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Johns Hopkins Bayview News - Regaining Control

Summer 2013

Regaining Control

By: Allison Eatough
Date: June 3, 2013

Sling surgery restores bladder function for patients with pelvic prolapse

Pelvic prolapse surgery patient, Karen Evans
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A minimally invasive procedure to treat her prolapsed bladder has allowed Karen Evans to return to her active lifestyle.

Karen Evans considers herself an active person. The 62-year-old Pennsylvania resident is always on her feet, teaching high-school Spanish, walking, gardening or doing yoga.

Yet four years ago, Evans began feeling an uncomfortable “bulge” in her abdomen. With time, that bulge began to impact her daily life. She could no longer do yoga or stand for long periods of time. Even simple bodily functions became a challenge. “I was almost fearful that if I coughed too hard, I would lose my bladder,” she says.

Evans had a prolapsed bladder, a pelvic floor disorder that can strike as women age. In the past, many women lived with pelvic floor disorders, accepting them as a normal part of aging. But thanks to the Johns Hopkins Women’s Center for Pelvic Health, patients like Evans are no longer suffering in silence. The center offers innovative research and treatments for patients with prolapsed bladder, urinary incontinence, fecal incontinence, and voiding and defecatory dysfunction.

Erasing the Stigma

Many patients dislike discussing health problems when they involve urine or the bladder, says Tola Fashokun, M.D., FACOG, a urogynecologist in the Department of Obstetrics and Gynecology. “Most feel like they are the only ones suffering from it,” she says.

But in reality, pelvic floor disorders are more common than many think, she says. For example, up to 30 percent of women have some sort of urinary incontinence in their lifetime. In the past decade, Dr. Fashokun says more and more doctors have encouraged women to discuss their symptoms instead of feeling ashamed of them.

“The good news is it’s becoming less of a stigma,” Dr. Fashokun says.

Evans says that when she was a young mother of four, no one told her how pregnancy and childbirth could eventually cause a prolapsed bladder. She didn’t hear about the condition until she entered her 50s.

A prolapsed bladder, also known as a cystocele, occurs when the supportive tissue between the bladder and vaginal wall weakens and stretches. This allows the bladder to bulge into the vagina. Symptoms can include pressure in the pelvis, increased discomfort when coughing or lifting and a feeling that the bladder isn’t completely emptied after urinating. As a result, many women experience stress urinary incontinence—unintentional urine leakage prompted by physical activities like coughing, sneezing or running.

Finding Relief

After consulting with Dr. Fashokun, Evans decided to have her bladder repaired surgically with a minimally invasive procedure. Using a mesh-like sling, Dr. Fashokun lifted Evans’ prolapsed bladder back into place. Evans says she could immediately feel a difference.

“I could tell the first time I stood up,” she says. “It was like the bulge was lifted out of there.”

Within two months, Evans was back at work. And more importantly, she says, her active lifestyle filled with walking, gardening and yoga had returned.

“It’s nothing to be afraid of,” Evans says. “If you have an active lifestyle, it’s something that can be dealt with, and you can move on. There’s no need to suffer in silence.”

Help for Pelvic Health Disorders

The Johns Hopkins Women’s Center for Pelvic Health offers advanced testing, as well as both surgical and non-surgical treatments, for pelvic floor disorders. Doctors recommend seeking help if you experience symptoms affecting daily activities, including:

  • Heaviness or pressure in the vagina or pelvis
  • A bulge of tissue coming through the vaginal opening
  • Accidental loss of urine
  • Frequent or unexpected urges to urinate
  • Difficulty urinating

For more information or to make an appointment, call the Johns Hopkins Women’s Center for Pelvic Health at 410-550-4406.