Ever Since I Had My Baby

by Roger Goldberg

  Perineorrhaphy: Surgical reconstruction of a loose perineum and vaginal opening.

  Perineum: The anatomic area between the genital and anal openings.

  Periurethral Injections: Bulking up the urethra by injecting material (collagen, Durasphere, Teflon) into its walls. An office-based therapy for urinary stress incontinence.

  Pessary: An object usually made of silicone or rubber, available in various shapes and sizes; worn like a diaphragm in the vagina to support pelvic prolapse.

  Pyelonephritis: Infection in one or both kidneys.

  Phytoestrogens: Natural estrogenlike substances found in various foods, such as soy products.

  Posterior Colporrhaphy (Posterior Repair): A vaginal operation to repair a rectocele.

  Progesterone: A female hormone abundant during pregnancy and present in smaller quantities during the normal menstrual cycle.

  Progestin: Synthetic progesterone.

  Prolapse: Weakening of pelvic supports leading to dropping or bulging of the pelvic organs (see: Cystocele, Enterocele, Rectocele, Uterine Prolapse, Vaginal Vault Prolapse).

  Pudendal Nerve: A nerve providing sensation and normal muscle tone to much of the pelvic floor, including the levator muscles, perineal area, bladder, and anal sphincter.

  Rectocele: The rectum bulging up into a weakened lower vaginal wall.

  Rectum: The lowest portion of the digestive tract, storing the bowel contents right before defecation; located right above the anal canal.

  Retention (Urinary Retention): An abnormal amount of urine remaining in the bladder after voiding. Indicates an inability to fully empty the bladder.

  Sacral Colpopexy: Surgically attaching the top of the vagina to the sacrum, a bone at the back of the pelvis. Performed either through an open abdominal incision or by laparoscopy.

  Sacral Nerve Stimulation (Neuromodulation, Interstim): A pacemaker for the pelvis, implanted near the tailbone and sacral nerves, used to treat a variety of bladder and pelvic symptoms.

  Sacrospinous Vaginal Vault Suspension: A vaginal operation that secures a prolapsed vaginal vault to the sacrospinous ligament, located deep within the pelvis.

  Salpingo-oophrectomy: Removal of the tubes (salpingo) and ovaries (oophoron).

  Sensory Urgency: Frequent strong bladder urges, resulting from irritation or sensitivity within the bladder or urethral lining.

  Sphincter: Muscle that surrounds the opening of an organ (including the anus and urethra), controlling the outflow of waste products.

  Splinting: Supporting the lower vaginal wall, usually with a finger, in order to help stool empty from a rectocele bulge.

  Stress Urinary Incontinence: Involuntary loss of urine during moments of increased physical stress (lifting, coughing, laughing, sneezing).

  Suburethral Sling (Bladder Sling): A stress incontinence procedure that places a strip of synthetic or natural material beneath the bladder neck and/or urethra.

  Suprapubic Catheter: A catheter inserted into the bladder through a tiny incision in the abdomen.

  Tension-free Sling (TVT, SPARC, SABRE, and others): Minimally invasive operations that place a loose synthetic mesh beneath the urethra; a highly effective and increasingly popular treatment for several types of stress urinary incontinence.

  Ureters: The pair of long narrow tubes connecting the kidneys to the bladder.

  Urethra: The anatomic tube leading from the bladder to the outside of the body.

  Urethral Hypermobility: A floppy urethra caused by a loss of underlying vaginal support; often found in association with urinary stress incontinence.

  Urethritis: Inflammation of the urethra.

  Urethrolysis: A procedure intended to loosen the urethral support after a previous incontinence operation, if voiding problems occur and persist after surgery.

  Urge Incontinence: Involuntary loss of urine triggered by an urge to urinate; most often resulting from an overactive bladder.

  Urgency: A strong and often sudden desire to urinate.

  Urinalysis: A test of the urine that can immediately identify chemicals suggestive of infection or other urinary conditions.

  Urinary Incontinence: Any involuntary leakage of urine.

  Urine Culture: A test for bacterial growth in the urine, requiring incubation for up to several days.

  Urodynamics: A test used to diagnose the specific underlying causes of incontinence symptoms and voiding problems.

  Uroflowmetry: A test that calculates the rate of urine flow during urination.

  Urogynecologist: A subspecialist devoted to the diagnosis and treatments of disorders related to the female pelvic floor and lower urinary tract. Urogynecologists are trained in obstetrics and gynecology, then receive additional subspecialty training.

  Urologist: Physician specializing in both male and female urinary systems. Subspecialists in female urology devote additional training to the female urinary and genital systems.

  Uterine Prolapse: A dropped uterus caused by weakening of the surrounding pelvic ligaments that secure it to the bony pelvis.

  Uterosacral Ligament Suspension: Reinforcing the top (apex) of the vagina to the uterosacral ligaments on the pelvic walls. Performed with vaginal, abdominal, or laparoscopic techniques.

  Uterus: The pear-shaped muscular organ that consists of a main portion (body) and a narrowed lower part (cervix) opening into the top of the vagina.

  Vagina: The canal between the uterus and outer genital area.

  Vaginal Hysterectomy: Removal of the uterus through the vagina, with no abdominal incision.

  Vaginal Vault Prolapse: Bulging of the upper vagina after it detaches from its pelvic supports, in a woman with a previous hysterectomy.

  Vaginal Vault Suspension: An operation suspending the top (apex) of the vagina to pelvic ligaments.

  Vaginitis: Inflammation of the vagina with a number of potential causes, including infection, chemical irritants, or a lack of estrogen (atrophic vaginitis).

  VBAC: Vaginal birth after a previous cesarean section.

  Voiding and Symptom Diary: A log for recording urinary patterns, incontinence episodes, and other pelvic-floor symptoms.

  Vulva: The outer female genitalia.

  Bibliography

  URINARY INCONTINENCE AND BLADDER PROBLEMS

  Arya, L.A., Jackson, N.D., Myers, D.L., and Verma, A. “Risk of New-Onset Urinary Incontinence After Forceps and Vacuum Delivery in Primiparous Women.” American Journal of Obstetrics and Gynecology 185(6)(2001):1318–23.

  Beck, R.P., and Hsu, N. “Pregnancy, Childbirth and the Menopause Related to the Development of Stress Incontinence.” American Journal of Obstetrics and Gynecology 91(1965):820–23.

  Black, N.A., Bowling, A., Griffiths, J.M., Pope, C., and Abel, P.D. “Impact of Surgery for Stress Incontinence on the Social Lives of Women.” British Journal of Obstetrics and Gynaecology 105(1998):605–12.

  Bo, K., Talseth, T., and Holme, I. “Single Blind, Randomized Controlled Trial of Pelvic Floor Exercises, Electrical Stimulation, Vaginal Cones and No Treatment in Management of Genuine Stress Incontinence in Women.” British Medical Journal 318(1999):487–93.

  Brubaker, L., Benson, J.T., Bent, A., Clark, A., and Shott, S. “Transvaginal Electrical Stimulation for Female Urinary Incontinence.” American Journal of Obstetrics and Gynecology 177(1997):536–40.

  Burgio, K.L., Robinson, J.C., and Engel, B.T. “The Role of Biofeedback in Kegel Exercise Training for Stress Urinary Incontinence.” American Journal of Obstetrics and Gynecology 154(1986):58–64.

  Burgio, K.L., Matthews, K.A., and Engel, B.T. “Prevalence, Incidence and Correlates of Urinary Incontinence in Healthy, Middle-Aged Women.” Journal of Urology 146(1991):1255–59.

  Cardozo, L.D., and Kelleher, C.J. “Sex Hormones, the Menopause, and Urinary Problems.” Gynecologic Endocrinology 9(1995):75–84.

  Chiarelli, P., and Cockburn, J. “Promoting Urinary Continence in Women After Delivery: Randomized Controlled Trial.” British Medical Journal 324(2002):
1241.

  Diokno, A.C. “Epidemiology and Psychosocial Aspects of Incontinence.” Urologic Clinics of North America 22(3)(1995):481–85.

  Farrell, S.A., Allen, V.M., and Baskett, T.F. “Parturition and Urinary Incontinence in Primiparas.” Obstetrics and Gynecology 97(3)(2001):350–56.

  Francis, W.J.A. “The Onset of Stress Incontinence.” Journal of Obstetrics and Gynaecology of the British Empire 67(1960):899–903.

  Hannah, M.E., Hannah, W.J., et al., Term Breech Trial 3-Month Follow-Up Collaborative Group. “Outcomes at 3 Months After Planned Cesarean vs. Planned Vaginal Delivery for Breech Presentation at Term: The International Randomized Term Breech Trial.” Journal of the American Medical Association 287(14)(2002):1822–31.

  Hassouna, M.M., Siegel, S.W., Nyeholt, A.A.B., et al. “Sacral Neuromodulation in the Treatment of Urgency-Frequency Symptoms: A Multicenter Study on Efficacy and Safety.” Journal of Urology 163(6)(2000):1849–54.

  Kegel, A.H. “Progressive Resistance Exercise in the Functional Restoration of the Perineal Muscles.” American Journal of Obstetrics and Gynecology 56(1948):238–48.

  Mason, L., Glenn, S., Walton, I., and Hughes, C. “Women’s Reluctance to Seek Help for Stress Incontinence During Pregnancy and Following Childbirth.” Midwifery 17(3)(2001):212–21.

  Meyer, S., Hohlfeld, P., Achtari, C., and De Grandi, P. “Pelvic Floor Education After Vaginal Delivery.” Obstetrics and Gynecology 97(2001): 673–77.

  Morkved, S., and Bo, K. “Effect of Postpartum Pelvic Floor Muscle Training in Prevention and Treatment of Urinary Incontinence: A One-Year Follow-up.” British Journal of Obstetrics and Gynecology 107(2000):1022–28.

  Nygaard, I., DeLancey, J.O.L., Arnsdorf, L., Murphy, E. “Exercise and Incontinence.” Obstetrics and Gynecology 75(1990):848–51.

  Persson, J., Wolner-Hanssen, P.A.L., and Rydhstroem, H. “Obstetric Risk Factors for Stress Urinary Incontinence: A Population-Based Study.” Obstetrics and Gynecology 96(2000):440–45.

  Peschers, U., Schaer, G., Anthuber, C., Delancey, J.O.L., and Schuessler, B. “Changes in Vesical Neck Mobility Following Vaginal Delivery.” Obstetrics and Gynecology 88(1996):1001–6.

  Reilly, E.T., Freeman, R.M., Waterfield, M.R., Waterfield, A.E., Steggles, P., and Pedlar, F. “Prevention of Postpartum Stress Incontinence in Primi-gravidae with Increased Bladder Neck Mobility: a Randomised Controlled Trial of Antenatal Pelvic Floor Exercises.” British Journal of Obstetrics and Gynaecology 109(1)(2002):68–76.

  Sampselle, C.M., Miller, J.M., Mims, B.L., DeLancey, J.O.L., Ashton-Miller, J.A., and Antonakos, C.L. “Effect of Pelvic Muscle Exercise on Transient Incontinence During Pregnancy and After Childbirth.” Obstetrics and Gynecology 91(1998):406–12.

  Sand, P.K., Richardson, D.A., Staskin, D.R., Swift, S.E., Appell, R.A., Whit-more, K.E., and Ostergard, D.A. “Pelvic Floor Electrical Stimulation in the Treatment of Genuine Stress Incontinence: A Multi-Center Placebo-Controlled Trial.” American Journal of Obstetrics and Gynecology 173(1995):72–79.

  Steele, A.C., Kohli, N., Mallipeddi, P., and Karram, M. “Pharmacologic Causes of Female Incontinence.” International Urogynecol Journal 10(1999):106–10.

  Stewart, W., Herzog, R., Wein, A., et al. “The Prevalence and Impact of Overactive Bladder in the U.S.: Results from the NOBLE Program.” Neurourology and Urodynamics 20(2001):406–8.

  Subak, L.L., Quesenberry, C.P., Posner, S.F., Cattolica, E., and Soghikian K. “The Effect of Behavioral Therapy on Urinary Incontinence: A Randomized Controlled Trial.” Obstetrics and Gynecology 100(2002):72–78.

  Thorp, J.M., Norton, P.A., Wall, L.L., Kuller, J.A., Eucker, B., and Wells, E. “Urinary Incontinence in Pregnancy and the Puerperium: A Prospective Study.” American Journal of Obstetrics and Gynecology 181(1999):266–73.

  Viktrup, L., Lose, G., Rolff, M., and Barfoed, K. “The Symptom of Stress Incontinence Caused by Pregnancy or Delivery in Primiparas.” Obstetrics and Gynecology 79(1992):945–49.

  Viktrup, L., and Lose, G. “The Risk of Stress Incontinence 5 Years After First Delivery.” American Journal of Obstetrics and Gynecology 185(2001):82–87.

  Wilson, P.D., Herbison, R.M., and Herbison, G.P. “Obstetric Practice and the Prevalence of Urinary Incontinence Three Months After Delivery.” British Journal of Obstetrics and Gynaecology 103(2)(1996):154–61.

  ANAL INCONTINENCE

  Bek, K.M., and Laurberg, S. “Risks of Anal Incontinence from Subsequent Vaginal Delivery After a Complete Obstetric Anal Sphincter Tear.” British Journal of Obstetrics and Gynaecology 99(1992):724–26.

  Crawford, L.A., Quint, E.H., Pearl, M.L., DeLancey, J.O.L. “Incontinence Following Rupture of the Anal Sphincter During Delivery.” Obstetrics and Gynecology 82(1993):527–31.

  Donnely, V., Fynes, M., Campbell, D., Johnson, H., O’Connell, P.R., and O’Herlihy, C. “Obstetric Events Leading to Anal Sphincter Damage.” Obstetrics and Gynecology 92(1998):955–61.

  Eason, E., Labrecque, M., Marcoux, S., and Monder, M. “Anal Incontinence After Childbirth.” Canadian Medical Association Journal 166(3)(2002):326–30. Available: www.cma.ca/cmaj/vol-166/issue-3/0326.asp.

  Fynes, M., Donnelly, V.S., O’Connell, P.R., and O’Herlihy, C. “Cesarean Delivery and Anal Sphincter Injury.” Obstetrics and Gynecology 92(1998):496–500.

  Fynes, M., et al. “Effect of a Second Vaginal Delivery on Anorectal Physiology and Faecal Incontinence: A Prospective Study.” Lancet 354(1995):983–86.

  Kammerer-Doak, D.N., Wesol, A.B., Rogers, R.B., Dominguez, C.E., and Dovin, M.H. “A Prospective Cohort Study of Women After Primary Repair of Obstetric Anal Sphincter Laceration.” American Journal of Obstetrics and Gynecology 181(6)(1999):1317–22.

  Malouf, A.J., Norton, C.S., Engel, A.F., Nicholls, R.J., Kamm, M.A. “Long-term Results of Overlapping Anal Sphincter Repair for Obstetrical Trauma.” Lancet 355(2000):260–65.

  Norton, C., Hosker, G., and Brazzelli, M. “Effectiveness of Biofeedback and/or Sphincter Exercises for the Treatment of Faecal Incontinence in Adults.” Cochrane Database of Systematic Reviews 2(2000): CD002111.

  Rieger, N., Schloithe, A., Saccone, G., and Wattchow, D. “The Effect of a Normal Vaginal Delivery on Anal Function.” Obstetrics and Gynecology 53(1998)345–46.

  Sultan, A.H., Kamm, M.A., Hudson, C.N., and Bartam, C.L. “Anal Sphincter Disruption During Vaginal Delivery.” New England Journal of Medicine 329(1993):1905–11.

  Swash, M. “Fecal Incontinence: Childbirth Is Responsible for Most Cases.” British Medical Journal 307(1993):636–37.

  SEXUAL DYSFUNCTION

  Clark, A., and Romm, J. “Effect of Urinary Incontinence on Sexual Activity in Women.” Journal of Reproductive Medicine 38(1993):679–83.

  Glazener, C.M. “Sexual Function After Childbirth: Women’s Experiences, Persistent Morbidity, and Lack of Professional Recognition.” British Journal of Obstetrics and Gynaecology 104(1997):330–35.

  Kelleher, C., Cardozo, L., Wise, B., et al. “The Impact of Urinary Incontinence on Sexual Function.” Neurology and Urodynamics 11(1992):359–60.

  Rogers, R.G. “Sexual Function in Women with Pelvic Floor Disorders.” American Urogynecologic Society Quarterly Report XXI(2002):1–3.

  Signorello, L.B., Harlow, B.L., Chekos, A.K., and Repke, J.T. “Postpartum Sexual Functioning and Its Relationship to Perineal Trauma: A Retrospective Cohort Study of Primiparous Women.” American Journal of Obstetrics and Gynecology 184(2001):881–88.

  Sutherherst, J.R. “Sexual Dysfunction and Urinary Incontinence.” British Journal of Obstetrics and Gynaecology 86(1979):387–88.

  Weber, A.M., Walters, M.D., and Piedmote, M.R. “Sexual Function and Vaginal Anatomy in Women Before and After Surgery for Pelvic Organ Prolapse and Urinary Incontinence.” American Journal of Obstetrics and Gynecology 182(2000):1610–15.

  PELVIC-FLOOR INJURY

  Allen, R.E., Hosker, G.L., Smith, A.R.B., Warrell, D.W. “Pelvic Floor Damage and Childbirth: A Neurophysiological Study.” British Journal of Obstetrics and
Gynaecology 97(1990):770–79.

  Angioli, R., Gomez-Martin, O., and Cantuaria, G. “Severe Perineal Lacerations During Vaginal Delivery: The University of Miami Experience.” American Journal of Obstetrics and Gynecology 182(5)(2000):1083–85.

  DeLeeuw, J.W., Struijk, P.C., Vierhout, M.E., and Wallenberg, H.C. “Risk Factors for Third Degree Perineal Ruptures During Delivery.” British Journal of Obstetrics and Gynaecology 108(4)(2001):383–87.

  Mallett, V., Hosker, G., Smith, A.R.B., and Warrell, D. “Pelvic Floor Damage and Childbirth: A Neurophysiologic Follow-up Study.” Neurourology and Urodynamics 13(1994):357–58.

  Martin, S., Labreque, M., Marcoux, S., Berube, S., and Pinault, J.J. “The Association Between Perineal Trauma and Spontaneous Perineal Tear.” Journal of Family Practice 50(4)(2001):333–37.

  Meyer, S., Schreyer, A., DeGrandi, P., and Hohfeld, P. “The Effects of Birth on Urinary Continence Mechanisms and Other Pelvic-Floor Characteristics.” Obstetrics and Gynecology 92(1998):613–18.

  Olsen, A.L., Smith, V.J., Bergstrom, J.O., Colling, J.C., Clark, A.L. “Epidemiology of Surgically Managed Pelvic Organ Prolapse and Urinary Incontinence.” Obstetrics and Gynecology 89(1997):501–6.

  Peschers, U.M., Schaer, G.N., DeLancey, J.O.L., and Schuessler, B. “Levator Function Before and After Childbirth.” British Journal of Obstetrics and Gynaecology 104(1997):1004–8.

  Smith, A.R.B., Hosker, G.L., and Warrell, D.W. “The Role of Pudendal Nerve Damage in the Aetiology of Genuine Stress Incontinence in Women.” British Journal of Obstetrics and Gynaecology 96(1989): 29–32.

  Snooks, S.J., Swash, M., Setchell, M., and Henry, M.M. “Injury to Innervation of Pelvic Floor Sphincter Musculature in Childbirth.” Lancet 2(1984):546–50.

  Snooks, S.J., Swash, M., Mathers, S.E., and Henry, M.M. “Effect of Vaginal Delivery on the Pelvic Floor: A Five-Year Follow-up. British Journal of Surgery 77(1990):1358–60.

  Sultan, A.H., Kamm, M.A., and Hudson, C.N. “Pudendal Nerve Damage During Labor: Prospective Study Before and After Outcome of Primary Repair.” British Medical Journal 101(1994):22–28.