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GYN Overview -- May 14, 2012 -- Dr. Terry Adkins and Dr. Phil Bressman

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MEDICAL MONDAYS News Notes
TOPIC: GYN Overview
Monday, May 14, 2012
Terry Adkins, MD: gynecologist
Phil Bressman, MD: gynecologist
BAPTIST HOSPITAL

news notes via www.webmd.com

Often times, as women move past childbearing age, they tend to only visit their GYN for problems. This segment is dedicated to common concerns of middle aged women, advancing treatment options and necessary screenings as we progress through the aging process.

Early Disease Detection - Screening, 50 to 64 Years

As you age, the risk of developing some diseases increases. Routine checkups and screening tests are important for you to stay in good health.

For a screening checklist, see www.ahrq.gov/ppip/men50.htm if you are a man and www.ahrq.gov/ppip/women50.htm if you are a woman.

How often you have the following tests depends on your age, your health, and things that increase your risk for specific diseases. Tests that may be done at your routine checkups include:

After reviewing all of the research, the U.S. Preventive Services Task Force has not recommended for or against routine screening for dementia in older adults.1

Monitor your weight, and see your doctor if you suddenly or consistently gain or lose weight. For more information, see the topics Weight Management and Obesity.

Sometimes doctors automatically schedule routine tests because they think that's what patients expect. But experts say that routine heart tests can be a waste of time and money.

 

 

Types of Urinary Incontinence

Urinary incontinence affects about 25 million Americans -- more women than men. It happens when you lose urine by accident. There are several different types of urinary incontinence.

Understanding Urinary Incontinence in Women

Stress Incontinence

Stress incontinence may happen when there is an increase in abdominal pressure -- such as when you exercise, laugh, sneeze, or cough. Urine leaks due to weakened pelvic floor muscles and tissues.

Causes of stress incontinence include pregnancy and childbirth, which cause stretching and weakening of the pelvic floor muscles. Other factors may also increase the risk for stress incontinence, such as being overweight, obesity, prostate surgery, and certain medications.

Urge Incontinence

Urge incontinence is often referred to as overactive bladder: You have an urgent need to go to the bathroom and may not get there in time, leaking urine.

Causes of overactive bladder include:

  • Damage to the bladder's nerves
  • Damage to the nervous system
  • Damage to muscles

Conditions such as multiple sclerosis, Parkinson's disease, diabetes, and stroke can affect nerves, leading to urge incontinence. Other conditions such as bladder infections, bladder stones, and use of certain medications can also contribute to symptoms.

Some women have both of these types of urinary incontinence -- stress and urge. Doctors call this mixed urinary incontinence.

Overflow Incontinence

You may have overflow incontinence if you are not able to empty your bladder appropriately. As a result, you may have leakage once the bladder is already full. This is more common in men with symptoms of frequent dribbling of urine.

Causes of overflow incontinence include:

  • Weak bladder muscles
  • Blockage of the urethra, such as by prostate enlargement
  • Medical conditions such as tumors causing obstruction of urine flow
  • Constipation

Functional Incontinence

With functional incontinence, physical problems such as arthritis, or cognitive problems such as dementia prevent you from getting to the bathroom in time.

Treatment for Different Types of Urinary Incontinence

To improve or eliminate urinary incontinence, you can make lifestyle changes and get treatment depending on which type you have.

For stress incontinence, treatment options include:

  • Pelvic floor exercises. If you've had a baby, chances are you've been told to do Kegel exercises. These help to strengthen the pelvic floor after childbirth. It is wise to keep doing the Kegels to keep your pelvic muscles and tissues strong, which can help prevent stress incontinence. Best of all, Kegels can be done anytime, anywhere.To do Kegels:
  1. Pretend you are trying to stop the flow of urine.
  2. Hold the squeeze for 10 seconds, then rest for 10 seconds.
  3. Do 3 or 4 sets daily.
  • Biofeedback. Using monitors, the biofeedback instructor feeds you information about bodily processes, including when your bladder and urethral muscles contract. This helps you gain control. It's also often used in combination with Kegel exercises.
  • Devices. For stress incontinence in women, doctors may prescribe a device called a pessary that is inserted into the vagina to reposition the urethra and reduce leakage
  • Injections and surgery. Injections to bulk up the urethral area may help with symptoms. In more extreme cases, surgery can help. One procedure pulls the bladder back up to a more normal position, relieving the pressure and leakage. Another surgery involves securing the bladder with a "sling," a piece of tissue or other material that holds up the bladder to prevent leakage.

For urge incontinence, treatment options include:

  • Timed voiding and bladder training. First, you complete a chart of the times you urinate and the times you leak. You observe patterns and then plan to empty your bladder before an accident would likely occur. You can also "retrain" your bladder, gradually increasing the time between bathroom visits. Kegel exercises are also helpful.
  • Medications, electrical stimulation, or surgery. Doctors sometimes prescribe medicines designed to inhibit the contractions of an overactive bladder. Electrical stimulation of the bladder nerves helps in some cases. Surgery is reserved for severe cases. It aims to increase the storage capacity of the bladder.

Hysterectomy

A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus

Hysterectomy is usually considered only after all other treatment approaches have been tried without success.

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Types of Hysterectomy

Depending on the reason for the hysterectomy, a surgeon may choose to remove all or only part of the uterus. Patients and health care providers sometimes use these terms inexactly, so it is important to clarify if the cervix and/or ovaries are removed:

  • In a supracervial or subtotal hysterectomy, a surgeon removes only the upper part of the uterus, keeping the cervix in place.
  • A total hysterectomy removes the whole uterus and cervix.
  • In a radical hysterectomy, a surgeon removes the whole uterus, tissue on the sides of the uterus, the cervix, and the top part of the vagina. Radical hysterectomy is generally only done when cancer is present.

The ovaries may also be removed -- a procedure called oopherectomy -- or may be left in place.

Surgical Techniques for Hysterectomy

Surgeons use different approaches for hysterectomy, depending on the surgeon's experience, the reason for the hysterectomy, and a woman's overall health. The hysterectomy technique will partly determine healing time and the kind of scar, if any, that remains after the operation.

There are two approaches to surgery – a traditional or open surgery and surgery using a minimally invasive procedure or MIP.

Open Surgery Hysterectomy

An abdominal hysterectomy is an open surgery. This is the most common approach to hysterectomy, accounting for about 70% of all procedures.

To perform an abdominal hysterectomy, a surgeon makes a 5 to 7 inch incision, either up-and-down or side-to-side, across the belly. The surgeon then removes the uterus through this incision.

On average, a woman spends more than three days in the hospital following an abdominal hysterectomy. There is also, after healing, a visible scar at the location of the incision.

MIP Hysterectomy

There are several approaches that can be used for an MIP hysterectomy:

  • Vaginal hysterectomy: The surgeon makes a cut in the vagina and removes the uterus through this incision. The incision is closed, leaving no visible scar.
  • Laparoscopic hysterectomy: This surgery is done using a laparoscope, which is a tube with a lighted camera, and surgical tools inserted through several small cuts made in the belly. The surgeon performs the hysterectomy from outside the body, viewing the operation on a video screen.
  • Laparoscopic-assisted vaginal hysterectomy: Using laparoscopic surgical tools, a surgeon removes the uterus through an incision in the vagina.
  • Robot-assisted laparoscopic hysterectomy: This procedure is similar to a laparoscopic hysterectomy, but the surgeon controls a sophisticated robotic system of surgical tools from outside the body. Advanced technology allows the surgeon to use natural wrist movements and view the hysterectomy on a three-dimensional screen.

Comparison of MIP Hysterectomy and Abdominal Hysterectomy

Using an MIP approach to remove the uterus offers a number of benefits when compared to the more traditional open surgery used for an abdominal hysterectomy. In general, an MIP allows for faster recovery, shorter hospital stays, less pain and scarring, and a lower chance of infection than does an abdominal hysterectomy.

With an MIP, women are generally able to resume their normal activity within an average of three to four weeks compared to four to six weeks for an abdominal hysterectomy. And the costs associated with an MIP are considerably lower than the costs associated with open surgery. There is also less risk of incisional hernias with an MIP.

Not every woman is a good candidate for a minimally invasive procedure. The presence of scar tissue from previous surgeries, obesity, and health status can all affect whether or not an MIP is advisable. You should talk with your doctor about whether you might be a candidate for an MIP.

Risks of Hysterectomy

Hysterectomy is a low-risk surgery. Most women who undergo hysterectomy have no serious problems or complications from the surgery. However, as with any surgery, hysterectomy can result in complications for a small minority of women. Those complications include:

  • Urinary incontinence
  • Vaginal prolapse (part of the vagina coming out of the body)
  • Fistula formation (an abnormal connection that forms between the vagina and bladder)
  • Chronic pain

Other risks from hysterectomy include wound infections and blood clots, although these are uncommon.

What to Expect After Hysterectomy

After a hysterectomy, if the ovaries were also removed, a woman will enter menopause. If the ovaries were not removed, a woman will likely enter menopause at an earlier age than she would have otherwise.

Most women are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.

After a hysterectomy, the vast majority of women surveyed feel the operation was successful at improving or curing their main problem (for example, pain or heavy periods).

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