Prolapse & Incontinence

Prolapse and Incontinence: when the pelvic floor is too weak

If the pelvic floor has a weak support structure, the organs in the pelvis start to sag and, in extreme cases, this can lead to a prolapse of the uterus, vagina, bladder or rectum. The function of the bladder and rectum can be severely impaired by such a prolapse. Urinary and faecal incontinence are serious consequences that can severely affect people's daily lives. But even in more serious cases, we can use modern methods to correct both the prolapse and the incontinence and thereby help patients to enjoy a better quality of life.

Urinary incontinence

Urinary incontinence

Regain bladder control by stimulating the genital nerves

If the affected person continues to suffer from urinary incontinence, in spite having had prolapse surgery, genital nerve stimulation, also known as GNS, is the method of choice for effective treatment. Urinary incontinence often occurs in women after an unsuccessful " sling operation ".

In order to stimulate the nerves in a targeted manner, a microstimulator system a few millimetres in size, is placed behind the pubic bone on the genital nerves. Hidden under the pubic hair, only a small incision is made under local anaesthetic.

For other indications that go beyond pure urinary incontinence, stimulation of the pudendal nerve leads to the best results. In both cases, the patient controls the duration and level of electrical stimulation with a remote control. Therapy using nerve stimulation is reversible - independent of the surgical procedure - and can be suspended at any time.

Fecal incontinence: stimulation of the pudendal nerve

Fecal incontinence: stimulation of the pudendal nerve

Controlling the bladder and rectum through nerve stimulation

In fecal incontinence or simultaneous fecal and urinary incontinence, stimulation of the pudendal nerve, which controls the sphincters of the bladder and rectum, among other things, produces excellent results.

In order to stimulate the pudendal nerve electrically, a laparoscopy procedure is performed under general anesthesia - the so-called LION procedure. This procedure is the first technique that allows the selective placement of electrodes on certain pelvic nerves. During the approximately 45-minute operation, a tiny electrode is attached directly to the pudendal nerve. A thin wire with a diameter of less than one millimeter then emits a harmless and painless electrical impulse, which has the following effects:

  • Contraction of the urethra sphincter (treatment of urinary incontinence)
  • relaxation of the bladder ( treatment of overactive bladder)
  • Better bladder control and therefore better bladder emptying

Another positive effect of nerve stimulation is the activation of sexual satisfaction. Since the pudendal nerve is one of the most important genital nerves, its stimulation significantly improves the erection of the penis or clitoris. This procedure is therefore also used for sexual disorders and erectile dysfunction.

Laparoscopic method

Laparoscopic method

The placement of the microstimulator system on the pudendal nerve can also be performed by minimally invasive laparoscopic surgery. A tiny camera is used (laparoscopic surgery). The procedure takes less than 30 minutes and can be performed by a gynaecologist or urologist on an outpatient basis. The stimulation of the pudendal nerve causes:

  • A contraction of the sphincters of the bladder and intestine ( treatment of urinary and fecal incontinence.
  • relaxation of both the rectum and the bladder ( treatment of the irritable bowel and bladder)
  • Better bladder and bowel control and thus improved emptying of the bladder and bowel.
Prolapse: Causes and Symptoms

Prolapse: Causes and Symptoms

Consequences of pelvic organ subsidence and prolapse

The uterus is held in position by ligaments, connective tissue and the pelvic floor muscles. If these support structures become weakened or if there is a chronic debility of the connective tissue, the entire pelvic floor may start to sag. The uterus rests lower in the pelvis than usual - the bladder and rectum can also slide downwards. The lowered uterus can exert pressure on the bladder due to its close proximity. Complaints such as pain when urinating or frequent urination (irritable bladder) with small amounts of urine can be experienced. In more severe cases, stress incontinence can occur, while stress such as coughing or sneezing causes urine to leak involuntarily from the bladder. Very rarely, the urinary bladder sinks and as a result urinary congestion travels to the kidneys.

In a prolapse of the uterus, the uterus emerges completely or partially from the vagina. This uterine prolapse usually occurs only if a uterine prolapse remains untreated for a long time. Vaginal prolapse can also occur, the vagina slips downwards. If parts of the vaginal wall emerge from the vagina, this is referred to as a vaginal prolapse. Vaginal prolapse can often be associated with a prolapse of the uterus. Problems with urinary retention are a typical symptom in this case.

If the uterus shifts its position downwards and backwards, it can exert pressure on the rectum. Constipation, pain during bowel movements and also fecal incontinence can be the result. In a bladder prolapse (cystocele, bladder prolapse), the urinary bladder is turned towards the anterior vaginal wall. The bladder prolapse is usually a secondary consequence of a uterine or vaginal prolapse. The urethra can also be inverted into the vagina.

Bladder prolapse is very rare in men. An inguinal hernia or a thigh hernia is likely to be the cause.

If the affected person suffers from the symptoms of urinary incontinence or fecal incontinence, the cause must be treated as a matter of urgency: a uterine, vaginal or bladder prolapse can be corrected either by a laparoscopic and/or vaginal surgical procedure.

This laparoscopic or vaginal prolapse operation can be extended to include cosmetic intimate surgery if desired.

Prof. Marc Possover MD

To help people in difficult situations to improve their quality of life has become his life's passion. Continuous research, decades of clinical experience and the focused determination to find a solution for previously unsolved medical problems, have enabled Prof. Possover to help often quite discouraged patients find release from their seemingly insurmountable problems.

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Photo Neuropelveology Nerve Tracts

Discovering the pelvic nerves

Neuropelveology is a medical discipline developed by Prof. Possover. It is based on the discovery of the pelvic nerves and includes the diagnosis of the diseases of these nerves by means of gynaecological examination methods and their treatment by means of laparoscopy.

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