Functional Urology and Chronic Pelvic Pain

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Functional Urology and Chronic Pelvic Pain

Chronic pelvic pain

Chronic pelvic pain is pain that occurs in the area below the navel and between the hips and lasts six months or longer. It can have several causes, and be a symptom of another disease or be a condition in itself.

If chronic pelvic pain seems to be caused by another medical problem, treating that problem may be enough to relieve the pain.

However, many times it is not possible to identify a single cause of this pain. If this is the case, the goal of treatment is to reduce pain and other symptoms and improve quality of life.


Chronic pelvic pain is usually described as follows:

  • Intense, constant pain
  • Pain that comes and goes (intermittent)
  • Stabbing pains or cramps
  • Pressure or heaviness in a deep area of the pelvis
  • Pain during sex
  • Pain with bowel movement or urination
  • Pain when sitting for prolonged periods of time

The discomfort may intensify after standing for long periods and ease when you lie down. The pain can be mild and annoying or it can be so severe that you miss work, can’t sleep, or can’t exercise.


Chronic pelvic pain is a complex condition that can have multiple causes, constituting a symptom of several medical conditions. For example, it is possible for a woman to have endometriosis and interstitial cystitis, both pathologies can cause chronic pelvic pain.

Some of the causes of chronic pelvic pain can be:

  • Endometriosis. This is a condition in which tissue from the lining of the uterus grows outside the uterus. These tissue deposits respond to the menstrual cycle, as does the uterine lining, i.e., thickening, rupturing, and bleeding, as hormone levels rise and fall. Because this takes place outside the uterus, blood and tissue cannot leave the body through the vagina. Instead, they remain in the abdomen, where they can lead to painful cysts and fibrous bands of scar tissue.
  • Musculoskeletal problems. Disorders that affect bones, joints, and connective tissues (musculoskeletal system), such as fibromyalgia, pelvic floor muscle tension, inflammation of the pubic joint (pubic symphysis), or hernias, and can lead to recurrent pelvic pain.
  • Chronic pelvic inflammatory disease. This can happen if a long-term infection, usually sexually transmitted, causes scarring that affects the pelvic organs.
  • Ovarian remains. After surgical removal of the uterus, ovaries, and fallopian tubes, small vestiges of the ovary may accidentally remain, which could then lead to painful cysts.
  • Fibroids. These noncancerous uterine growths can cause pressure or a feeling of heaviness in the lower abdomen. In rare cases, they cause sharp pain.
  • Irritable bowel syndrome. Symptoms associated with irritable bowel syndrome, such as inflammation, constipation, or diarrhea, may be the source of pelvic pain and pressure.
  • Painful bladder syndrome (interstitial cystitis). This condition is associated with recurrent bladder pain and a frequent need to urinate. You may experience pelvic pain as your bladder fills, which may temporarily give way when you urinate.
  • Some doctors believe that dilated varicose veins (varicose veins) around the uterus and ovaries can cause pelvic pain. However, other doctors doubt that pelvic congestion syndrome is the cause of pelvic pain because most women with dilated veins in the pelvis do not have associated pain.
  • Psychological factors. Depression, chronic stress, or a history of sexual or physical abuse can increase the risk of chronic pelvic pain. Emotional distress makes pain worse, and living with chronic pain contributes to emotional suffering. These two factors often create a vicious circle.


Figuring out what’s causing chronic pelvic pain often involves a process of elimination because there are so many disorders that can cause pelvic pain.

In addition to a detailed interview about your pain, your personal medical history and family history, your doctor may ask you to keep a diary of pain and other symptoms.

Tests or exams your doctor may order include:

  • Pelvic exam. It may reveal signs of infection, abnormal growths, or tight pelvic floor muscles. The doctor checks for areas of tenderness. Let your doctor know if you feel any discomfort during this test, especially if the pain is similar to what you’ve been feeling.
  • Laboratory analysis. During the pelvic exam, your doctor may order lab tests to check for infections.
  • Echography. This procedure is especially useful for detecting masses or cysts in the ovaries, uterus, or fallopian tubes.
  • Other imaging tests. Your doctor may recommend abdominal X-rays, computed tomography (CT) scans, or magnetic resonance imaging (MRI) scans to help detect abnormal structures or growths.
  • Laparoscopy. During this surgical procedure, the doctor makes a small incision in your abdomen and inserts a thin tube connected to a small camera (laparoscope). The laparoscope allows the doctor to look at the pelvic organs and check for abnormal tissues or signs of infection. This procedure is especially useful for detecting endometriosis and chronic pelvic inflammatory disease.

Finding the underlying cause of chronic pelvic pain can be a lengthy process and, in some cases, a clear explanation may never be found.

However, with patience and open communication, you and your doctor can develop a treatment plan that will help you live a full life with minimal discomfort.


The goal of treatment is to reduce symptoms and improve quality of life.

If your doctor can determine a specific cause, treatment will focus on that cause. However, if it is not possible to identify a cause, treatment will focus on controlling pain and other symptoms. In many cases, the optimal approach involves a combination of treatments.


  • Analgesics. It is a symptomatic treatment that helps improve the clinic although they do not treat the cause of chronic pain.
  • Hormonal treatments. Some women find that days when they have pelvic pain may coincide with a particular phase of their menstrual cycle and the hormonal changes that control ovulation and menstruation. When this is the case, birth control pills or other hormonal medications can help relieve pelvic pain.
  • Antibiotics. If the source of the pain is an infection, your doctor may prescribe antibiotics.
  • Antidepressants. Some types of antidepressants may be helpful in relieving chronic pain. Tricyclic antidepressants, such as amitriptyline and others, appear to have analgesic and antidepressant effects. They can help improve chronic pelvic pain even in patients who do not have depression.

Other therapies

Your doctor may recommend specific therapies or procedures as part of treatment for chronic pelvic pain. These may include the following:

  • Physiotherapy. Stretching exercises, massage, and other relaxation techniques can improve chronic pelvic pain. A physical therapist can help you with these therapies and develop strategies for coping with pain. Sometimes specific pain points are treated with a medical instrument called transcutaneous electrical nerve stimulation. Transcutaneous electrical nerve stimulation sends electrical impulses to nearby nerve pathways. It may also be helpful to use a psychological technique called biofeedback, which helps you identify areas of tight muscles so you can learn to relax those areas.
  • Neurostimulation (stimulation of the spinal cord). This treatment involves implanting a device that blocks nerve pathways so that the pain signal cannot reach the brain. It may be helpful, depending on the cause of the pelvic pain.
  • Trigger point injections. If your doctor finds specific points where you feel pain, you may benefit from injections of numbing medication into those painful spots (trigger points). The medication, usually a long-acting local anesthetic, can block pain and relieve discomfort.
  • Psychotherapy. If pain may be intertwined with depression, or any type of psychological disorder, you may find it helpful to talk to a psychologist or psychiatrist. There are different types of psychotherapy, such as cognitive behavioral therapy and biofeedback. Regardless of the underlying cause of the pain, psychotherapy can help you develop strategies for dealing with pain.


  • Laparoscopic surgery. If you have endometriosis, your doctor may remove adhesions or endometrial tissue through laparoscopic surgery.
  • Hysterectomy. In rare and complicated cases, your doctor may recommend removing your uterus (hysterectomy), fallopian tubes (salpingectomy), or ovaries (oophorectomy). Undergoing this intervention has significant health consequences. Your doctor will discuss the risks and benefits in detail before recommending this option.
  • Transurethral bladder resection. In some pathologies, such as interstitial cystitis, it is sometimes useful to resect endoscopically the lesions that are in the inner lining of the bladder and that are associated with chronic pain.
  • Intravesical injections. In some cases, the injection of various substances into the mucosa and bladder muscles, such as Botox and some anti-inflammatories, is very decisive. This procedure is performed endoscopically, under anesthesia.
  • Anesthetic block of the nerves of the pelvis. In cases where it is identified that the pain comes specifically from the trigger points where sensitive nerves of the pelvis pass, the doctor may indicate the anesthetic block of these points, which would reduce the painful sensations of that area. Sometimes it is necessary to carry out this procedure in the operating room.

Pain Rehabilitation Program

You may need to try a combination of treatment approaches before you find the best option for you. If applicable, you may need to consider entering a pain rehabilitation program. In Uros Associats we have the support of the Pelvic Floor Rehabilitation section of the Teknon Clinic. They are medical specialists and nurses highly trained in stretching, biofeedback and relaxation-stimulation therapies.


Chronic pain can significantly affect your daily life. When you feel pain, you have trouble sleeping, exercising, or performing physical tasks.

Chronic pain can also cause anxiety and stress, both of which in turn can make pain worse.

Relaxation techniques can help relieve tension, reduce pain, calm emotions, and induce sleep. You can learn many techniques on your own, such as meditation and deep breathing.

Multidisciplinary approach

Depending on the suspected cause of pain, your doctor may refer you to a digestive system specialist (gastroenterologist), gynecology specialist, or musculoskeletal pain specialist (physiatrist or physical therapist).

How to prepare for your appointment

  • Make a list of all the signs and symptoms you’re experiencing. He mentions those that seemed unrelated to the reason for the consultation.
  • Write down key medical information. Include major stressors or recent changes in your life.
  • Make a list of all the medications you take and the dosages you take. Indicate prescription and over-the-counter medications, vitamins or other supplements you’re taking.
  • It’s a good idea to bring a family member or friend. Sometimes it can be difficult to remember all the information provided during a visit. Someone who accompanies you may remember some fact that you forgot or did not notice.
  • Prepare questions. Preparing a list of questions can help you not forget any.

Neurogenic or underactive bladder

Neurogenic bladder Bladder control is a lack of bladder control due to a nervous system disturbance, such as a stroke, spinal cord injury, or tumor. Chronic diseases such as diabetes can also cause it.

Types of neurogenic bladder

There are some variants of the VN:

  • Flaccid: A flaccid bladder does not contract so it fills to overflowing. The urine is then released by overflow (continuous drip) through the urethra.
  • Spastic: The patient has involuntary bladder contractions and perceives the need to urinate, even when there is little or no urine in the bladder. Normally, contractions occur in an uncoordinated manner with the muscle that closes the opening of the bladder (urinary sphincter).
  • Mixed: some patients have elements of both flaccid and spastic bladder.


The main symptom of NV is urinary incontinence. The patient continuously releases small amounts of urine.

Some patients with spastic neurogenic bladder They also have to urinate frequently, often urgently, and need to get up during the night to urinate. In addition, the spastic variant may be caused by central nerve injury, and is associated with weakness, muscle spasms, and/or loss of sensation in the legs.

Patients with OAB are at risk for
urinary tract infections

. They are also at risk of developing a Hydronephrosis when urine retained in the bladder builds up to the kidneys.


Any disorder that damages or interferes with the nerves that control the bladder or sphincter can lead to a neurogenic bladder. Common causes are stroke, spinal cord injuries or trauma, amyotrophic lateral sclerosis (ELA), Parkinson’s disease, multiple sclerosis, diabetic neuropathy and nerve injury during pelvic surgery.


To diagnose neurogenic bladder, we proceed:

  • Measure the amount of urine left in the bladder after urination.
  • Perform an ultrasound of the urinary tract.
  • Sometimes more detailed studies, such as cystography, cystoscopy, urodynamic study, tomography, magnetic resonance imaging of the spinal cord and electrophysiological studies.

Your doctor may suspect neurogenic bladder in people with nerve injuries who have incontinence. It usually measures the amount of urine left in the bladder when the patient has just urinated (residual volume after urination) by inserting a probe into the bladder or performing an ultrasound. He also studies the rest of the urinary tract with ultrasound to detect other abnormalities. Kidney function is assessed by blood tests.


The specific treatment of neurogenic bladder will be determined by your doctor based on the following:

  • Your age, general health, and medical history.
  • The severity of symptoms.
  • The cause of nerve damage.
  • The type of emptying dysfunction.
  • Your tolerance to certain medications, procedures, or therapies.
  • Your expectations for the trajectory of the disease.
  • Your opinion or preference.

Early treatment It can help prevent permanent dysfunction and kidney damage. Catheterization or certain techniques used to stimulate urination can help prevent urine from staying too long in the bladder. For example, some patients with spastic bladder may trigger urination by pressing on the lower abdomen or scratching their thighs. When urine stays in the bladder too long, the patient is at risk for developing urinary tract infections. The insertion of a catheter into the bladder periodically (Intermittent catheterization) is generally safer than leaving a catheter continuously.

The patient has to drink enough fluids and limit calcium in the diet to prevent stone formation. Your doctor also checks your kidney function regularly.

Antibiotics They are sometimes used prophylactically to prevent recurrent infections. In addition, there are Non-antibiotic medications that can help reduce the frequency of infections, and that the patient can take uninterruptedly.

Sometimes, drugs used to treat urge incontinence can be helpful. Used anticholinergics and stimulants of certain nerve receptors in the bladder, which relax it and therefore improve incontinence. On rare occasions Surgery to create another pathway for urine to leave the body.

In Uros Associats we have all the diagnostic resources to address patients with neurogenic bladder. After a thorough evaluation, our urologists will propose the best possible therapeutic options, and will schedule a close follow-up to avoid complications in the short, medium and long term. Likewise, we help ourselves with a Multidisciplinary team, with neurologists, neurophysiologists and pelvic floor physiotherapists. Our action protocols are based on international guidelines, and guarantee optimal results.

Overactive bladder

Overactive bladder causes an urgent and sudden need to urinate. That need can be difficult to control, and overactive bladder can lead to involuntary loss of urine (urge incontinence).

Overactive bladder and urinary incontinence have a profound effect on the quality of life of affected individuals, with social, psychological, occupational, domestic, physical and sexual repercussions.


If you have overactive bladder, you may:

  • You feel an urgent, sudden urge to urinate that is hard to control.
  • Have urge incontinence: The involuntary loss of urine immediately after the urgent need to urinate.
  • Urinate frequently, usually eight or more times in a 24-hour period.
  • Wake up two or more times during the night to urinate.

Although you may arrive at the bathroom on time when you feel the need to urinate, having to urinate unexpectedly frequently or at night can be life-altering.


Overactive bladder occurs when the bladder muscles begin to contract involuntarily, even though the volume of urine stored in the bladder is low. This involuntary contraction generates the urgent need to urinate.

There are a number of conditions that can contribute to the signs and symptoms of overactive bladder, including:

  • Neurological disorders, such as stroke, multiple sclerosis, spina bifida, Parkinson’s disease.
  • Diabetes.
  • Medicines that cause a rapid increase in urine output or that must be taken with plenty of fluids.
  • Acute urinary tract infections that can cause symptoms similar to those of overactive bladder.
  • Abnormalities in the bladder, such as tumors or stones.
  • Factors that obstruct bladder outflow: enlarged prostate (benign prostatic hyperplasia), constipation, or previous surgeries to treat other types of incontinence.
  • Excessive consumption of caffeine or alcohol.
  • Impaired cognitive function due to aging, which can prevent the bladder from correctly interpreting signals sent by the brain.

The specific cause of overactive bladder may be unknown.

Risk factors

Risk factors for overactive bladder include:

  • Aging. With aging, the risk of certain diseases, such as an enlarged prostate and diabetes, which can contribute to other problems related to bladder function, increases.
  • Cognitive impairment. Alzheimer’s disease and neurological deterioration that occurs after some strokes can lead to overactive bladder. Incontinence that occurs from these types of situations can be controlled with fluid drinking schedules, urination schedules and reminders, absorbent clothing, and bowel movement programs.
  • Smoking, alcoholism and some illicit drugs. All of these substances are considered bladder irritants, and they cause the nerves in the bladder to work abnormally.
  • Consumption of coffee, tea, very sugary and carbonated drinks. They are also bladder irritants and diuretics.


Overactive bladder can significantly affect daily activities, such as work and social relationships. This disease can cause:

  • emotional distress or depression
  • anxiety
  • sleep disturbances
  • sexuality problems


The first step is an adequate diagnostic evaluation through interrogation, specific questionnaires, physical examination, voiding diary and, if necessary, complementary studies.

The urodynamic study It is the complementary test par excellence to diagnose overactive bladder. It is a minimally invasive study that requires prior preparation. It is usually indicated in cases of difficult control with medications or with mixed symptoms.

Before starting a specific treatment, any cause that could cause the symptoms should be ruled out, such as urinary infections, lithiasis, among others.


Treatment of overactive bladder is multiple. Patients are asked to Modify their fluid intake schedules, make adjustments to their diet, and abandon certain habits that contribute to the severity of the pathology (smoking, drinking alcohol, illicit drugs).

If modifying these habits is not enough, oral or topical medications (in the form of patches) are used. These drugs act on receptors in the bladder. They are not without side effects, most often mild and well tolerated. Despite this, many patients stop the drug treatment after a few months.

Some antidepressants, such as imipramine, are also helpful in managing symptoms.

When drug therapy is not effective due to the severity of symptoms or is not tolerated by the patient, intravesical botulinum toxin injection is indicated.. This procedure is performed in the operating room, under regional anesthesia, and produces relief of symptoms for a long time (sometimes up to 1 year). It is a very used treatment with good results.

In other cases, the use of neuromodulation is proposed.. Several sessions of electrostimulation of nerve roots that have connection with the bladder are performed, to readapt its contractile function to low bladder volumes. This procedure is performed in the consultation of our Pelvic Floor Unit, and manages to control the symptoms very resistant to other therapies in a good percentage of cases. Neuromodulation can also be carried out by implanting a small device that is placed under the skin of the patient’s back or buttock, with anesthesia and sedation. This device avoids the need for repetitive electrostimulation sessions in consultation, and has a low complication rate.

In Uros Associats we have specialists in Pelvic Floor and bladder emptying and filling disorders. Our diagnostic-therapeutic approach ensures that the patient controls their symptoms and that their quality of life increases significantly.

Urinary incontinence

Urinary incontinence — loss of bladder control — is a common problem. The intensity ranges from occasionally leaking urine when you cough or sneeze to having a need to urinate so sudden and loud that you don’t get to the bathroom in time.

While it occurs more frequently as people age, urinary incontinence is not an inevitable consequence of aging. In most people, simple lifestyle changes or medical treatment can relieve discomfort or stop urinary incontinence.

Types of urinary incontinence

Types of urinary incontinence include:

  • Stress incontinence. Urine leaks out when you put pressure on your bladder by coughing, sneezing, laughing, exercising, or lifting something heavy.
  • Urge incontinence. You have a sudden, intense urge to urinate, followed by an involuntary loss of urine. You may need to urinate frequently, even throughout the night. Urge incontinence may be due to a minor condition, such as an infection, or a more serious illness, such as a neurological disorder or diabetes.
  • Overflow incontinence. You have frequent or constant dribbling of urine because your bladder doesn’t empty completely.
  • Functional incontinence. A physical or mental deterioration prevents you from getting to the bathroom in time. For example, if you have severe arthritis, you may not be able to unbutton your pants fast enough.
  • Mixed incontinence. You have more than one type of urinary incontinence.


Urinary incontinence is not a disease, but a symptom. It can be caused by certain daily habits, underlying illnesses or physical problems. A thorough evaluation by your doctor can help determine what causes incontinence.

Transient urinary incontinence

Certain foods, drinks, and medications can act as diuretics (stimulate the bladder and increase the volume of urine). Some of them are:

  • Alcohol
  • Caffeine
  • Soft drinks and sparkling mineral water
  • Artificial sweeteners
  • Chocolate
  • Chewing gum
  • Foods high in spices, sugar, or acid, especially citrus fruits
  • Blood pressure and heart medications, sedatives, and muscle relaxants
  • Large doses of vitamin C

Urinary incontinence can also be caused by an easily treatable disease, for example:

  • Urinary tract infection. Infections can irritate the bladder, cause a strong urge to urinate, and sometimes incontinence.
  • Constipation. The rectum is located near the bladder and shares many nerves. Hard, tight stools in the rectum cause these nerves to stay overactive and increase urinary frequency.

Persistent urinary incontinence

Urinary incontinence can also be a persistent disorder caused by underlying physical problems or disorders, including:

  • Pregnancy. Hormonal changes and fetal weight gain can lead to stress incontinence.
  • Parturition. Vaginal delivery can weaken the muscles needed to control the bladder and also damage your nerves and bra tissue, leading to the pelvic floor descending (prolapsed). Prolapse can push down the bladder, uterus, rectum, or small intestine from their usual position, causing them to appear in the vagina. These bumps can be associated with incontinence.
  • Age-related changes. Aging bladder muscle can decrease the ability to store urine. In addition, involuntary bladder contractions become more frequent over the years.
  • Menopause. In menopause, women produce less estrogen, a hormone that helps keep the membrane lining the bladder and urethra healthy. Deterioration of these tissues can aggravate incontinence.
  • Hysterectomy. In women, the bladder and uterus are supported by many muscles and ligaments they share. Any surgery involving a woman’s reproductive system, such as removal of the uterus, can damage the pelvic floor support muscles and lead to incontinence.
  • Enlarged prostate. Especially in older men, incontinence often comes from enlargement of the prostate gland, a condition known as benign prostatic hyperplasia.
  • Prostate cancer. In men, stress incontinence or urge incontinence may be associated with untreated prostate cancer. But more often, incontinence is a side effect of prostate cancer treatments, such as surgery and radiation therapy.
  • Obstruction. A tumor anywhere in the urinary tract can block the normal flow of urine and cause overflow incontinence. Urinary stones can sometimes cause urine leakage.
  • Neurological disorders. Multiple sclerosis, Parkinson’s disease, stroke, brain tumor, or spinal cord injury can interfere with nerve signals involved in bladder control and cause urinary incontinence.
  • Surgical or non-surgical treatments of pelvic diseases. Prostate surgery, for both benign and malignant diseases, can be complicated by incontinence. Radiotherapy in men and women for the treatment of pelvic cancer (prostate, cervix, uterus) is also associated.

Risk factors

Factors that increase the risk of urinary incontinence include:

  • Sex. Women are more likely to suffer from stress incontinence. Pregnancy, childbirth, menopause and normal female anatomy account for this difference. However, men with prostate problems are at high risk for urge and overflow incontinence.
  • Age. As we age, the muscles of the bladder and urethra lose strength. The changes that occur with age reduce the amount the bladder can hold and increase the chance of releasing urine involuntarily.
  • Being overweight. Excess weight increases pressure on your bladder and surrounding muscles, weakening them and allowing you to lose urine when you cough or sneeze.
  • Smoke. Tobacco use can increase the risk of urinary incontinence.
  • Family history. If a close family member has urinary incontinence, especially urge incontinence, you’re at increased risk for the condition.
  • Other diseases. Neurological diseases or diabetes can increase the risk of incontinence.


Complications of chronic urinary incontinence include:

  • Skin disorders. When the skin remains constantly moist it can promote the appearance of rashes, skin infections and sores.
  • Urinary tract infections. Incontinence increases the risk of recurrent UTIs.
  • Impact on private life. Incontinence can affect social, work, and personal relationships.


Urinary incontinence cannot always be prevented. However, to reduce the risk, it may be helpful to:

  • Maintaining a healthy weight
  • Practice pelvic floor exercises
  • Avoiding foods that irritate the bladder, such as caffeine, alcohol, and acidic foods
  • Eating more fiber, which can prevent constipation, a cause of urinary incontinence
  • Not smoking or seeking help to quit smoking


For the diagnosis of incontinence we use simple, but very practical resources. The Medical history and physical examination are essential.

We usually request:

  • Urine test and culture. Analysis of a urine sample is used to look for signs of infection, traces of blood, or other abnormalities.
  • Journal of bladder function. For several days, write down how much you drink, when you urinate, how much urine you produce, whether you experienced a urge to urinate, and how many episodes of incontinence you had.
  • Post-urination measurement. Your doctor asks you to urinate into a container that measures urine output. He or she then monitors the amount of residual urine in your bladder using a catheter or ultrasound. A large amount of residual urine may mean you have a blockage in your urinary tract or a problem with your bladder nerves or muscles.

In addition, to evaluate the anatomical state of the urinary system, it may be indicated:

  • Echography
  • Pelvic floor MRI
  • Urodynamic study
  • Cystoscopy


Treatment of urinary incontinence depends on the type of incontinence, severity, and underlying cause.

Your doctor is likely to suggest less invasive treatments at first and continue other options only if these techniques fail.

Behavioral techniques

Your doctor may recommend:

  • Bladder training, to delay urination after you feel the need to urinate. You can start by trying to contain it for 10 minutes whenever you feel the urge to urinate. The goal is to extend the time between trips to the bathroom until you urinate only every 2.5 to 3.5 hours.
  • Urinating twice, to help you learn how to empty your bladder as much as possible to avoid overflow incontinence. In this case, “urinating twice” means urinating, and then waiting a few minutes and trying again.
  • Scheduled times to go to the bathroom, to urinate every two to four hours instead of waiting until you have the need to go.
  • Fluid and diet control, to regain bladder control. You may need to limit or avoid alcohol, caffeine and acidic foods. Reducing fluid intake, losing weight, or increasing physical activity can also alleviate the problem.

Pelvic floor exercises

Your doctor may recommend that you do these exercises frequently to strengthen the muscles that help control urination. These exercises, also known as “Kegel exercises” are especially effective in treating stress incontinence, but can also be helpful in treating urge (urgent) incontinence.

When performing the exercises to strengthen the pelvic floor, imagine that you are trying to stop the flow of urine. After:

  • Tighten (contract) the muscles you would use to stop urination and hold contraction for five seconds; Then, relax them for five seconds. (If you find it too difficult, start by holding the contraction for two seconds and relax them for three seconds.)
  • Continue the exercise until you hold contractions for 10 seconds at a time.
  • Aim for at least three sets of 10 reps per day.

To help you identify and contract the right muscles, your doctor might suggest that you work with a physical therapist or try biofeedback techniques.


Electrodes are temporarily inserted in the rectum or vagina to stimulate and strengthen the pelvic floor muscles. The Mild electrical stimulation can be effective for stress incontinence and urge incontinence, but you may need multiple treatments over several months.


Medicines commonly used to treat incontinence include:

  • Anticholinergics.
  • Mirabegron.
  • Alpha-blockers.
  • Topical estrogen.


  • The urethral occluder. A small, disposable tampon-like device that is inserted into the urethra before a specific activity that can trigger incontinence; for example, playing tennis. The occluder acts as a plug to prevent leakage and is removed before urinating.
  • Anti-incontinence tweezers. They are placed in the balanopreputial groove of the penis. They occlude the urethra to prevent the exit of urine, like a sphincter.
  • The pessary. A rigid ring that is inserted into the vagina and worn throughout the day. The device is often used in women who have a prolapse that causes incontinence. The pessary helps hold the bladder, which is located near the vagina, to prevent urine leakage.


Minimally invasive interventions may be indicated in certain cases:

  • Injections of filler material. A synthetic material is injected into the tissue surrounding the urethra. The filling material keeps the urethra closed and reduces urine leakage. This procedure is usually much less effective than more invasive treatments, such as surgery for stress incontinence, and often has to be repeated periodically.
  • Botulinum toxin type A (botox). Botox injections into the bladder muscle may be beneficial for people who have overactive bladder. Botox is usually prescribed only if other first-line medications have not worked.
  • Nerve stimulators. A pacemaker-like device is implanted under the skin that delivers painless electrical impulses to nerves involved in bladder control (sacral nerves). Stimulation of the sacral nerves may control urge incontinence if other therapies have not worked. The device can be implanted under the skin on the buttocks and connected to wires in the lower back, above the pubic area or, with the use of a special device, it can be inserted into the vagina.


If other treatments don’t work, several surgical procedures can treat the problems that cause urinary incontinence:

  • Procedures with sling. To create a pelvic sling around the urethra or bladder neck, small bands of synthetic material or mesh are currently used. The sling helps keep the urethra fixed by preventing incontinence, especially when performing Valsalva (such as when you cough or sneeze). This procedure is used to treat stress incontinence.
  • Suspension of the bladder neck. This procedure is intended to support the urethra and bladder neck. This involves an abdominal incision; therefore, it is carried out under general or intradural anesthesia.
  • Prolapse surgery. In women with mixed incontinence and pelvic organ prolapse, surgery may include a combination of the sling procedure and prolapse surgery.
  • Artificial urinary sphincter. A small mechanism is implanted around the urethra to prevent incontinence. This mechanism is activated and deactivated at will to be able to perform urination voluntarily.

Absorbent compresses and catheters

If medical treatments can’t completely eliminate incontinence, you can try products that help relieve the discomfort and discomfort of urine leakage:

  • Compresses and protective clothing. Most products are no bulkier than regular underwear and can be worn comfortably under everyday clothing. Men with urine drip problems may use a droplet collector (a small pocket of absorbent compress that is placed over the penis and held in place in tight underwear).
  • Catheter. If you have incontinence because your bladder doesn’t empty properly, your doctor might recommend that you learn how to insert a catheter into your urethra several times a day to drain your bladder.

At Uros Associats we have specialists in the Pelvic Floor and in the treatment of incontinence. The approach is carried out in steps, from less invasive therapies to surgical ones, always indicating the most beneficial procedure for the patient.

Pelvic organ prolapse

Uterine prolapse occurs when the muscles and ligaments of the pelvic floor stretch and weaken, so they stop providing adequate support for the uterus. Consequently, the uterus slips into or protrudes from the vagina. Uterine prolapse can affect women of any age. However, it usually affects postmenopausal women who had one or more vaginal births.

Pelvic organ prolapse is less common than urinary or faecal incontinence, but affects about 3% of women in Europe, and 1 in 11 women will need intervention to treat prolapse in their lifetime.

Mild uterine prolapse usually does not require treatment. However, when symptoms occur, such as discomfort, pelvic weight sensation, obstruction of urine leakage or incontinence, trouble having sex, repeated UTIs, etc., treatment may help.


In general, mild uterine prolapse causes no signs or symptoms. Signs and symptoms of moderate to severe uterine prolapse include:

  • Feeling of heaviness or a pull in the pelvis
  • Tissue protruding from the vagina
  • Urinary problems, such as leakage (incontinence) or retention of urine
  • Problems having a bowel movement
  • Feeling of sitting on a small ball or as if something is falling out of your vagina
  • Sexual concerns, such as a feeling of loosening the tone of vaginal tissue

Symptoms are often less bothersome in the morning and worsen throughout the day.


Uterine prolapse occurs as a result of weakening of the pelvic muscles and bra tissues. Causes of weakening of pelvic muscles and tissues include:

  • Pregnancy
  • Difficult labor and delivery or trauma during childbirth
  • Delivering a large baby
  • Overweight or obesity
  • A lower estrogen level after menopause
  • Chronic constipation or pressure when bowel movements
  • Bronchitis or chronic cough
  • Lifting heavy objects repeatedly
  • Some types of pelvic surgery (external or internal genitalia)
  • Ageing

Patients with a family history of connective tissue weakness and those who come from Hispanic or Caucasian ethnicity are at increased risk of developing prolapse.


In general, uterine prolapse is associated with prolapse of other pelvic organs. You might have:

  • Anterior prolapse (cystocele). Weakness of the connective tissue separating the bladder and vagina can cause the bladder to protrude into the vagina. Anterior prolapse is also called a prolapsed bladder.
  • Posterior vaginal prolapse (rectocele). Weakness of the connective tissue separating the rectum and vagina can cause the rectum to protrude into the vagina. You may have difficulty having a bowel movement.
  • Uterine prolapse. It occurs when the uterus protrudes from the vagina. Severe uterine prolapse can displace part of the vaginal lining, causing it to protrude out of the body. Vaginal tissue that rubs against clothing can cause sores in the vagina (ulcers). Rarely, sores can become infected.


To reduce the risk of uterine prolapse:

  • Perform Kegel exercises regularly. These exercises can strengthen your pelvic floor muscles, which is especially important after having a baby.
  • Treats and prevents constipation. Drink plenty of fluids and eat fiber-rich foods.
  • Lift objects correctly and avoid heavy lifting. When lifting, use your legs instead of your waist or back.
  • Control coughing. Seek treatment for chronic cough or bronchitis, and don’t smoke.
  • Prevents weight gain. Talk to your doctor to determine your ideal weight and get advice on weight-loss strategies if you need them.


In general, uterine prolapse is diagnosed during a pelvic exam.. In the pelvic exam we evaluate the degree of prolapse and strength of pelvic floor musculature asking the patient to increase abdominal pressure and then tightening the pelvic and vaginal muscles. The degree of prolapse is classified according to international scales, from which treatment may be recommended.

In some cases, a test that clarifies the functioning of the bladder may be requested, such as the urodynamic study.

Urinalysis will rule out a concomitant urinary tract infection, which alone worsens the symptoms related to prolapse and decreases the effectiveness of conventional treatments.

Pelvic floor MRI is also a useful tool, as it allows you to measure how descended the uterus and bladder are relative to the pelvic frame, and how much that decrease worsens during an increase in abdominal pressure, such as when we cough or bowel movements.

Conservative treatment

Treatment depends on the severity of the uterine prolapse. Your doctor might recommend:

  • Self-care measures. If your uterine prolapse causes few or no symptoms, some simple self-care measures can provide relief or help prevent the prolapse from getting worse. Some of the self-care measures are performing Kegel exercises to strengthen pelvic muscles, lose weight, and treat constipation.
  • Pessary. A vaginal pessary is a plastic or rubber ring that is inserted into the vagina to support weakened tissues. The pessary should be removed regularly for cleaning.

Surgical treatment

Your doctor might recommend surgery to repair uterine prolapse. Minimally invasive (laparoscopic) or vaginal surgery may be an option.

Surgery may involve:

  • Repair of weakened pelvic floor tissues. This surgery is usually done through the vagina, but sometimes through the abdomen. The surgeon may place a graft of his own tissue, a donor, or a synthetic material into the weakened pelvic floor structures to support the pelvic organs.
  • Removal of the uterus (hysterectomy). In certain cases, hysterectomy may be recommended for uterine prolapse.
  • Surgery to close the vagina. This surgery, called colpocleisis

    , treats prolapse by closing the vaginal opening. It may be an option for women who don’t have sex.

The Pelvic Floor Unit of Uros Associats has an excellent team of professionals specialized in the diagnosis and treatment of pelvic organ prolapse. The thorough evaluation and selection of the most appropriate treatment depending on the degree of prolapse, is what guarantees the optimal results we offer our patients.