER 11
Anesthesia for Surgery and a Crash Course in Pain Medications
Summary
“Surgery has never been safer than it is today. In many respects, this
fact is due to the advances in anesthesia. The medications are safer, the monitoring
devices are more sensitive, and the anesthesiologists are more highly trained.
Safe anesthesia includes careful preoperative preparation, open disclosure of
foods and medications ingested by you prior to surgery, and the selection of
appropriate anesthetic agents in the operating room.”
“Adequate postoperative pain management follows successful intraoperative anesthesia. The balance between effective pain control and reduced side-effects from medications can be tricky. Because so many options are available, everyone should be able to find something that will relieve their discomfort without too many problems.”
CHAPTER 12
A Visit to the Urologists Office: Definitions and Explanations of the Diagnostic
Procedures
Summary
“The point of this chapter is to alleviate one’s fears about visiting
an urologist’s office. Although we are a procedure-oriented field, none
of the tests that are performed in the office need to be painful or unpleasant.
In order to remain collaborative with your doctor; you need to know the reason
for the tests being done, the results that are obtained, and the outcomes of
treatments that are chosen.”
CHAPTER 13
Safety in Numbers: The Epidemiology of Urinary Incontinence
Summary
“The epidemiology of urinary tract incontinence is complex. Clearly, older
women suffer from the condition more than any other group of patients. However,
other conditions can contribute to its presence, and certain behaviors can make
it worse. Regardless of the cause of urinary incontinence and pelvic-floor prolapse,
we do know that both conditions are on the rise, they are costing people and
society a fortune in supplies, and they can be treated successfully by an interested
health-care professional.”