Words You Need to Know - Central Coast News KION/KCBA

Words You Need to Know

Anal Sphincter:  The anal sphincter is a small circular muscle that goes around the anal opening that allows you to control when you have a bowel movement or pass gas.  This muscle can be damaged during childbirth and lead to fecal incontinence.

Anal Sphincteroplasty:  This is a repair of a torn anal sphincter muscle, most often torn at the time of childbirth.  Not all partial tears are recognized at the time of delivery and lead to fecal incontinence years later.

Anorectal Manometry:  This is a test to see if the rectal and anal sphincter muscles are strong and able to function properly. 

Anterior Repair:  An anterior repair is done for a "cystocele" (herniation or prolapse of the front vaginal wall).  There are several different surgical techniques that can be used to perform this repair.

The "Front Wall" of the Vagina: This is the vaginal wall that the bladder sits on top of.

Anus: This is the opening of the lower intestine where stool comes out.

Biofeedback:  Biofeedback makes use of electrodes attached to a computer to show how your muscles are working and how well you can coordinate these muscles with a full bowel or in trying to tighten your pelvic muscles.  Biofeedback can aid you in learning how to correctly empty the bowel and also how to contract the pelvic floor muscles. 

Bladder Drills: These are timed voidings that aid you to control the sensation of urgency. To be effective they must be performed over several months' duration.  The goal is to be able to increase the time between voids up to 2.5 to 3 hours.

Bladder Neck: This is the area where the bladder meets the urethra (the tube to the outside), and it is composed of muscles that help control the flow of urine. 

Bladder Neck Ultrasound:  A specific type of ultrasound exam done to measure how much the bladder neck falls or prolapses with Valsalva (taking a big breath, closing your mouth, and then performing a maximal strain).

Catheter:  A catheter is a thin tube that is passed up the urethra to empty the bladder.

Cystocele (Fallen Bladder, Bladder Prolapse): A cystocele is the herniation or prolapse of the front wall of the vagina.  This is the development in weakness of the area of the tissue between the bladder and the vagina.

Cystometry: Cystometry is another word for "urodynamics."  Cystometry consists of filling the bladder and using special types of small mini pressure transducer catheters to measure pressure in the bladder and the urethra simultaneously.  These readings aid in determining the presence nerve damage in the bladder wall, bladder flow rates, urethral pressure, and other information associated with incontinence.

Cystoscopy: A small telescope (cystoscope) is passed through the urethra into the bladder to evaluate the bladder wall and bladder lining.

Dyspareunia: Painful intercourse.

External Anal Sphincter: The anal sphincter is composed of 2 muscles. The external sphincter is the outer anal sphincter muscle that is under voluntary control, which you can relax or contract to pass or hold stool.

Fecal Incontinence: The inability to control the passage of gas, liquid, or solid stool.

Flatus: Another word used for "gas" released from the rectum.

Internal Anal Sphincter: This is a circular muscle inside the external sphincter around the anus.  It is not under voluntary control, and when damaged, you can have involuntary or unconscious loss of stool.

Interstitial Cystitis (IC): This is an inflammatory disease of the lining of the bladder that can lead to severe frequency and urgency.

Laparoscopic Reconstructive Surgery: This is minimally invasive surgery for procedures that in the past were done through large abdominal incisions.  Procedures include sacral colpopexy, uterosacral ligament suspension, and different types of incontinence procedures.  Because it is minimally invasive, the postoperative recovery time is significantly shortened. 

Ligaments: Ligaments are tough bands of connective tissue that hold bones, cartilage, and muscles together in pelvic organ support.  They can be damaged and weakened, which can play a role in the development of prolapse or herniation of pelvic organs. 

Mid-Urethral Sling:  This is a minimally invasive small sling that is placed under the mid portion of the urethra to treat urinary stress incontinence. 

Mixed Incontinence: When a woman has both stress and urge incontinence it is called mixed incontinence.  For adequate treatment, mixed incontinence usually requires a surgical repair for the stress incontinence and medication for the urge incontinence.

Overactive Bladder (OAB): Overactive bladder is caused by involuntary contractions of the bladder wall and causes the famous symptom "gotta go, gotta go".  This disease is treated by specific medications and bladder drills.

Paravaginal Repair: A paravaginal defect is when the vaginal wall tears loose from their lateral sidewalls.  At the Center for Female Continence and Urogynecology, if this repair is necessary, it is done laparoscopically.  Dr. Ross was the first physician to report on repairing paravaginal defects laparoscopically.

Pelvic Floor: The pelvic floor is composed of the muscles, ligaments, and connective tissue that help support the opening of the pelvic floor, allowing the urethra, vagina, and rectum to exit.  These muscles and ligaments work together in supporting the vagina, uterus, bladder, and bowel. 

Pelvic Floor 4D Ultrasound:  This is a special 4 dimensional (4D) ultrasound technique that demonstrates whether or not the pelvic floor muscles are intact.  It also allows the determination of the extent of prolapse and other types of pelvic floor diseases that cannot be diagnosed on routine examination. This scanning technique requires special equipment and is not offered in any clinic other than the Center for Female Continence and Urogynecology. 

Pelvic Organ Prolapse (POP): POP is the herniation of bulging of the uterus (uterine prolapse), bladder (cystocele), or rectum (rectocele) into the vagina. 

Pessary: This is a device worn in the vagina to help support herniated vaginal walls or a prolapsed uterus.  Pessaries come in many different shapes and sizes and must be fitted specifically for each patient.

Posterior Repair: This is the repair of a herniation of the back vaginal wall.  It is due to damage of the support tissue between the rectum and the back vaginal wall.  Herniation of the rectum results in a bulge of the back vaginal wall when straining.  The hernia sac traps stool making, it difficult to empty your bowels.

Posterior Vaginal Wall (Back Vaginal Wall): The back wall of the vagina over the rectum.

Post-Void Residual (PVR):  A post-void residual is the measuring (usually by bladder ultrasound) of how much urine is left in your bladder after you have tried to empty.  A normal post-void residual is between 0-60 ml.  If you have a post-void residual greater than 100 ml, evaluation will be carried out to determine why you are not able to completely empty your bladder. 

Prolapse:  A herniation, protrusion, or dropping of the pelvic organs such as the uterus (uterine prolapse), the vagina (cystocele), or rectum (rectocele).

Rectocele:  This is a bulge of the back wall of the vagina over the top of the rectum.  Large rectoceles can cause difficulty in having bowel movements. 

Rectum:  The lowest part of the large intestine just before the anus.

Robotic-Assisted Laparoscopic Surgery: This is a system that uses robotic arms controlled by the operating surgeon setting at an operating console.  It allows many physicians with limited laparoscopic ability to perform advanced minimally invasive laparoscopic surgery. 

Sacral Colpopexy: This is the attachment of a Y-shaped piece of mesh to the back and front wall of the vagina and then up to the sacrum to keep the top or apex of the vagina from prolapsing.

Stress Incontinence: This is the involuntary loss of urine with actions such as coughing, laughing, sneezing, jumping, or any vigorous exercise that increases the pressure inside the abdomen.

Tension-Free Vaginal Tape: This is a type of a mid-urethral sling used for the treatment of stress incontinence. 

Trans-Anal Ultrasound: This is a specialized ultrasound probe that can be placed just in the lower portion of the rectum to evaluate the internal and external anal sphincter muscles.

Transobturator Tension-Free Vaginal Tape: This is a special mid-urethral tape used for stress incontinence that is passed through the obturator foramen (holes in the pelvic bone on each side).  This is a minimally invasive procedure with a very high success rate in curing stress incontinence.

Urethra:  The tube which urine passes from the bladder to the outside of the body.

Urethral Diverticulum: This is a small outpouching from the urethral wall.  It can cause symptoms of frequency and mimic stress incontinence.  This can be diagnosed with cystoscopy.

Urge Incontinence: Urinary incontinence caused by involuntary contractions of the bladder wall, which lead to urgency and then loss of urine on the way to the toilet.  This is also called overactive bladder (OAB)  and is usually treated with bladder drills and medication.

Urinalysis:  A microscopic examination of the urine to rule out the possibility of infection.

Urinary Incontinence:  Involuntary loss of urine.

Urodynamics:  Urodynamic testing is the same as cystometrics and is an essential test to determine how the lower urinary tract, i.e. bladder and urethra, act as the bladder is filled.  This testing is mandatory to correctly determine the different types of urinary incontinence.

Uterine Prolapse (Fallen Uterus):  Uterine prolapse is a dropped or fallen uterus caused by damage of the ligamentous supports that hold the uterus up at the top of the vagina. Damaged support allows the uterus to fall down into the vagina toward the vaginal opening. 

Uterosacral Ligament Suspension (USL):  Uterosacral ligaments are deep pelvic ligaments that help hold the uterus in its correct anatomical position at the top of the uterus.  If these ligaments are damaged they can be shortened and used to reattach the top or apex of the vagina or the uterus if either has prolapsed.

Vaginal Hysterectomy:  A vaginal hysterectomy is done by making a vaginal incision and removing the uterus through the vagina.  There are no abdominal incisions.  This is a minimally invasive type procedure and allows rapid post operative recovery.  The tubes and ovaries can be removed with the uterus if there is a medical reason necessitating their removal.  Vaginal hysterectomy was often performed in the treatment of pelvic floor prolapse in the past.  Now with the improved minimally invasive procedures that are available, uterine sparring is much more common (resupporting and leaving the uterus in place).

Valsalva:  In a Valsalva maneuver, you are asked to take a deep breath, close your mouth holding that air in place, and bearing down strongly.  This will demonstrate pelvic organ prolapse on examination.

Voiding Dysfunction:  Any problem that leads to difficulty in emptying of the bladder.  This might be difficulty in starting the stream or hesitancy (involuntary stop and start of stream) or just incomplete emptying.