Surgical Treaments

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Urinary Incontinence

Urinary incontinence means leaking urine. Incontinence can range from leaking just a few drops of urine to empty of the bladder completely.

It is common for other symptoms to occur along with urinary incontinence:

  • Urgency-Having a strong urge to urinate
  • Frequency-Urinating (also called voiding) more often than what is usual for you
  • Nocturia-Waking from sleep to urinate
  • Dysuria-Painful urination
  • Nocturnal enuresis-Leaking urine while sleeping

Types of Urinary Incontinence

Urinary incontinence in women can be divided into three main types:

  • Stress urinary incontinence (SUI) is leaking urine when coughing, laughing, or sneezing. Leaks also can happen when a woman walks, jumps, runs, or exercises.
  • Urgency urinary incontinence is a sudden strong urge to urinate that is hard to stop. Women with this type of urinary incontinence may leak urine on the way to the bathroom. If you have an “overactive bladder” (OAB), it means that you have symptoms of urgency and frequency that may or may not include incontinence.
  • Mixed incontinence combines symptoms of both SUI and urgency urinary incontinence.

Causes of Urinary Incontinence

Some of the causes of urinary incontinence may include the following:

  • Urinary tract infection (UTI) are otherwise known as bladder infection or cystitis sometimes cause discomfort and leakage. UTI’s are treated with antibiotics.
  • Diuretic medication, caffeine, or alcohol intake may cause incontinence.
  • Pelvic floor disorders are caused by weakening of the muscles and tissues of the pelvic floor and include urinary incontinence, accidental bowel leakage (fecal incontinence), and pelvic organ prolapse.
  • Long-term constipation often is present in women with urinary incontinence, especially in older women.
  • Neuromuscular problems is when nerve (neurologic) signals from the brain to the bladder and urethra are disrupted, the muscles that control those organs can malfunction, allowing urine to leak.
  • Anatomical problems is the outlet of the bladder into the urethra can become blocked by bladder stones or other growths.

Diagnosing Urinary Incontinence

The first two steps in assessing urinary incontinence usually are a medical history and physical exam:

  • Your physician will ask you to explain your signs and symptoms in detail. You may be asked to fill out a bladder diary for a few days.
  • Physical exam may be done to see if you have pelvic organ prolapse and to look for other anatomical problems. A “cough test” may be done during the exam. During a cough test, you are asked to cough and bear down with a full bladder to see if urine leaks. A test to measure the support of the urethra may be done. Sometimes, imaging tests and bladder function tests may be ordered (Urodynamics) are done if more information is needed.

Treatment options for Urinary Incontinence

Your physician may first recommend non-surgical treatment. This may include lifestyle changes, bladder training, physical therapy, and using certain bladder support devices (Pessaries). For urgency urinary incontinence, the treatment may involve medication. Surgery may help certain types of incontinence. Often, several treatments are used together for the best effect.

Lifestyle changes

The following lifestyle changes may help decrease urine leakage:

  • Lose weight. In overweight women, losing even a small amount of weight (less than 10% of total body weight) may decrease urine leakage.
  • Manage your fluid intake. If you have leakage in the early morning or at night, you may want to limit your intake of fluids several hours before bedtime. Limiting the amount of fluids you drink also may be useful (no more than 2 liters total a day). Limiting alcohol and caffeine may be helpful as well.
  • Train your bladder. The goal of bladder training is to learn how to control the urge to empty the bladder and increase the time span between urinating to normal intervals (every 3–4 hours during the day and every 4–8 hours at night).

Types of exercise and physical therapy can help treat Urinary Incontinence

Kegel exercises can help strengthen the pelvic muscles. Exercises to strengthen the abdomen and back “core” are also helpful. These exercises are helpful for all types of incontinence. Biofeedback is a training technique that may help you locate the correct muscles. This can be done with a physical therapists. In one type of biofeedback, sensors are placed inside or outside the vagina that measure the force of pelvic muscle contraction. When you contract the right muscles, you will see the measurement on a monitor. The “In Tone” device is also available for patients to perform biofeedback exercises at home.

Available non-surgical options

A pessary is a device that is inserted into the vagina to treat pelvic support problems and SUI. Pessaries support the walls of your vagina to lift the bladder and urethra. These are fitted by a Gynecologist. Pessaries come in many shapes and sizes. Usually you can insert and remove a support pessary yourself. Pessaries may provide relief of symptoms without surgery. An over-the-counter tampon-like device also is available that is designed specifically to help prevent bladder leaks.

Many medications are available to help reduce the symptoms of urgency urinary incontinence and OAB:

  • Drugs that control muscle spasms or unwanted bladder contractions can help prevent leakage from urgency urinary incontinence and relieve the symptoms of urgency and frequency.
  • Mirabegron is a drug that relaxes the bladder muscle and allows the bladder to store more urine. This drug is used to treat urgency urinary incontinence and relieve the symptoms of urgency and frequency.
  • Injection of a drug called onabotulinumtoxinA into the muscle of the bladder helps stop unwanted bladder muscle contractions. The effects last for approximately 3–9 months.

Surgical Procedures to treat Urinary Incontinence

There are different types of surgical procedures for different types of incontinence. You and your physician may discuss many factors before choosing the surgery that is right for you, including the risks and benefits of each type.

Surgery to correct SUI includes the following procedures:

  • Slings-Different types of slings, such as those made from your own tissue or synthetic materials, can be used to lift or provide support for the urethra. The synthetic midurethral sling is the most common type of sling used to correct SUI. This sling is a narrow strap made of synthetic mesh that is placed under the urethra.
  • Colposuspension stitches are placed on either the side of the bladder neck and attached to nearby supporting structures to lift up the urethra and hold it in place.
  • If surgery is not an option for you or has not worked for your SUI, urethral bulking may help. A synthetic substance is injected into the tissues around the urethra. The substance acts to “plump up” and narrow the opening of the urethra, which may decrease leakage.

Treatment Options for Urinary Urge Incontinence

  • Sacral neuromodulation is a technique in which a thin wire is placed under the skin of the low back and close to the nerve that controls the bladder. The wire is attached to a battery device placed under the skin nearby. The device sends a mild electrical signal along the wire to improve bladder function.
  • Percutaneous tibial nerve stimulation (PTNS) is a procedure that is similar to acupuncture. In PTNS, a slender needle is inserted near a nerve in the ankle and connected to a special machine. A signal is sent through the needle to the nerve, which sends the signal to the pelvic floor. PTNS usually involves weekly 30-minute office sessions for a few months.

Cervical cancer screening is used to find changes in the cells of the cervix that could lead to cancer. Screening includes the Pap test and, for some women, testing for human papillomavirus.

Technique

Cervical cancer screening is simple and fast. It takes less than a minute to do. With the woman lying on an exam table, a speculum is used to open the vagina. This device gives a clear view of the cervix and upper vagina.

For a Pap test, a small number of cells are removed from the cervix with a brush or other tool. The cells are put into a liquid and sent to a lab for testing. For an HPV test, usually the same sample taken for the Pap test can be used. Sometimes, two different cell samples are taken.

Who should have Cervical Cancer Screening and how often?

You should start having cervical cancer screening by the age of 21 years. How often you should have cervical cancer screening depends on your age and health history:

  • Women younger than 21 may have a pap test if they are sexually active.
  • Women aged 21–29 years should have a Pap test at least 3 years if they are at low risk.
  • Women aged 30–65 years should have a Pap test and HPV test (co-testing) at least 5 years. However, we believe an annual pelvic exam should be done. A risk assessment for cervical disease will be done by the physician at the time of the visit. If appropriate, a pap smear will be done at that time. Screening pap test are covered by insurance.

When can I stop having Cervical Cancer Screening?

You can stop having cervical cancer screening after age 65 if you do not have a history of moderate or severe cervical dysplasia or cervical cancer and if you have had either three negative Pap test results in a row or two negative co-test results in a row within the past 10 years, with the most recent test performed within the last 5 years. This assumes that your risk profile has not changed, for example: no new sexual partners.

What happens if I have an abnormal screening test result?

You most likely will have additional testing after an abnormal test result. This testing can be simply a repeat Pap test, An HPV test or a more detailed examination called a colposcopy (with or without a biopsy). If results of follow-up tests indicate precancerous changes, you may need treatment to remove the abnormal cells.

Are Cervical Cancer Screening results always accurate?

As with any lab test, cervical cancer screening test results are not always accurate. Sometimes, the results show abnormal cells when the cells are normal. This is called a “false-positive” result. The tests also may not detect abnormal cells when they are present. This is called a “false-negative” result. Many factors can cause false results:

  • The sample may contain too few cells.
  • There may not be enough abnormal cells to study.
  • An infection or blood may hide abnormal cells.
  • Douching or vaginal medications may wash away or dilute abnormal cells.

To help prevent false-negative or false-positive results, avoid douching, sexual intercourse and using vaginal medications or hygiene products for 2 days before your test. You also should not have cervical cancer screening if you have your menstrual period.

A colposcopy allows your physician to look very closely at your cervix using a colposcope, this instrument has a series of lenses that allows the physician to view the cervix under magnification.

During the procedure

Initially, a colposcopy procedure feels similar to a pap smear. A speculum is placed and the colposcope is used to view the cervix. If you’re cervical tissue appears abnormal, your physician may use an instrument to remove a small tissue sample. This is called a biopsy. Our physician may use a topical antibiotic for your comfort. You may feel a slight pinch or cramp. The tissue will be sent to the pathology lab for analysis.

After the procedure?

Most women feel no after effects. You will be given written instruction regarding any limitation and follow up care.

D&C is a surgical procedure in which the cervix is opened (dilated) and a thin instrument is inserted into the uterus. This instrument is used to remove tissue from the inside of the uterus (curettage).

Why is a D&C done?

D&C is used to diagnose and treat many conditions that affect the uterus, such as abnormal bleeding. A D&C also may be done after a miscarriage. A sample of tissue from inside the uterus can be viewed under a microscope to tell whether any cells are abnormal. A D&C may be done with other procedures, such as hysteroscopy, in which a slender device with a camera is used to view the inside of the uterus.

Where is a D&C done?

A D&C is done in a sterile operating room at a surgery center or the hospital. You will receive some sedation for the procedure.

Preparation needed for a D&C?

Your physician may want to start dilating your cervix before surgery using a medication, Cytotec or Misoprostol.  You will be instructed on the use of the medications. It can be inserted directly into the vagina or taken orally. The medication is used to soften the cervix, making it easier to dilate.

During the procedure

During the procedure, you will lie on your back and your legs will be placed in stirrups. A speculum will be inserted into your vagina. The cervix will be held in place with a special instrument.

The cervix will then be slowly dilated. This is done by inserting a series of slender rods that become progressively larger through the cervical opening. Usually only a small amount of dilation is needed (less than one half inch in diameter).

Tissue lining the uterus will be removed, either with an instrument called a curette or with suction. The tissue will be sent to a laboratory for examination.

Risks of D&C

Complications include bleeding, infection, or perforation of the uterus (when the tip of an instrument passes through the wall of the uterus). Problems related to the anesthesia used also can occur. These complications are rare.

Rarely, after a D&C has been performed bands of scar tissue, or adhesions, may form inside the uterus. This is called Asherman Syndrome. These adhesions may cause infertility and changes in menstrual flow. However, Asherman Syndrome, can be treated successfully with surgery. .

What should I expect after the surgery?

After the procedure, you probably will be able to go home within a few hours. You will need someone to take you home. You should be able to resume most of your regular activities in 1 or 2 days. Pain after a D&C usually is mild. You may have spotting or light bleeding. You will be given specific instructions by your physician.

Our practice offers endometrial ablations using the Novasure and Thermachoice systems. If you have heavy periods, schedule an appointment to find out if this procedure is right for you. Many physicians refer patients to us because of our expertise in surgical treatments.

  • No need for a hysterectomy
  • No incisions
  • Recovery time less than 48 hours
  • No general anesthesia
  • About 15 minutes to perform
  • Over 90% satisfaction rate

What is Endometrial Ablation?

Endometrial ablation destroys a thin layer of the lining of the uterus and stops the menstrual flow in many women. In some women, menstrual bleeding does not stop but is reduced to normal or lighter levels. If ablation does not control heavy bleeding, further treatment or surgery may be required.

Why is Endometrial Ablation done?

Endometrial ablation is used to treat many causes of heavy bleeding. In most cases, women with heavy bleeding are treated first with medication. If heavy bleeding cannot be controlled with medication, endometrial ablation may be used.

Who should not have Endometrial Ablation?

Endometrial ablation should not be done in women past menopause. It is not recommended for women with certain medical conditions, including the following:

  • Disorders of the uterus or endometrium
  • Endometrial hyperplasia
  • Cancer of the uterus
  • Recent pregnancy
  • Current or recent infection of the uterus

Can I still get pregnant after having Endometrial Ablation?

Pregnancy is not likely after ablation, but it can happen. If it does, the risk of miscarriage and other problems are greatly increased. If a woman still wants to become pregnant, she should not have this procedure. Women who have endometrial ablation should use birth control until after menopause. Sterilization may be a good option to prevent pregnancy after ablation.

A woman who has had ablation still has all her reproductive organs. Routine cervical cancer screening and pelvic exams are still needed.

What techniques are used to perform Endometrial Ablation?

The following methods are those most commonly used to perform endometrial ablation:

  • Radiofrequency-A probe is inserted into the uterus through the cervix. The tip of the probe expands into a mesh-like device that sends radiofrequency energy into the lining. The    energy and heat destroy the endometrial tissue, while suction is applied to remove it.
  • Freezing-A thin probe is inserted into the uterus. The tip of the probe freezes the uterine lining. Ultrasound is used to help guide the procedure.
  • Heated fluid- Fluid is inserted into the uterus through a hysteroscope, a slender, light-transmitting device. The fluid is heated and stays in the uterus for about 10 minutes. The      heat destroys the lining.
  • Heated balloon-A balloon is placed in the uterus with a hysteroscope.
  • Heated fluid is put into the balloon. The balloon expands until its edges touch the uterine lining. The heat destroys the endometrium.
  • Microwave energy-A special probe is inserted into the uterus through the cervix. The probe applies microwave energy to the uterine lining, which destroys it.
  • Electrosurgery-Electrosurgery is done with a resectoscope. A resectoscope is a slender telescopic device that is inserted into the uterus. It has an electrical wire loop, roller-        ball, or spiked-ball tip that destroys the uterine lining. This method usually is done in an operating room with general anesthesia. It is not as frequently used as the other             methods.

What should I expect after the procedure?

Some minor side effects are common after endometrial ablation:

  • Cramping, like menstrual cramps, for 1–2 days
  • Thin, watery discharge mixed with blood, which can last a few weeks. The discharge may be heavy for 2–3 days after the procedure.
  • Frequent urination for 24 hours
  • Nausea

What are the risks associated with Endometrial Ablation?

Endometrial ablation has certain risks. There is a small risk of infection and bleeding. The device used may pass through the uterine wall or bowel. With some methods, there is a risk of burns to the vagina, vulva, and bowel. Rarely, the fluid used to expand your uterus during electrosurgery may be absorbed into your bloodstream. This condition can be serious. To prevent this problem, the amount of fluid used is carefully checked throughout the procedure.

What is a Hysterectomy?

Hysterectomy is the most common non-pregnancy-related major surgery performed on women in the United States. In 1995, approximately 590,000 women in this country will undergo the procedure. Surgical removal of the uterus, and frequently the ovaries, is widely accepted both by medical professionals and the public as appropriate treatment for uterine cancer, and for various common non-cancerous uterine conditions that can produce often disabling levels of pain, discomfort, uterine bleeding, emotional distress, and related symptoms. Yet, while hysterectomy can alleviate uterine problems, less invasive treatments are available.

What are the conditions leading to Hysterectomy?

Most women who undergo hysterectomy are between the ages of 65 and 54, with the highest age-specific rate for women 35 to 44 years of age. Overall, uterine fibroids account for approximately one-third of all hysterectomies performed in the United States. Endometriosis is the second most common condition leading to hysterectomy, accounting for 18 percent. Hysterectomy rates also are correlated with a number of non-clinical characteristics of patients, such as socioeconomic status, geographical diversity, and with provider variables, such as physician training and gender of physician.

What is Hysterosalpingography (HSG)?

Hysterosalpingography (HSG) is an X-ray procedure that is used to view the inside of the uterus and fallopian tubes. It often is used to see if the fallopian tubes are partly or fully blocked. It also can show if the inside of the uterus is of a normal size and shape. All of these problems can lead to infertility and pregnancy problems.

HSG also is used a few months after some tubal sterilization procedures to make sure that the fallopian tubes have been completely blocked. HSG is not done if a woman has any of the following conditions:

  • Pregnancy
  • Pelvic infection
  • Heavy uterine bleeding at the time of the procedure

What should I do to prepare for HSG?

Your physician may recommend that you take an over-the-counter pain reliever an hour before the procedure. Discuss this decision with your health care provider. In some cases, he or she also may prescribe an antibiotic for you to take before HSG. Most people can drive themselves home after having HSG. However, you may not feel well after the procedure, so you may want to make arrangements for someone to drive you home.

How is HSG done?

HSG is done in a hospital or physician’s office. It is best to have HSG done in the first half (days 1–14) of the menstrual cycle. This timing reduces the chance that you may be pregnant.

During HSG, a contrast medium is placed in the uterus and fallopian tubes. This is a fluid that contains a dye. The dye shows up in contrast to the body structures on an X-ray screen. The dye outlines the inner size and shape of the uterus and fallopian tubes. It also is possible to see how the dye moves through the body structures.

The procedure is performed as follows:

  • You will be asked to lie on your back with your feet placed as for a pelvic exam. A device called a speculum is inserted into the vagina. It holds the walls of the vagina apart to allow the cervix to be viewed. The cervix is cleaned.
  • The end of the cervix may be injected with local anesthesia (pain relief). You may feel a slight pinch or tug as this is done.
  • One of two methods may be used to insert the dye. In one method, the cervix is grasped with a device to hold it steady. An instrument called a cannula is then inserted into the    cervix. In the other method, a thin plastic tube is passed into the cervical opening. The tube has a small balloon at the end that is inflated. The balloon keeps the tube in place      in the uterus.
  • The speculum is removed, and you are placed beneath an X-ray machine.
  • The fluid slowly is placed through the cannula or tube into the uterus and fallopian tubes. The fluid may cause cramping. If the tubes are blocked, the fluid will cause them to        stretch.
  • X-ray images are made as the contrast medium fills the uterus and tubes. You may be asked to change position. If there is no blockage, the fluid will spill slowly out the far          ends of the tubes. After it spills out, the fluid is absorbed by the body.
  • After the images are made, the cannula or tube is removed.

What should I expect after the procedure?

After HSG, you can expect to have a sticky vaginal discharge as some of the fluid drains out of the uterus. The fluid may be tinged with blood. A pad can be used for the vaginal discharge. Do not use a tampon. You also may have the following symptoms:

  • Slight vaginal bleeding
  • Cramps
  • Feeling dizzy, faint, or sick to your stomach

What are the risks associated with HSG?

Severe problems after an HSG are rare. They include an allergic reaction to the dye, injury to the uterus, or pelvic infection. Call your physician if you have any of these symptoms:

  • Foul-smelling vaginal discharge
  • Vomiting
  • Fainting
  • Severe abdominal pain or cramping
  • Heavy vaginal bleeding
  • Fever or chills

Are there alternatives to HSG?

There are other procedures that can give your physician some of the same information as HSG:

  • Laparoscopy -This surgical procedure requires general anesthesia
  • Hysteroscopy -This procedure can give a detailed view of the inside of the uterus. However, it cannot show whether the fallopian tubes are blocked
  • Sonohysterography -This technique uses ultrasound to show the inside of the uterus. Like hysteroscopy, it does not give information about the fallopian tubes

What is Hysteroscopy?

Hysteroscopy is used to diagnose or treat problems of the uterus. A hysteroscope is a thin, lighted telescope-like device. It is inserted through your vagina into your uterus. The hysteroscope transmits the image of your uterus onto a screen. Other instruments are used along with the hysteroscope for treatment.

Why is Hysteroscopy done?

One of the most common uses for hysteroscopy is to find the cause of abnormal uterine bleeding. Abnormal bleeding can mean that a woman’s menstrual periods are heavier or longer than usual or occur less often or more often than normal. Bleeding between menstrual periods also is abnormal

Hysteroscopy also is used in the following situations:

  • Remove adhesions that may occur because of infection or from past surgery
  • Diagnose the cause of repeated miscarriage when a woman has more than two miscarriages in a row
  • Locate an intrauterine device
  • Perform sterilization, in which the hysteroscope is used to place small implants into a woman’s fallopian tubes as a permanent form of birth control

How is Hysteroscopy performed?

Before the procedure, you may be given a medication to help you relax, or general anesthesia or local anesthesia may be used to block the pain. If you have general anesthesia, you will not be awake during the procedure.

Hysteroscopy can be done in a doctor’s office or at the hospital. It will be scheduled when you are not having your menstrual period. To make the procedure easier, your health care provider may dilate (open) your cervix before your hysteroscopy. You may be given medication that is inserted into the cervix, or special dilators may be used.

A speculum is first inserted into the vagina. The hysteroscope is then inserted and gently moved through the cervix into your uterus. Carbon dioxide gas or a fluid, such as saline (salt water), will be put through the hysteroscope into your uterus to expand it. The gas or fluid helps your health care provider see the lining more clearly. The amount of fluid used is carefully checked throughout the procedure. Your health care provider can view the lining of your uterus and the openings of the fallopian tubes by looking through the hysteroscope. If a biopsy or other procedure is done, small instruments will be passed through the hysteroscope.

What should I expect during recovery?

You should be able to go home shortly after the procedure. If you had general anesthesia, you may need to wait until its effects have worn off.

It is normal to have some mild cramping or a little bloody discharge for a few days after the procedure. You may be given medication to help ease the pain. If you have a fever, chills, or heavy bleeding, call your health care provider right away.

What are the risks of Hysteroscopy?

Hysteroscopy is a safe procedure. However, there is a small risk of problems. The uterus or cervix can be punctured by the hysteroscope, bleeding may occur, or excess fluid may build up in your system. In rare cases, hysteroscopy can cause life-threatening problems.

Adefris & Toppin provides a full range of gynecologic services in both an ambulatory and inpatient basis. Services are devoted to addressing the individual needs and concerns of our patients. We provide routine and preventive care services as well as a full range of minimally invasive surgical procedures including laparoscopic total and subtotal hysterectomy.

We are experienced gynecologic surgeons who are dedicated reducing pain during to postoperative period. Toward that end we have pioneered the use of the On-Q pain pump for patients having cesareans and other major abdominal surgeries.

We are skilled laparoscopic surgeons who provide care to treat heavy periods, fibroids, ovarian cysts, pelvic prolapse, and endometriosis.

Benefits of laparoscopic surgery include:

  • Smaller incisions
  • Significantly less pain
  • Faster recovery
  • Shorter hospital stay
  • Lower risk of infections
  • Less blood loss
  • Less scarring
  • In many cases, better outcomes

What is a loop Electrosurgical Excision Procedure (LEEP) and why is it done?

If you have an abnormal cervical cancer screening result, your physician may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment (see the FAQ Cervical Cancer Screening). LEEP is one way to remove abnormal cells from the cervix by using a thin wire loop that acts like a scalpel (surgical knife). An electric current is passed through the loop, which cuts away a thin layer of the cervix.

How is LEEP performed?

A LEEP should be done when you are not having your menstrual period to give a better view of the cervix. In most cases, LEEP is done in the office. The procedure only takes a few minutes.

During the procedure you will lie on your back and place your legs in stirrups. Your physician then will insert aspeculum into your vagina in the same way as for a pelvic exam. Local anesthesia will be used to prevent pain. It is given through a needle attached to a syringe. You may feel a slight sting, then a dull ache or cramp. The loop is inserted into the vagina to the cervix. There are different sizes and shapes of loops that can be used. You may feel faint during the procedure. If you feel faint, tell your health care provider immediately.

After the procedure, a special paste may be applied to your cervix to stop any bleeding. Electrocautery also may be used to control bleeding. The tissue that is removed will be studied in a lab to confirm the diagnosis.

What are the risks of LEEP?

The most common risk in the first 3 weeks after a LEEP is heavy bleeding. If you have heavy bleeding, contact your physician. You may need to have more of the paste applied to the cervix to stop it.

LEEP has been associated with an increased risk of future pregnancy problems. Although most women have no problems, there is a small increase in the risk of premature births and having a low birth weight baby. In rare cases, the cervix is narrowed after the procedure. This narrowing may cause problems with menstruation. It also may make it difficult to become pregnant.

What should I expect during recovery from LEEP?

After the procedure, you may have

  • a watery, pinkish discharge
  • mild cramping
  • a brownish-black discharge (from the paste used)

It will take a few weeks for your cervix to heal. While your cervix heals, you should not place anything in the vagina, such as tampons or douches. You should not have intercourse. Your physician will tell you when it is safe to do so.

You should contact your physician if you have any of the following problems:

  • Heavy bleeding (more than your normal period)
  • Bleeding with clots
  • Severe abdominal pain

Will I need follow-up visits?

After the procedure, you will need to see your physician for follow-up visits. You will have cervical cancer screening to be sure that all of the abnormal cells are gone and that they have not returned. If you have another abnormal screening test result, you may need more treatment.

You can help protect the health of your cervix by following these guidelines:

  • Have regular pelvic exams and cervical cancer screening.
  • Stop smoking-smoking increases your risk of cancer of the cervix.
  • Limit your number of sexual partners and use condoms to reduce your risk of sexually transmitted diseases.

What is Sonohysterography?

Sonohysterography is a technique in which fluid is injected through the cervix into the uterus, and ultrasound is used to make images of the uterine cavity. The fluid shows more detail of the inside of the uterus than when ultrasound is used alone. The procedure can be done in a health care provider’s office, hospital, or clinic. It usually takes about 15 minutes.

Why is Sonohysterography done?

Sonohysterography can find the underlying cause of many problems, including abnormal uterine bleeding, infertility, and repeated miscarriage. A sonohysterogram may be ordered when a woman has had a normal ultrasound exam but is still having symptoms. This procedure can detect the following conditions:

Abnormal growths inside the uterus, such as fibroids or polyps

  • Scarring inside the uterus
  • Abnormal uterine shape
  • Sonohysterography also is done before and after some surgical procedures.

When is Sonohysterography done?

The procedure will be scheduled when you are not having your menstual period. If you are bleeding, the results may not be as clear. The test may be postponed until the bleeding stops. The procedure is not done if you are or could be pregnant, or if you have a pelvic infection or pelvic inflammatory disease. You may be given a urine test to rule out pregnancy.

What preparation is involved before the procedure?

Sonohysterography is done when your bladder is empty. You will be asked to undress from the waist down and lie on an exam table. Your health care provider may do a pelvic exam to check if you have any tenderness or pain. In some situations, you may be given antibiotics.

How is Sonohysterography performed?

Sonohysterography has two parts. A transvaginal ultrasound exam is done first. Next, a fluid is injected through the cervix into the uterus, and an ultrasound exam is done again.

  • In a transvaginal ultrasound exam, an ultrasound transducer—a slender, handheld device —is placed in the vagina. It sends out sound waves that are used to make images of    the internal organs. These images are shown on a screen.
  • After the first transvaginal ultrasound exam, the transducer is removed. A speculum is placed in the vagina. It holds the vagina open. The health care provider passes a swab      through the speculum to clean the cervix.
  • Next, a thin tube called a catheter is inserted through the vagina. It is placed in the opening of the cervix or in the uterine cavity. The speculum then is removed.
  • The transducer is placed in the vagina again. A sterile fluid is slowly passed through the catheter. Cramping may occur as the fluid goes into the uterus. A transabdominal           ultrasound exam also may be done while the fluid is passed into the uterus. In this type of ultrasound exam, a transducer is moved over the abdomen.
  • When the cavity is filled with fluid, ultrasound images are made of the inside of the uterus and the uterine lining.

What can I expect after the procedure?

Most women are able to go home right away and return to their normal level of activity that day. Some of the following symptoms may occur after the procedure:

  • Cramping
  • Spotting
  • Watery discharge

What are the risks associated with Sonohysterography?

This procedure is safe, but there is a rare risk of pelvic infection. Call your health care provider if you have any of the following symptoms:

  • Pain or fever in the day or two after you go home
  • A change in the type or amount of discharge

What are some alternatives to Sonohysterography?

There are alternatives to sonohysterography that also can be used to diagnose problems of the uterus:

  • Hysterosalpingography-This X-ray procedure is used to view the inside of the uterus and fallopian tubes and can show whether the tubes are blocked. Radiation is used and a     fluid that contains a dye. Some women may be allergic to the dye that is used.
  • Hysteroscopy-A slender, light-transmitting device with a small camera attached—the hysteroscope —is inserted into the vagina and through the cervix to look inside the uterus.    Unlike sonohysterography, this test usually requires general anesthesia or local anesthesia.
  • Magnetic resonance imaging (MRI)-This imaging test is used to view the internal organs, but it does not show the inside of the uterus as clearly as sonohysterography.

Pelvic organ prolapse is a disorder in which one or more of the pelvic organs sag or drop from their normal position. It is caused weakening of the muscles or tissues that support the pelvic organs. The main cause of weakening is due to pregnancy and childbirth, especially vaginal childbirth. Other causes include prior pelvic surgery, menopause, and aging. This problem may also run in families.

The following videos show the different types of prolapse that can occur. Keep in mind that often more than one organ can be affected at the same time. Prolapse occurs in stages. Mild cases are those in which the organs have dropped only a short distance. Severe cases are those in which the organs have dropped a greater distance.

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