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The Truth About Incontinence

The Truth About Incontinence

Sept 25, 2012 - In an interview on Channel 4's New York Live, Urogynecologist Lisa Dabney, MD, debunks several myths about urinary incontinence.

FDA Reports to Patients on Risks of Vaginal Mesh
March 27, 2013

The FDA wants patients with pelvic-organ prolapse to know that having a surgery with transvaginal mesh may put you at risk for needing additional surgery, and in some cases, repeat surgery may not resolve complications. Click here for the full patient advisory PDF.

Controversies in the Field of Urogynecology: Mesh Used in Vaginal Surgery

Message from the Urogynecology Division, Department of Obstetrics and Gynecology, Mount Sinai St. Luke’s and Mount Sinai West

An ongoing public controversy was stimulated by the FDA’s 2011 warning regarding the use of synthetic mesh in vaginal surgery for prolapse.

As a matter of fact, departmental urogynecologists Lisa Dabney, MD, and Anne Hardart, MD, have never used much mesh in their practices. They have been especially reluctant to use mesh to augment pelvic-organ-prolapse repairs performed through the vaginal route. Fortunately, they have extensive expertise in performing these procedures vaginally without the use of mesh—and they have had excellent results.
Read full story here.

Grooming Tips for GYN Health

Barely-there underwear, Brazilian bikini waxes, and shaved pubic hair have become cultural beauty standards for women. And yet, the skin of a woman’s genital area is more sensitive than the skin on her face. The very practices women undertake to keep their private areas “pretty and pristine” are actually doing just the opposite. These cultural “norms” are landing women in their doctor’s offices with complaints of irritation and discomfort.
 
Lisa Dabney, MD, urogynecologist in the Department of Obstetrics and Gynecology at Mount Sinai St. Luke’s and Mount Sinai West, wants to remind women that redness and irritation from harsh grooming procedures and tight clothing are the body’s way of saying, “stop torturing me.”
 
Here are the general guidelines that Dr. Dabney hands out to her patients with pain and discomfort in the vaginal area and recurrent yeast infections. Most of the time, says Dr. Dabney, these patients don’t have some horrible infection; they just need to change their grooming habits.
 
Are you wearing panty liners?  If so, STOP!  Panty liners actually trap moisture and allow yeast infections to grow, and irritation to develop.
 
Wear cotton underwear ONLY, and we don’t mean just the crotch of the underwear. The entire pair of underwear should be 100% cotton – it’s the least irritating and allows moisture to evaporate.
 
Underwear should not rub against the genital and anal areas, as is true with thongs or tight bikini-style panties. Instead, it should comfortably cover the sensitive areas, and be loose enough not to chafe.
 
Waxing or shaving your public hair? We evolved with pubic hair for a reason: it protects the vagina from dirt and other irritants. Continually removing pubic hair can cause ingrown hairs, decreased sensitivity and/or irritation and red bumps.
 
No tight clothes for the gym. We know you want to look cute in your workout clothes, but opting for loose-fitting, cotton shorts will help prevent vaginal irritation and infection.
 
No harsh soaps or douches. The vulvar and vaginal region should be treated gently, and kept on the acidic side, the opposite of most soaps. Wash gently with plain water and use a very dilute solution of vinegar, if you feel douching is necessary.
 
Create conditions that will help good bacteria to grow. What we call a “yeast infection” is simply an overpopulation of a yeast microorganism, Candida albicans, that is found normally in the vagina. The way to prevent yeast infections, other bacterial infections, and the irritation that comes with them, is to make sure that there is a healthy population of good bacteria, called probiotics, in the vagina. One of these, Acidophilus lactobaccilus, has a name that means “acid-loving.” Help keep an acidic environment in your vagina and vulva by following all of the tips above.
 
Dr. Dabney isn’t saying that you can never wear a thong, sport some hot workout attire or do some personal grooming, but there are consequences to these practices that you may not have considered.

The Least-Invasive Route for Gynecologic Surgery is Through the Vagina

AN EXPERT’S VIEWPOINT:

There has been a lot of talk in the media about minimally-invasive surgery for uterine fibroids, endometriosis, and other noncancerous gynecologic problems. The route discussed for these surgeries is usually laparoscopic; that is, through small incisions in the abdomen for insertion of a camera and instruments. While this approach has revolutionized some procedures, especially those for cancer cases, sometimes the practice of laparoscopy overshadows the least invasive approach for noncancerous gynecological conditions: the vaginal approach. Read full story here





Urogynecology Overview

Don’t Be Sidelined by Bladder-Control Problems or Other Pelvic-Floor Disorders!

Women are living longer and staying healthier these days. Increased exercise and other active pursuits are part of this new lifestyle, but unfortunately, bladder control problems slow down or sideline many of the 13 million Americans. Most of those affected are women. Sufferers often see bladder control problems and other pelvic-floor disorders as a roadblock to health, vitality, and self-esteem.

Pelvic floor disorders include bladder control problems (urinary incontinence), fecal incontinence, and pelvic organ prolapse—that is, the dropping or falling of the uterus, bladder, rectum, and vagina. Any of these problems may occur separately or in some combination with each other.

Women need to know that these disorders need not stand in the path to a full life. At Mount Sinai St. Luke’s and Mount Sinai West, the Urogynecology and Pelvic Reconstructive Surgery Division is made up of highly qualified, experienced specialists with advanced training. Our approach allows for comprehensive care, even for patients with the most complex conditions. We begin with state-of-the-art diagnostic procedures and evaluation, and then offer a complete treatment and education plan to each patient based her own individual needs and preferences.


Urogynecology physicians
Lisa Dabney, MD, and Anne Hardart, MD

We provide a broad range of management and treatment options for urinary incontinence and prolapse. Treatment types may include behavioral modification, pelvic muscle rehabilitation, biofeedback, and pharmaceuticals, with or without the latest minimally-invasive surgery. Contact us today and get on the road to an active, vital life!

Minimally-Invasive Surgery for Fibroids and Other Gynecologic Conditions

In addition to urogynecologic care—for bladder control problems and pelvic floor disorders--our specialists are also leaders in minimally-invasive surgery for other noncancerous gynecologic conditions. They are experts in vaginal hysterectomy, which is considered the method of choice in women who need a hysterectomy for noncancerous problems. A woman who has been told she is not a candidate for vaginal surgery because of a prior cesarean section, because her fibroids are too large, or because she hasn’t had children can, in fact, usually have vaginal surgery without much problem.

 

Contact Us at 212-523-7570

Treatments for Bladder-Control Problems and Pelvic-Organ Prolapse

Overview

In the Division of Urogynecology and Pelvic Reconstructive Surgery at Mount Sinai West, our expert physicians offer you the best treatments for prolapse and incontinence. These treatments range from conservative education and behavior modification to advanced, minimally-invasive surgical procedures. During the diagnostic process, our specialists will listen closely to you and explain your options. You can then choose the most effective and suitable plan for your needs and lifestyle. Below are some possible components of a comprehensive plan.

Behavioral Treatment and Education

Pelvic floor exercises, also known as pelvic muscle rehabilitation, can be very effective for stress incontinence and may help increase quality of life for those with prolapse. Bladder retraining is a behavior modification technique that helps correct incontinence. We offer education and support for these and other non-invasive treatments.

Kegel Exercises

The levator ani muscles are the set of muscles that span the pelvic floor. They are attached to the pubic bone in front and the hip bones on either side. The levator ani muscles provide support to both the vagina and the urethra, so keeping them strong will help support the pelvic organs and prevent or minimize urinary incontinence.

Kegel exercises involve contracting the levator ani muscles. These are simple exercises that all women should know about and learn how to do. In order to keep the pelvic floor muscles strong, you need to exercise them as part of your daily routine, just as you would with any fitness program.

First, learn to identify the muscles. It is often difficult for some women to do this. Many times women are instructed to try to stop the flow while urinating. This is a good tool for identifying the pelvic floor muscle. However, Kegels should not be practiced this way on a routine basis, as it can lead to urinary retention and dysfunctional voiding. If you continue having trouble identifying your pelvic floor muscles (and you will not be alone), a consultation with your gynecologist can help. There are also physical therapists who specialize in pelvic floor dysfunction, and can be an invaluable resource in teaching patients to get the most out of their Kegel exercises.

Once you can identify the muscles, get in the habit of doing Kegels twice each day. I usually instruct patients to do a set of 10 contractions at a time, holding each contraction for 10 seconds. The exact exercise plan isn’t as important as making sure that you do these exercises on a regular basis.

Once you get the muscle strong, it is important to put them to work. Before and during coughing, laughing and sneezing, when you have problems with urinary leakage, make sure that you contract your pelvic floor. You may be surprised how much you can cut down on the leakage of urine. Remember, squeeze before you sneeze…or cough…or laugh…or lift a heavy object.

Pessaries are Effective and Noninvasive

A pessary is a device made of silicone that is placed in the vagina to relieve symptoms of prolapse or stress incontinence. They can actually prevent prolapse from getting worse. After being fitted, most women don’t notice that they are wearing a pessary.

Medications

Medications are used for both forms of incontinence, and can be very effective for urge incontinence, which does not respond to other treatments.

Minimally-Invasive Surgery for Bladder Control and Pelvic Organ Support

Many women find relief from prolapse or stress incontinence without surgery. However, to truly and permanently correct these problems, pelvic reconstructive surgery is the only option. The choice is yours. If you decide it is right for you, a typical surgical treatment is minimally invasive, performed through the vagina and without a major incision. The division’s physicians are accomplished and flexible surgeons who will customize the procedure to your problem. At your request, they will employ surgical treatments that conserve the uterus.

Minimally-Invasive Incontinence Surgery. To correct bladder control problems, we typically use the tension-free transvaginal tape (TVT sling) procedure. Over a million of these minimally-invasive procedures have been performed worldwide over the past 10 years, with excellent success rates and low rates of complications. Our urogynecologists perform a high volume of TVT sling procedures, with excellent results and minimal complications. The procedure is performed through the vagina, takes only 20 minutes, does not require an overnight stay, and if desired by the patient, can be done under local anesthesia. Other operators have made various attempts to modify the transvaginal tape procedure. However, a huge body of data, and our own excellent results, have led us to conclude that the original TVT is still the best. For incontinence, we also perform the transobtuator tape slings, which are also minimally-invasive and more appropriate for some patients.

Minimally-Invasive Prolapse Surgery. We repair the dropping of the vagina and uterus through the vagina, supporting these organs with the patient’s own tissue. This is the least-invasive approach, with the quickest recovery time and the fewest complications because mesh is not usually required. In addition, we are skilled at correcting vaginal-vault prolapse via the vaginal route in women who have had a prior hysterectomy, a procedure many gynecological surgeons avoid. We have had good success rates with these approaches and still see many of our patients many years after their surgeries for their gynecologic care.

Minimally-Invasive Surgery for Other Gynecologic Problems

Dr. Dabney and Dr. Hardart are experts at treating many additional gynecologic problems without a major incision, through the vagina or laparoscopically.

Surgery by the Vaginal Route for Hysterectomy, Fibroid Removal, or Ovarian Cysts

Vaginal surgery is the least invasive approach for many procedures because the patient ends up with no incisions on her abdomen. The only incision is made through the vagina. In addition to this, the surgeries are often shorter and require less anesthesia than the abdominal route. Patients also recover more quickly. Our specialists do many hysterectomies through the vagina that other New York City surgeons would only perform abdominally. Vaginal hysterectomy has been found to be the route of choice by recent scholarly publications. Vaginal ovarian cystectomy and vaginal myomectomy, respectively allow ovarian cysts and fibroids to be safely removed through the vagina.

Laparoscopic Hysterectomy or Fibroid Removal

These procedures are much less invasive than conventional, "open" abdominal surgeries, and utilize a camera and instruments inserted through minor incisions to remove the uterus or fibroids.


OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Home
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Contacts
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Clinical Services


OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Division Overview
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Physicians
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Appointments
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Types of Urinary Incontinence
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians About Prolapse
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Treatments for Incontinence & Prolapse
OB Gyn Gynecology St. Luke's Hospital New York Manhattan Pregnancy Risks Specialist Midwife Physicians Minimally-Invasive Surgery for Other GYN Problems

Types of Urinary Incontinence

Your doctor will work with you to determine the type of incontinence, so that you can receive appropriate therapy.

Stress Incontinence: Loss of urine during exertion, such as coughing, laughing, or running.

Urge Incontinence: Loss of urine for no apparent reason after suddenly feeling the need or urge to urinate.

Mixed Incontinence: A combination of stress and urge incontinence.

About Pelvic Organ Prolapse

Pelvic organ prolapse is the dropping or falling of the uterus, bladder, rectum, or vagina.



Uterine Prolapse: Pelvic support structures break down and the uterus drops into the vagina. Most often, other organs are also out of place.

Anterior wall prolapse, or cystocele: This is the most common type of pelvic floor defect. The bladder drops and rotates into the vaginal opening, and sometimes bulges out. Some cystoceles can cause urine leakage while large cystoceles can cause difficulty voiding.

Posterior wall prolapse, or rectocele: This condition can result in the rectum bulging into the vaginal opening. A large rectocele can make it difficult to move the bowels.
 
Pelvic prolapse images and captions
used by permission of Ethicon Women’s Health and Urology, a Johnson and Johnson Company.

Treatments for Incontinence & Prolapse: