Pelvic Medicine and Reconstructive Surgery
792 College Parkway
Fanny Allen, Medical Office Building, Suite 101
Colchester, VT 05446-3052
Do you have difficulties controlling your bladder or bowels? Have these problems forced you to wear pads and/or limit your activities or lifestyle for fear of an embarrassing accident? If you are experiencing involuntary leakage or soiling, frequent or difficult urination, or waking up multiple times each night to urinate there are two things you should know:
- You're not alone. Millions of people like you cope with issues related to poor bladder or bowel control every day.
- You shouldn't have to accept the loss of these functions as a normal part of aging. Effective treatments are available, and people of all ages may resume a full and active lifestyle after treatment.
Incontinence: What You Need to Know
Incontinence can be associated with pelvic support problems, but can also occur separately. Pelvic support problems affect women exclusively in the urethra and bladder, the small intestine, the rectum, the uterus, and the vagina. When the supporting tissues of these pelvic organs are stretched or damaged, the organ may drop down and press against the wall of the vagina.
Symptoms of incontinence and pelvic support problems include:
- Involuntary leaking or soiling
- Frequent or difficult urination
- Waking up multiple times each night to urinate
- Unnoticed loss of feces
- Pelvic heaviness
- Aching in the lower abdomen, groin or
- Lower back
- Problems having a bowel movement
Several factors can increase your risk of developing either or both urinary incontinence and fecal incontinence, including:
- Age - the older you are the more likely you are to develop either or both urinary incontinence and fecal incontinence
- Gender - both urinary incontinence and fecal incontinence are more common in women than men
- Smoking - contributes to urinary incontinence. The UVM Medical Center offers a quit smoking program
- Overweight - contributes to urinary incontinence
- Other diseases - Diabetes or kidney disease can contribute to urinary incontinence
- Nerve damage - contributes to fecal incontinence
- Dementia - contributes to fecal incontinence
- Physical disability - contributes to fecal incontinence
Conditions We Treat
- Stress incontinence - Stress incontinence refers to accidental leakage of urine brought on by physical activities such as sneezing, laughing, coughing or exercise. Stress incontinence affects over fifteen million Americans, almost 85 percent of whom are women between the ages of 30 and 59.
- Urge incontinence - Often associated with symptoms of urinary frequency, and frequent night-time voids, urge incontinence is urinary leakage associated with a sudden overpowering desire to urinate. Patients with this problem often “map out” bathrooms all over town; the fear of not being able to get to a toilet fast enough results in feelings of anxiety in new situations. The combination of urinary frequency, urgency, night-time voiding and urge incontinence are referred to as “overactive bladder.”
- Mixed incontinence - Many patients suffer from a mixture of both stress and urge incontinence, or “mixed incontinence.” If you suffer from this condition, you generally will leak both with and without activity. You may be very wet, requiring the use of multiple pads per day.
- Overflow incontinence - Overflow incontinence may occur when the bladder does not empty properly due to obstruction of flow (as can occur with an enlarged prostate), or from a weakened bladder muscle. Over time, the amount of urine in the bladder builds up and exceeds the capacity of the bladder, causing leakage.
Fecal incontinence is the loss of normal control of the bowels. This leads to stool leaking from the rectum (the last part of the large intestine) unexpectedly. It affects as many as 1 million Americans, particularly the aged, and is more frequent in women.
It can be a minor problem when it is limited to occasional soiling of the underwear, to a considerable problem with loss of bowel control, leading to restriction of daily activities and the fear of soiling can be socially isolating. Two types of fecal incontinence include:
- Passive rectal incontinence - The unnoticed loss of feces, or soiling. This can include the loss of minimal stool that is retained in the anal canal after normal defecation, and also nighttime incontinence.
- Urge rectal incontinence – When a patient has warning symptoms before they lose fecal material.
Pelvic Support Problems
Pelvic support problems affect women exclusively in the urethra and bladder, the small intestine, the rectum, the uterus, and the vagina.
- Pelvic floor dysfunction - When the supporting tissues of these pelvic organs are stretched or damaged, the organ may drop down and press against the wall of the vagina. The symptoms of pelvic support problems depend on which organs are involved. The result may be minor discomfort or major problems in the way the organs work.
- Pelvic organ prolapse - Some symptoms include a feeling of pelvic heaviness or fullness, or as if something is “falling out” of the vagina (prolapse); pulling or aching feeling in the lower abdomen, groin, or lower back; and leakage of urine or problems having a bowel movement. Different forms of prolapse include:
- Bladder prolapse
- Urethra prolapse
- Small bowel prolapse
- Rectal prolapse
- Uterine prolapse
After a precise diagnosis is established, we can tailor therapy to a patient's individual needs, arriving at an improvement or cure in the shortest possible period of time.
Urinary Incontinence Tests
Common and specialized tests include:
- Bladder diary - track your daily drinks, when you urinate, how much urine you produce, whether you had the urge to urinate and the number of times you experience incontinence
- Urinalysis - your urine sample is examined for signs of infection, traces of blood or other problems
- Blood test - your blood sample is analyzed for various chemicals and substances that may be contributing to your incontinence
- Postvoid residual (PVR) measurement - you're asked to urinate (also called void) into a container that measures the amount of urine. Then a catheter or ultrasound test measures the leftover (also called residual) urine in your bladder
- Pelvic ultrasound - your urinary tract or genitals are examined for abnormalities
- Bladder stress test - your doctor will examine you and watch for loss of urine when you either
coughor bear down
- Urodynamic testing - the pressure in your bladder when it's at rest and when it's filling is measured
- Cystourethrogram - your urinary tract is examined by injecting a fluid with a special dye that shows up on a series of X-rays of your bladder as you urinate
- Cystoscopy - abnormalities in your urinary tract are examined using a thin tube with a tiny lens (cystoscope)
Fecal Incontinence Tests
Common and specialized tests include:
- Digital rectal exam (DRE) - the strength of your sphincter muscles and any abnormalities in the rectal area are examined by inserting a gloved and lubricated finger into your rectum
- Balloon expulsion test - a small balloon filled with water is inserted into the rectum and you're asked to go to the toilet to push it out (also called expel). How long the process takes is tracked. Typically any time over one minute is a sign of a problem
- Anal manometry - the tightness of your anal sphincter and the sensitivity and functioning of your rectum are measured by inserting a narrow, flexible tube with an expandable balloon at the tip into the anus and rectum
- Anorectal ultrasonography - the structure of your sphincter is examined by inserting a narrow, wand-like instrument into the anus and rectum that makes video images
- Proctography - this test measures how much stool your rectum can hold and how well your body expels stool by making X-ray video images while you have a bowel movement on a specially designed toilet
- Proctosigmoidoscopy - the last two feet of the colon (called the sigmoid) are examined for signs of inflammation, tumors or scar tissue by inserting a flexible tube into your rectum
- Endorectal ultrasound (ERUS) - the anal sphincters are inspected by inserting a special endoscope to look at the lower colon and using sound waves to make images
- Colonoscopy - your large intestine (also called the colon) is inspected by using a flexible scope called a colonoscopy
- Analelectromyography -Nerve damage is measured by inserting tiny electrodes into muscles around the anus
- Magnetic resonance imaging (MRI) - makes pictures of the sphincter during defecation to determine if the muscles are intact
Incontinence Treatment in Burlington, VT
Today there are many effective treatments available for regaining bladder or bowel control and resolving pelvic support problems.
We offer a wide range of on-site incontinence treatments and therapies at The UVM Medical Center, including:
- Self-help and behavioral solutions, such as:
- Fluid and dietary changes/management
- Bladder and bowel training
- Medical and minimally invasive solutions, such as:
- Intermittent self-catheterization
- Sacral nerve stimulation (SNS)
- Surgical and reconstructive solutions, such as:
- Sling procedures
- An artificial sphincter for urinary incontinence in men
- Rectal prolapse surgery