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An obstructed bladder is a cranky
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Pelvic floor disorders include problems with urinary
incontinence, pelvic organ prolapse, fecal incontinence,
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fistula, urinary tract infections, and mechanical sexual
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dysfunction. Who wants to think about this stuff?  Well, for 
starters, women who suffer these disastrous conditions.
Pelvic organ prolapse, on which I’ve written aplenty, can SEARCH
sometimes induce a rather nasty condition called To search, type and hit enter
overactive bladder. Overactive bladder happens when your
bladder muscle (yes, the bladder is a muscle, an
BLOGROLL
automatic muscle, like the muscles in your intestines or
your heart) decides to EVACUATE, any time it wants to, Heal India e-Newsletter
whether you’re on the toilet or riding the bus. Women with Seek Wellness
overactive bladder often report a compelling, sometimes
Womens Voices for Change
sudden urge to void (urinate) that is difficult or impossible
to defer. She may find her bladder waking her from deep
sleep many times at night with this same horrible urgency. LINKS
When this urgency control is “difficult”, she’s Kegeling her
Health Guru
legs off, squeezing her thighs together and sweating
JonasWeb – Webmaster
bullets trying to make that horrible urge feeling stop so she
can uncross her legs and dash to the nearest powder SearchTROOP
room. When the urge to void is “impossible” to defer, she Seek Wellness
wets her pants. It’s messy, horrifying, and terribly unsexy.
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Urge Incontinence from Overactive
Bladder
While most cases of overactive  bladder are idiopathic 
(medicalese for “no apparent cause”), some cases are
caused by prolapse.  When the bladder or uterus (or 
December 2009 both) prolapse, the urethra can be kinked or compressed,
November 2009 obstructing urine outflow and making it difficult for the
bladder to empty completely. Obstructed bladders are
October 2009
cranky bladders, often becoming overactive in response to
August 2009
this interference with emptying.

A recent multicenter European study published in

Neurourology and Urodynamics showed a distinct
correlation between severe pelvic organ prolapse, bladder
outlet obstuction, and overactive bladder. Prolapse can
obstruct bladder outflow and if it does, the bladder tends to
become overactive, reminiscent of that vaudeville song,
“The head bone’s connected to the … neck bone…”.  In
this timely review, they also found that successful prolapse
surgery often, but not always, calmed down bladder
overactivity by un-blocking the urethra and normalizing
bladder outflow. The connection between prolapse,
bladder outlet obstruction and overactive bladder

Women with prolapse and bladder problems often want to

know if surgery will fix both. This study helps us
understand that it indeed may help fix both the prolapse
and the obstructed/overactive bladder disorders in a large
portion of women with this unhappy combination. For
years, I’ve used pessaries (vaginal widgets that
comfortably hold prolapse in place) to help predict whether
or not prolapse surgery might also stop obstructed voiding
and overactive bladder, and most of the time it correlates
well to surgical outcome. And sometimes, the patient is so
pleased with the pessary that she cancels the operation.

For a detailed case report on women with prolapse,

obstructed voiding and overactive bladder, click on this
MedScape review:

Dr R for MedScape- prolapse, overactive bladder, stress

incontinence, obstructed bladder

http://cme.medscape.com/viewarticle/700135

One last note for women with prolapse and bladder

problems – there is another urinary incontinence
condition, called stress incontinence, that may actually
increase with pessary use or prolapse surgery, because a
stress – incontinent urethra may actually seal better with
the kinking and compression caused by prolapse, and
may therefore increase when the prolapse and kinking are
mechanically corrected. Stress incontinence is caused by
poor urethral closure that allows urine to leak out with
strenuous physical exertion, like sneezing or coughing or
opening a window or lifting heavy grocery bags. No
urgency, just “exert and squirt”.
Stress Urinary Incontinence = "Exert and
Squirt"

If you have prolapse and stress incontinence, your

problems require therapies for prolapse and therapies for
stress incontinence. Prolapse therapy options usually
involve pessary use or reconstructive surgery. Stress
incontinence options include Kegel exercises with pelvic
floor physical therapy, medications, or procedures such
as urethral bulking injections or minimally invasive sling
operations. You can do prolapse reconstruction and
urethral sling in one operation, for instance, taking care of
both your plumbing and your renovation problems at the
same time (on Plumbing and Renovations).

Prolapse or no prolapse, urge incontinence from

overactive bladder and stress incontinence from a weak
urethral seal can plague any woman at any age. About
13% of women with overactive bladder are under the age
of 35, and up to 30% college female athletes report
regular urinary incontinence of one sort or another during
training and competition. It comes with the territory, and it
increases in prevalence as women age.

1/3 of incontinent women suffer only stress incontinence,

1/3 only urge (overactive bladder) incontinence and 1/3
suffer a mixture of both overactive bladder / urge
incontinence AND stress incontinence.

If you have incontinence, or prolapse and bladder

problems, make sure you don’t undertake any therapeutic
measures without first understanding if you have
overactive bladder, bladder outlet obstruction, and/or
stress urinary incontinence. It is absolutely possible, and
not at all uncommon, to have all three conditions if you
suffer severe prolapse. Take the time to sort it all out,
make sure it’s clear in your mind, then work with your
doctor to set a common-sense course of action to restore
your core to normal anatomic and physiologic function.

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