Top Ten Misconceptions in Urogynecology
1) Anatomy
It is common for women to not fully understand their own anatomy. The opening that urine comes out of is not the same opening as the vagina, but they are very close. They are closer in some women than others, and may be the reason some women are more prone to having bladder infections. A “fallen bladder” (or cystocele) is not the same as a fallen uterus (or uterine prolapse) or a fallen rectum (or rectocele); these are all different conditions and are treated differently. An important point to understand is that woman can have more than one type of prolapse at a time. For example, women can have uterine prolapse and a cystocele at the same time; or a cystocele and a rectocele at the same time.
2) Mesh
There are a multitude of attorney-generated commercials focusing on “bad mesh”. Unfortunately, this creates an overall thought that all mesh is bad when in fact, there are many mesh products that are still used today, and are considered the “gold standard” for the surgical treatment of pelvic organ prolapse and urinary incontinence. The surgeries that use these mesh products are sometimes able to provide very high long-term success rates with low complication rates, when compared to surgeries that do not use mesh. For more information, please see the position statement published by AUGS (American Urogynecologic Society) and SUFU (Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction).
3) Surgery
Not all forms of urinary incontinence or pelvic organ prolapse need surgical intervention. In fact, the general rule is that if a woman is not bothered (or symptomatic) by her leakage or prolapse, then no surgery is needed. Urinary incontinence and pelvic organ prolapse are conditions that are not life-threatening, therefore surgeries for these conditions are considered ‘elective’. If a woman is bothered by the feeling of a bulge, by the change in urinary function, or by the change in bowel movements, we discuss all treatment options available. These may or may not include surgery. There are non-surgical alternatives most women are candidates for, such as pessary support or pelvic floor physical therapy.
4) Rectal prolapse versus Rectocele
Many patients and even physicians get these terms confused. Rectal prolapse is when the rectal mucosa extrudes from the rectal opening (part of the rectum bulges out of the anus); this is a condition that should be evaluated by a colorectal surgeon or general surgeon. A rectocele is when the rectum bulges into the vagina and can then bulge on out of the vaginal opening; this is a condition that is considered a urogynecologic condition.
5) Hysterectomy
A hysterectomy does not prevent nor cause pelvic organ prolapse. It is a very common misconception that having a hysterectomy automatically means a woman will have a fallen bladder later in life. This is absolutely not true. The supportive structures of the bladder are separate from the supportive structures of the uterus. Studies have demonstrated that rates of pelvic organ prolapse are the same in women with a uterus and in women who have had a hysterectomy.
6) Pelvic organ prolapse is painful
This is a common misconception. Many women think that prolapse is painful, when in fact, it is not a painful condition. Prolapse happens gradually over time and can lead to a sense of fullness or pressure in the vagina and at the opening of the vagina. Some women will have some slight discomfort, such as a sense of “not feeling normal down there” or that “something feels out of place”.
7) Age
Pelvic organ prolapse and urinary incontinence are not conditions only seen in the elderly. Many women feel as if these conditions are “older woman” conditions, when in fact, prolapse and incontinence can begin much earlier in life. Commonly, women will feel these conditions present shortly after having children.
8) Interstitial cystitis is treated with antibiotics
While the symptoms of interstitial cystitis are very similar to those of urinary tract infections, antibiotics are NOT an appropriate treatment for it. One of the main differences between a UTI (urinary tract infection) and IC (interstitial cystitis) is that IC is not caused by a bacterial infection. Therefore, an antibiotic will not treat it. There are many different treatment options for IC which can be discussed at a visit with a urogynecologist.
9) Pelvic floor physical therapy
Many women do not want to “waste their time” with physical therapy because they have the misconception that it doesn’t really work to treat prolapse or incontinence. The truth is that it is very helpful in the treatment of both pelvic organ prolapse and urinary incontinence. Many studies have found very high success rates when women are motivated to keep up with the pelvic floor exercises taught to them by the physical therapists.
10) Bladder prolapse causes urinary incontinence
Another very common misconception is that urinary incontinence must mean a woman has a fallen bladder, when the truth is, that incontinence can occur in women without a fallen bladder and vice versa: a women can have a fallen bladder without urinary incontinence. They are independent conditions and are treated with different types of treatments. The confusing part is that both conditions can occur simultaneously, making women feel as if they are the same. Most of the time, if a woman has both a cystocele (fallen bladder) and urinary incontinence, she will need two types of treatments: one for the cystocele and one for the incontinence.