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Prolapse and continence

Expert: Christine Murray, RN

Christine Murray is a registered nurse and midwife who has worked for many years in a urogynaecology subspecialty clinic at a large women’s hospital. Christine is interested in all aspects of incontinence and prolapse, both conservative and surgical, affecting women of all ages.

Watch the video

The following video is a useful resource for your patient to find out about prolapse.

Let’s talk about prolapse is a brief and informative educational video that answers the common questions, and outlines where to go for help or more information.

Click here to download a brochure about prolapse

Q&A with Christine Murray

Q: I have a patient who has a large vaginal prolapse which is causing her a lot of discomfort. It is also affecting her bladder emptying and she has recently been getting repeated urinary tract infections. She is quite elderly, has had a recent mild stroke and is not interested in having surgery to fix the prolapse. Is there any other way that the prolapse can be managed so that this lady is more comfortable?

An intravaginal pessary would be of great benefit. A pessary can be used to support the part of the vagina that is prolapsing and causing discomfort, in this case the front wall of the vagina, behind which sits the bladder. The pessary, once positioned, can often improve a patient’s voiding. This might also reduce the incidence of urinary tract infections by getting the bladder to empty more completely. Using a pessary can allow treatment of the prolapse without the need for surgery. Pessaries can be used for a long period of time but do require regular checks to make sure all is well.

 

Q: We recently had a patient with a large prolapse, so much so that she would have to lay down for about an hour in order to be able to void. I discussed this with urogynae Joe Lee who suggested we use  a gelhorn pessary. She states that it has changed her life. 

Sometimes the use of a vaginal pessary can really make a difference to a woman’s ability to empty her bladder. The pessary, when correctly positioned, can allow the bladder to empty more fully, without a woman having to lay down first.

 

Q: I have just been tranferred patient from another staff member. She is 24. Leaking with cough and has urgency and Urge I/C. Previous physio was external palpation TA. She was using vaginal weights. All urodynamics normal. I did internal and got no pelvic floor contraction at all. She has internal trigger points on Right side. She is anxious. I am thinking EMG feedback. I have limited experience with this machine. Advice?

This lady sounds quite complicated so we need to break down her symptoms and see what can be done. Firstly she sounds like she has stress incontinence (leaking with cough) and symptoms of overactive bladder (urgency and urge incontinence).

A visit to a specialist continence physiotherapist or continence nurse advisor would be advantageous. A physiotherapist or continence nurse would assess this young lady and perhaps suggest a program of pelvic floor exercises. Maybe this lady needs some instruction in reducing bladder irritants such as caffeine (tea, coffee, Coke, Pepsi, energy drinks), carbonated drinks or alcohol. A reduced intake of these known irritants may help this woman to control her bladder urgency better. She may have reduced her overall fluid intake to compensate for her leakage episodes and the physio or nurse will give her instruction on good bladder habits.

She may also benefit from telephoning the continence nurse advisors on the National Continence Helpline, who can chat with her and reassure her to reduce her anxiety over her problems and their management. The Helpline is open from 8am – 8pm Monday to Friday, is staffed by qualified continence nurse advisors and is free and confidential. The Helpline nurses also a have directory of services of available Physiotherapists and Continence Nurse Advisors around Australia. They can give out the contact details for the relevant services.