intrinsic sphincter deficiency

Intrinsic Sphincter Deficiency

What is "Intrinsic Sphincter Deficiency"?

Primarily affecting women, "Intrinsic Sphincter Deficiency" is defined as a weakening of the urethra sphincter muscles.

Asa result of the weakening of the urethra sphincter muscles, the urethra does notfunction normally regardless of the position of the bladder neck or urethra. This condition is a common cause of FemaleStress Urinary Incontinence.

Whatis "Urethral Hypermobility"?

Primarilyaffecting women, "Urethral Hypermobility" is defined as a failure ofthe urethra to close.

Whatis a "Transobturator Sling"?

TheTransobturator Sling is another minimally-invasive surgical procedure that isperformed to help women with Female Stress Urinary Incontinence. The
Transobturator Sling surgery is performed by the doctor placing a narrow stripof tape or mesh in a position that provides support for the woman's urethra. TheTransobturator Sling procedure eliminates some of the potential complicationsthat come about from other Sling type surgical procedures that blindly passes alarge needle carrier through the retropubic space.

Whatis a "Midurethral Sling"?

The"Midurethral Sling" is a minimally-invasive surgical procedure that isperformed to treat women with "FemaleStress Urinary Incontinence."

Whatis a "Suburethral sling"?

A"Suburethral Sling" is a type of pelvic support that is constructed (surgically) from muscle, ligament, or synthetic material that elevates the bladder from underneath in the treatment of stress incontinence.

Whathappens during "Suburethral Sling" surgery?

InSuburethral Sling surgery, the surgeon inserts a supportive strap of material(called the suburethral sling) which elevates the woman's urethra and bladder neck,and then "anchors" it to each side of her pubic bone.

SuburethralSlings are medical devices made from synthetic material, or they can be fashioned from donor tissue or the patient's own tissue, which is cut fromher abdominal wall. Although it is a more invasive procedure, some patients prefer using their own tissue, because synthetic material may erode into the urinary tract and cause infection or reduce effectiveness.

Newer techniques for SuburethralSling insertion are minimally invasive, allowing for smaller incisions and shorter hospital stays. These techniques are "variations on the suburethralsling and they conceptually work the same way to provide a little hammock for support to theurethra.

Whatis a "Tension Free Vaginal Sling"?

TensionFree Vaginal Sling is a minimally-invasive surgery that provides support forwomen with a sagging urethra. This will help prevent or eliminate theaccidental release of urine when women cough, laugh or move vigorously orsuddenly.

The Tension Free Vaginal Sling procedure uses a mesh or tape that is placedunder a woman's urethra like a sling or hammock to keep the urethra in itsnormal position. The Tension Free Vaginal Sling is inserted through smallincisions in a woman's lower abdomen and vaginal wall. Sutures are not requiredto hold the Tension Free Vaginal Sling in place. Tension Free Vaginal Slingsurgery takes about 30 minutes and may be done under local anesthesia so you cancough when asked by the doctor during the procedure to make sure theTension Free Vaginal Sling is providing the necessary support of your urethra.

Whatis a "Suburethral sling"?

A"Suburethral Sling" is a type of pelvic support that is constructed(surgically) from muscle, ligament, or synthetic material that elevates thebladder from underneath in the treatment of stress incontinence.

Whathappens during "Suburethral Sling" surgery?

InSuburethral Sling surgery, the surgeon inserts a supportive strap of material(called the suburethral sling) which elevates the woman's urethra and bladderneck, and then "anchors" it to each side of her pubic bone.

SuburethralSlings are medical devices made from synthetic material, or they can befashioned from donor tissue or the patient's own tissue, which is cut from herabdominal wall. Although it is a more invasive procedure, some patients preferusing their own tissue, because synthetic material may erode into the urinarytract and cause infection or reduce effectiveness.

Newer techniques for Suburethral Sling insertion are minimally invasive,allowing for smaller incisions and shorter hospital stays. These techniques are"variations on the suburethral sling and they conceptually work the sameway to provide a little hammock for support to the urethra.

What is "Urethropexy"?

Urethropexy is a surgical procedurewhere the support of a woman's urethra is re-supported through sutures thatsurround the urethra's pelvic floor and vaginal tissues to her pubic bone.

What IsSacrocolpopexy?

Sacrocolpopexyis an operation performed from the abdomen to support the vagina to the ligament on the spine (after previous orpresent surgery to remove the uterus) by using a synthetic mesh.

Why IsSacrocolpopexy Performed?

Sacrocolpopexy is performed to treat severe protrusion or bulge(s) of the vagina after removal of theuterus.

A woman's vagina that has one or more of these vaginal protrusion(s) mayexperience one or more of the following:

• The vaginal lump/bulge or protrusion feels uncomfortable or causespain.
• Difficulty with urination (e.g. unable to completely empty the bladder)
• Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
• Pain
• Infection
• Bleeding

The objective of the Sacrocolpopexyoperation is to relieve the woman's symptoms and to restore her vagina and hervaginal anatomy (as much as possible) and recover her sexual function.

Are there any risks associated with Sacrocolpopexysurgery?

Sacrocolpopexy surgery is a very common and relatively safe operation withexcellent prognosis and outcomes. However, like any surgical procedure,there are complications which may occur. Possible complications from Sacrocolpopexysurgery may include:

• Bleeding
• Infection
• Injury to surrounding tissues (e.g. nerve or blood vessels, ureter, intestines)
• Formation of blood clot(s) in the legs or lungs
• Recurrence of problem
• Slow return of bowel or bladder function
• Erosion of synthetic material through vaginal mucosa

What Happens Before SacrocolpopexySurgery?

1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure that you are in optimal health forSacrocolpopexysurgery.

2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are already menopausal. It is important to comply with this medication as it ensures that your vaginal tissues are optimal for surgery and healing.

3. You willbe admitted to the hospital one day before Sacrocolpopexysurgery.

4. You will be given preparations to clear your bowels.

5. Your pubic area will be shaved.

6. You will not be allowed to eat or drink after midnight on the day before the surgery.

7. All your medical and surgical conditions, if any, must be made known to the doctor and must be optimally controlled.

8. If you are on aspirin, please keep your doctor informed. You must stop taking aspirin at leastone week before Sacrocolpopexy surgery.

What happens during the Sacrocolpopexy surgery?

The surgery is done under general or regional anesthesia. The anesthesiologist will discuss with you the advantages and disadvantages of both methods.

An abdominal incision is made. The synthetic mesh is stitched to the posterior surface of the vagina and to the ligaments in front of the spine.

A tube / drain may be inserted into the abdomen to monitor the bleeding.

Another tube will be inserted into the urethra as there may be difficulty in urination after theSacrocolpopexy procedure.

Painkillers, laxatives and antibiotics would generally be prescribed after the procedure.

What happens after Sacrocolpopexy surgery?

1. Immediately after the operation, you mayexperience one or more of the following:

• Tiredness - You should rest and gradually increase your mobilization until you feel fit to return to your normal activities.

• Discomfort - In the lower part of the abdomen, over the incision. This is to be expected and painkillers should help to relieve the discomfort.

• Vaginal bleeding - Mild to moderate amount of reddish watery discharge after surgery is quite normal. Youwill need to wear a menstrual pad during the recovery period, but you will notbe permitted to use tampons for obvious reasons.

2. One day after surgery, you will usually be allowed to drink and eat. You willbe encouraged to move around. Blood chemistries and normal follow-up visits willbe performed.

3. The catheterthat was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.

4. You may be discharged on the third or fourth day after surgery ifthe doctor is pleased with your progress and the outcome of the Sacrocolpopexyprocedure.

5. You should refrain from:

• Strenuous exercise for 2 months. You may return to normal activity after that, or upon clearance by your doctor.

• Using tampons, douching, sexual intercourse and driving for 4 weeks.

• Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexysurgery.

6. You should (immediately) return to the hospital or notify your doctor if younotic any of the following:

• Heavy vaginal bleeding
• Foul smelling vaginal discharge
• Severe abdominal distension and / or pain not relieved by painkillers
• High fever
• Pain associated with passing urine
• Difficulty in passing urine
• Constipation

Follow-up doctor visits after Sacrocolpopexysurgery

You will be examined by your doctor (at your doctor's office) at approximately;2 weeks, 4 weeks, six months and and one year after Sacrocolpopexysurgery.

It is important to keep your follow-up appointments to ensure the best possible results.

Whatis "Colposuspension" surgery?

Age and vaginal childbirth takes it toll on women's pelvic organs.

"FemaleUrinary Incontinence" is one of the problems most (over 50%) women who havedelivered babies vaginally have to contend with. Women with Female UrinaryIncontinence "leak" urine when they strain, cough, laugh or run.This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotionalstress is causing her to "leak" urine.

The problemsassociated with female urinary incontinence are corrected in the the "floor" of thewoman's pelvis by several methods or types of surgeries - one of which is calledColposuspension.

Awoman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of thefemale pelvis. Women can feel it "tighten" when they try to hold backthe flow of urine - or when they strain, cough, laugh or run. The uterus andbladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through thepelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine isthereby weakened.

Colposuspensionsurgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back upto their correct position within the woman's pelvis

Colposuspensioncomes from the Greek word for vagina - "colpos."

Whatis "Urethropexy"?

Urethropexy is a surgical procedure where the support of a woman's urethra isre-supported through sutures that surround the urethra's pelvic floor and vaginal tissues toher pubic bone.

Whatis "vulvar health"?

Vulvarhealth is a term that covers the many health issues of a woman's - or younggirl's vulva. This includes vulva care, gynecology,feminine hygiene, vaginal health, vaginalhygiene, menstruation, and the changes inwomen's vulvas from menarcheto menopause.

Husbandsand fathers - as well as women and mothers need to learn more about vulvahealth, to provide the care and support the special women in their lives mayneed. Husbands and fathers have a unique role in providing the healthcare andknowledge, especially those single dad's that have young daughters.

Vulvarhealth is an area that is related to the health and care of the vulva. Manymen and women are afraid to use the term "vulva" due to its'technical, and medical sound, and most simply prefer to call the vulva a"vagina." Yet that would be incorrect. The vagina is justone part of the vulva. Nobody, with the exception of a doctor, can see a woman'svagina, and only he/she can see a woman's vagina by looking into the vagina,using a special instrument called a speculum.

It'stime to begin calling a "spade a spade." When mother's andfathers are bathing, or toilet training their daughters, they should explainthat the vulva, which is on the outside, has several parts, and that her vagina,is on the inside.

Whatis/are Vulvar Diseases?

Vulvodynia-chronicvulva discomfort, vulvar vestibulitis,dysesthetic vulvodynia

Vulvardystrophy-broad term to describe various epithelial changes. In 1987-ISSVDInternational Society Studies of Vulvar diseasefound the following symptoms; a. nonneoplastic. b.intraepithelialneoplasms - spuamous cell CIS c. nonsquamousintraepithelial neoplasia

LESIONSAND DISEASES

HSV

Womenwith HSV reports flu like symptoms, pain, itching, UTI symptoms, vaginaldischarge, sores on labia, anus, perineum, buttocks, thighs, dyspareuniaVesicles, ulcers, pustules, tender adenopathy, 70% will have lesion in vagina

Syphilis

Womenwith syphilis report painless sores in vulvovaginal area. Primary - red,round, firm ulcer with granular base with well-formed edges. Secondary- moist,mucus lesions which resemble herpes. Moist cutaneous lesions called condylomalata, appear flat and gray. Adenopathy, maculopapular rash.

CondylomaAcuminata

Womenwith CA report new bump: itching, generalized pruritus, last pap. Warty,flesh colored, sharp and pointed, cauliflower, + acetowhite

Candidiasis

Womenwith candidiasis report burning, itching, discharge, dyspareunia, vulvar edema,h/o diabetes, high carbohydrate diet, use of AB, frequent intercourse, h/osteroids, HIV.

Bartholin'sGland Infection

Womenwith barthloin's gland infections eportr unilateral bump. Reports active sex,recent trauma, new sexual partner leading to infections, fever, complaints ofpain with intercourse, warmth, tender to touch, difficulty walking, sitting. H/OCrohn’s disease.

ContactDermatitis

Womenwith contact dermatitis report vulvovaginalitching, rash, and increased incidence when wearing tight pants. The vulvaskin is red, inflamed, edematous, vesicles or bullae if severe, weeping,crusting and lichenification.

LichenSclerosus

Womenwith LS report vulvovaginal itching, familiallinkage, edema, superficial ulcers, burning, area feels different. Womenwith LS in all ages, show symptoms in clitoris, prepuce, labial majora, minora,edema, scarring, color, appearance of tissue paper of skin.

LichenPlanus - Women with lichen planus report vulvar itching, burning, withvulvovaginitis symptoms on mucosal surface of vulva. Dyspareunia, painfulerosive areas. Bleeding on contact, stenosis of introitus. The vulva has whiteraised lesion with reticular, lacy pattern. Erosive reddened area bordered byreticular white epithelium. External labia has appearance of lichen sclerosus +acetowhite. Other signs may appear in her mouth.

VulvarNeoplasm-Melanoma - affects mostly postmenopausal women that affects theclitoris and labia majora. Usually no symptoms.

VulvarIntraepithelial Neoplasm - Pruritus, vulvar burning, pain, discharge,bleeding, may report urethra, vaginal and anal symptoms. White, dk, red,ulcerated, raised warty, or nodular lesions. Labia mayora most common site,minora, clitoris and perineum.

Vulvodynia(Vulvar Pain Syndrome) - Various levels of burning, stinging, pain, dryness,irritation, rawness. No pruritus. May report long term hx.

VulvarVestibulitis is a burning, dysuria, frequency, with repeatedyeast infections or HPV. Significant/severe pain with touch or attemptingintercourse.

Paget'sDisease

VulvarPruritis, usually affecting older women. The vulva appears red/tan withscaly lesions.

What is Vulvar Cancer?

Vulvarcancer is cancer that is found in and on the vulva.

Whatis Vulvar Vestibulitis?

VulvarVestibulitis is a condition which causes redness and pain of the vestibule. VulvarVestibulitis is an inflammation of this skin and the mucous secreting glandsfound in the skin. The mucous secreting glands are called the lesser vestibularglands.

VulvarVestibulitis may include all the area around the opening of the vagina butis normally seen in the lower part of the vaginal opening.

VulvarVestibulitis occurs in women of all ages. It can occur in women who aresexually active and also in women who have never been sexually active.

Manywomen with this problem have suffered physically and emotionally for months oryears, have seen a number of physicians, and have tried many unsuccessfultreatments in search of relief.

Whatare the signs and symptoms of VulvarVestibulitis?

* Severe pain with pressure (for example: biking, exercise,tight fitting clothes ).

* Vaginal entry such as tampon use or intercourse.

* Burning, stinging, irritation, or raw sensation within thevestibular area.

* Vestibular redness

* The urge to urinate frequently or suddenly.

How is Vulvar Vestibulitisdiagnosed (identified)?

Yourdoctor or health care provider will examine the vulva and vestibule to identifythe common skin changes seen with vulvarvestibulitis. Pain is usually felt if the vestibule area is touched with acotton tipped applicator. A sample of your vaginal discharge is collected andtested to rule out infection.

Whatcauses Vulvar Vestibulitis?

The exact cause is unknown, but many studies are being conducted to determinethe cause of vulvar vestibulitis.

Thefollowing factors have been associated with vulvarvestibulitis:

* HPV (Human Papilloma Virus)
* Chronic Yeast Infections
* Chronic bacterial infections
* Chronic changes of pH (acid-basebalance in the vagina)
* Chronic use ofchemicals/irritants such as detergents, soaps, spermicides or lubricants.

What is the treatment for VulvarVestibulitis?

Treatment may include any of the following:

* Follow the Guidelines for Vulvar Skin Care
* Steroid Ointments

How it is used: A thin layer is applied to the vulvovaginalareas.

How it Works: Decreases redness, irritation, and burning. Caution: Use only asprescribed by your doctor. Overuse may result in thinning of the skin which willmake your problem worse rather than helping it.

* Trichloroacetic Acid (TCA) may beused in some cases as determined by the severity of the symptoms you have. TCAis a chemical that is used to destroy small areas of the irritated skin allowingnew healthy skin to grow in its place.

* Interferon Injections are used toincrease your body's response to infection.

Helpful treatment hints for VulvarVestibulitis:

* Vitamin A and D Ointment Howit is used: Apply to the areas of discomfort.
How it Works: Protects the skin, decreases irritation, heals, and soothes.

* Lidocaine Gel may be prescribed after initial treatment.
How it is used: Apply lidocaine gel to thevulvovaginal areas of discomfort.
How it Works: Numbs areas before intercourse.
Caution: After applying, wait until area becomes less sensitive beforeintercourse. Burning may occur for a short time ( 5 to 10 mins.) after the gel is applied.

* Witch Hazel Pads (TUCS Pads) How it is used: Apply to the vulvovaginalareas of discomfort.
How it Works: Decreases burning and irritation after intercourse and urinating.

* Cleansing Bottle - Pour plain luke-warm water over the vulva afterurinating to remove urine from irritated area.

* Calcium Citrate Tablets- How it is used: Take orally 1200-1800mg.elemental calcium every day. How it Works: Thought to decrease certain crystalsin the urine which may cause burning.

* Cranberry Juice How itis used: Drink an 8oz. glass every day.
How it Works: Increases the acid content of the urine to decrease bladderirritation.

* Limit High Oxalate Foods - May decrease amount of oxalate crystalsin urine. Oxalate crystals cause urinary symptoms such as the urge to urinatefrequently or suddenly.

* Baking Soda Soak- Soak in luke warm bath water with 4 to 5 tablespoonsof baking soda to help soothe vulvar itching and burning. Soak 1 to 3 times aday for 10 to 15 minutes. If you are using a sitz bath, use 1 to 2 teaspoons ofbaking soda.

Whatis a Vaginal Vault Prolapse?

The vaginal vault is the area at the top of the vagina, next to and adjacent tothe cervix. It can only “fall” or descend downwards toward the introitus, orthe entrance of the vagina, after a woman's womb has been removed(hysterectomy). Vaginal Vault Prolapseoccurs in about 15% of women who have had a hysterectomy for uterine prolapse,and in about 1% of women who have had a hysterectomy for other reasons.

Whatis Pelvic Organ Prolapse?

PelvicOrgan Prolapse is a very common condition, particularly among older women.It's estimated that half of women who have children will experience some form ofPelvic Organ Prolapse in later life. Many women, particularly because they mayno longer be sexually active, and fail to continue receiving their annual pelvicexams, don't seek help from their doctor. Therefore, the actual number of womenaffected by Pelvic Organ Prolapse is unknown.

Pelvic Organ Prolapse may also becalled; genital prolapse, pelvic relaxation, pelvic prolapse, uterine prolapse,uterovaginal prolapse, pelvic floor disorder, urogenital prolapse or vaginalwall prolapse.

Whatis Pelvic Prolapse?

PelvicProlapse is another term used for "pelvic organ prolapse." Pelvic prolapse is a very common condition, particularly among older women. It'sestimated that half of women who have children will experience some form ofPelvic Organ Prolapse in later life. Many women, particularly because they mayno longer be sexually active, and fail to continue receiving their annual pelvicexams, don't seek help from their doctor. Therefore, the actual number of womenaffected by Pelvic Organ Prolapse is unknown.

Pelvic Prolapse may also be called; genitalprolapse, pelvic relaxation, uterine prolapse, uterovaginal prolapse, pelvicfloor disorder, urogenital prolapse or vaginal wall prolapse.

What is a Prolapsed Uterus?

AProlapsed Uterus refers to a collapseduterus, or descended uterus, or other change in the position of the uterus inrelation to the surrounding structures within the pelvis. The pelvis containsmany soft tissue structures vital to normal body functions, supported primarilyby the diaphragms, layers of muscles, fibrous coverings called fasciae, andvarious ligaments and tendons. These soft tissues of the pelvis derive theirultimate support from the bony pelvis.

A Prolapsed Uterus may be one of three types,depending on the severity:

• First-degree prolapse occurs when the uterus sags downward into the upper
vagina.

• Second-degree prolapse occurs when the cervix is at or near the outside ofthe
vagina.

• Third-degree prolapse (sometimes referred to as total prolapse) occurs whenthe entire uterus extends outside the vagina.

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Clitoral Adhesions     Colposuspension    Depression Help     EssentialTrace Minerals

Female Sexual Health     FemaleUrinary Incontinence    FeminineDeodorant   Feminine Hygiene

Feminine Itching     FeminineOdor     Feminine Wipes  Gynecology for Guys    Gynecologic Disorders

Gynecologic Laparoscopy     GynecologicUrology    Intrinsic Sphincter Deficiency    LabialAdhesions     Menarche

Menorrhagia     MenstrualDisorders    MenstrualHygiene    Menstruation  Midurethral Sling

NaturalHormone Cream    NaturalProgesterone Cream    OrganicCotton Tampons     OrganicFor Life

Organic Trace Minerals    Painful Periods     PelvicAdhesions    PelvicFloor Dysfunction

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Pelvic Reconstructive Surgery   Period Protection     PolycysticOvary Syndrome    Pregnancyand Childbirth

Premature Ovarian Failure     PremenstrualSyndrome     ProlapsedUterus     Puberty   Reconstructive Pelvic Surgery

Sacrocolpopexy     SanitaryProtection     SuburethralSling     Tampon Safety   SymptoThermal Method

TensionFree Vaginal Sling TensionFree Vaginal Tape ThermalBalloon Ablation ToxicShock Syndrome

Transobturator Sling Urethral Hypermobility Urinary Tract Infections Urethropexy Uro-Gynecology

UterineBalloon Therapy VaginalBirth After Cesarean VaginalDryness Vaginal Hygiene

VaginalMoisturizers Vaginal Odor Vaginal Relaxation VaginalSponge VaginalVault Prolapse

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