MEDICAL MONDAYS News Notes
TOPIC: GYN Overview
Monday, May 14, 2012
Terry Adkins, MD: gynecologist
Phil Bressman, MD: gynecologist
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:
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.
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 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:
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.
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:
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:
For urge incontinence, treatment options include:
A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:
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:
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.
There are several approaches that can be used for an MIP hysterectomy:
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:
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).