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Medical Edge Newspaper Column from Mayo Clinic

SURGERY ONE OPTION FOR REPAIRING PROLAPSED BLADDER

DEAR MAYO CLINIC: I’m 80 years old and have a prolapsed bladder. I’m using a pessary, but I’d like to have my bladder repaired instead. What is the least invasive option? — East Meadow, N.Y.

ANSWER: Even at an advanced age, women can do well with surgical repairs for a prolapsed bladder.
A prolapsed bladder, where the bladder protrudes down into or out of the vagina, is common as women age. It occurs when pelvic floor supportive tissues weaken due to various factors including vaginal childbirth, chronic straining and the effects of aging. Symptoms include a feeling of vaginal pressure or heaviness, urine leakage or difficulty passing your urine, and a bulge of tissue at the vaginal opening.

Using a pessary, a supportive device inserted into the vagina, is one way to improve symptoms. The pessary is taken out regularly, cleaned and then reinserted. Most women can do this themselves. While a pessary is the least invasive treatment option, it’s not for everyone. Surgery is also an option. An estimated one in 11 women will have this type of surgery in her lifetime.

The least-invasive surgery is performed through the vagina. Several surgical procedures can be used to support the bladder and other areas that may be affected. Often, when the bladder is affected, so are the uterus, rectum and other areas in the vagina.

Vaginal pelvic-floor repair procedures are commonly done on women of all ages. It would be the preferred approach in your situation. Repairs via an abdominal route are effective for specific types of vaginal prolapse, but this surgery typically has a longer recovery time.

These are some issues to consider: You need to be able to tolerate surgery. Your health-care provider will want to review your medical history and current medications, perform a physical examination and order appropriate medical tests prior to considering surgery. If everything is OK, you would meet with a surgeon (gynecologist, urogynecologist or urologist) to discuss the specific procedure(s) and an anesthesiologist to discuss the type of anesthesia (regional vs. general) that is best for you.

Having surgery of any sort involves taking a risk. By preparing ahead of time and having appropriate care before, during and after your surgery, you will minimize your risks.

— John B. Gebhart, M.D., Director, Urogynecology Incontinence and Pelvic Organ
Prolapse Clinic, Mayo Clinic, Rochester, Minn.

Additional Resources:
Prolapsed Bladder
Diagnosis of Prolapse

READERS: Jet lag — it’s what happens when you’ve arrived at your travel destination but your body is out of sync with local time. It can cause irritability, decreased concentration, dizziness, headaches, muscle soreness and gastrointestinal problems such as constipation or diarrhea. Symptoms can be aggravated by stress, lack of sleep, dry air, dehydration and a bumpy airplane ride.

The severity of symptoms is related to the number of time zones crossed during a flight. For every one-hour time zone change you undergo, it generally takes a day to fully adjust.

While there’s no single, proven method for preventing or curing jet lag, the following suggestions could help.

Arrive at your destination in mid- to late afternoon — this gives you time to get to the place you’ll be staying, have a light snack and sleep. If possible, avoid flights that arrive early in the morning.

Rest up — before your trip, make sure you’re well rested and not sleep-deprived.

During the flight, drink plenty of fluids to stay hydrated — but limit or avoid alcohol and caffeine. They can increase the amount of time it takes your body to adjust to the new time zone and may prevent you from sleeping once you reach your destination.

Avoid taking sleeping pills during the flight — sleeping pills can cause sleepiness long after your intended sleep time and can worsen the sleepiness associated with jet lag.

Consider melatonin — this nonprescription supplement has long been touted as a remedy for reducing jet lag. There are mixed opinions and research on whether it’s helpful. If you want to give it a try, or have found it helpful in the past, there appears to be no harm in taking melatonin for short periods. If you take other medications, check with your doctor to ensure there are no potential interactions between melatonin and other drugs.

Additional Resources:
News Release: Jet Lag: Getting Back in Sync
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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.