Las Colinas OBGYN | Patient Feedback

Prolapse of pelvic organs such as the bladder, rectum, bowel and uterus have rapidly increased over the years as the baby boomer generation ages and the traumas of childbearing become apparent. Many women are either too shy or too embarrassed to even bring up the problem with their physicians. While it may be an embarrassing topic, living with these conditions without seeking medical help has consequences.

How Does it Happen?
The origin of a pelvic organ prolapse can usually be traced to the weakening of tissues as a baby passes through the birth canal. This stretching an tearing of tissues gradually worsens over time as gravity and estrogen loss results in the loss of collagen in the vaginal tissues and various muscles, fascia (bands of fibrous connective tissue), and ligaments. Babies born today are usually larger than those born a few generations ago, causing more trauma during birth. In addition, women today are heavier and have more weight pushing on their pelvic organs. It also doesn’t help if one is a smoker. The loss of connective tissue and the chronic smoker’s cough also factor in. a coughing asthmatic or one with chronic bronchitis is also more prone to prolapse and incontinence. Occasionally, these problems occur in women who have never had children or have had cesarean sections. This is explained by one’s inherited weakness of supporting structure.

A Look at the Symptoms
The general symptoms of pelvic organ prolapse include a sensation of fullness or heaviness in the vaginal region. A woman finds a bulge starting to protrude through the vaginal opening. Sometimes the entire vagina or uterus may protrude between a woman’s legs.

Others find physical activity difficult because of the incontinence that often accompanies the prolapse. It takes a careful examination by a gynecologist or urogynecologist to precisely diagnose whether the defect is a cystocele/urethrocele (bladder and urethral prolapse), a rectocele (rectal prolapse into the vagina), an enterocele (small bowel into the vagina) or a uterine prolapse (the uterus descending down the vaginal canal).

Diagnosis of pelvic prolapse includes a complete history and physical examination. “Bladder studies,” performed with a computerized machine, are often required to make a specific diagnosis.

Treatment Options
Nonsurgical Treatments include the use of pessaries. These are latex, or rubber devices that are placed inside the vagina to hold back the prolapsing structures. Some women even find the use of a tampon to function a similar manner. Unfortunately, the well-known Kegel exercises have essentially no effect on pelvic organ prolapse but may be helpful for incontinence.

Surgery is often needed to repair the weakened tissues that bulge into and out of the vagina. However, surgical repair of the cystocele remains one of the most difficult challenges in female pelvic floor reconstruction. Failure rates of traditional “anterior colporrhaphy” range from 20 to 40 percent. New techniques using biologic tissue or polypropylene mesh have dramatically reduced these failures to less than 10 percent. Unfortunately, most gynecologists, urologists, and even urogynecologists have not been trained in laying down tissue or mesh in the repair of these vaginal hernias. The use of tissues, such as human or pig dermis carries its own risks, including rejection and infection. The use of polypropylene mesh also has added risks of erosion into the vagina or bladder.

With improving techniques and technology, these risks have been lowered, and acceptance of these methods in the United States has increased dramatically. The European and Australian medical communities are about five years ahead of the United States. They deserve the credit for the changes affecting American urogynecology today.

Millions of women suffer from stress incontinence, the involuntary leakage of urine during exercise or certain movements such as coughing, sneezing, or laughing. In the past, women had to manage this problem with pads and adult diapers, but recent advances in surgery have made it possible to treat the conditions with a high rate of success.

The impact of urinary incontinence can cause a loss of one’s sense of well-being and quality of life. Additionally, it carries a financial cost. Lifetime medical costs for each woman treated for stress incontinence can reach nearly $60,000, excluding the cost of personal hygiene products which are not covered by medical insurance. Ironically, women spend more money on diapers and pads for incontinence than for menstruation.

France’s Dr. Emmanuel Delorme pioneered the transobturator sling in 1999. It was introduced to the European market. It soon became popular because the procedure is simpler and faster, with less risk of complications, than alternative procedures. In the last two years over 11,000 women have been successfully treated for stress incontinence with the transobturator sling.

Minimally invasive sling surgery for the management of female stress urinary incontinence was introduced in the early 1990s. Las Colinas Medical Center in Irving was the first medical center in the Southwest region of the United States to offer the procedure. Innovations in minimally invasive sling surgery for the management of femal stress urinary incontinence seek to improve safety, efficacy, and patient satisfaction. The transobturator approach is one of the latest developments in the field. John J. Zavaleta, M.D., medical director of Las Colinas ObGyn is participating in a national multi-center trial designed to confirm perioperative risks.

Clinical experience indicates that the transobturator approach shares the same success rate as the standard, more complex procedure. Yet this new approach avoids the need to operate in the proximity of major blood vessels and the bowel, significantly reducing operative risks, complications and recovery time. Most patients are able to manage any discomfort with over-the-counter analgesics.

Source:Southern Vanity Magazine

A rectocele is a defect in the shape of the vagina, which is caused by a detachment of the rectovaginal septum (RV septum). The RV septum acts as a bridge of tissue between the vagina and the rectum, providing support and stability. The defect can occur from the detachment of the RV septum at the entrance of the vagina, the sidewalls of the vagina, or the top of the vagina behind the cervix. The defect makes the vagina feel expanded and loose and is often referred to as vaginal pressure.
A rectocele can cause a variety of symptoms, which are often misunderstood or attributed to other conditions. They can include worsening constipation since giving birth, or the requirement of an increase of fiber in the diet, use of stool softeners, or change in positions to have bowel movement. When the RV septum detaches from the back of the vagina, the small intestines and a part of the rectum can bulge into the affected part of the vagina, causing a change in bowel habits and making it difficult to defecate spontaneously. A rectocele can also cause the expulsion of air from the vagina during sexual intercourse.
“Natural tears” can occur during childbirth for many reasons, such as giving birth to large babies, difficult or long labors, and the use of instrumentation such as forceps, episiotomies, or unrecognized tears deep in the pelvis, which damage the nerve supply. Unfortunately, even delivery by C-section (with or without labor) can cause damage to the RV septum. Other predisposing factors can include obesity, poor nutrition, smoking, chronic cough, constipation, heavy lifting, or having genetically poor tissue strength. The surgical procedure to correct these defects is called a “site specific repair.”
This will help enhance sexual pleasure for the woman and allows the penis more direct contact with the “G-spot,” since the correct angle of the penile penetration is restored. Additionally, since the repair procedure restores the muscular structure of the vagina, a woman’s male partner receives more stimulation to his penis. Women should take a proactive position, and discuss her symptoms or concerns with her gynecologist. These medical conditions may be covered by health insurance and are often done in a day surgery, so that the patient can go home a few hours after surgery with recovery time of about a week. Resumption of sexual intercourse is usually between three to six weeks (depending on the situation).

With the recent FDA approval of the Essure System (Conceptus), women seeking permanent sterilization now have the option of choosing a minimally invasive procedure performed without abdominal incisions or general anesthesia.

Las Colinas Medical Center in Irving, Texas is one of the first centers in the state to offer this new sterilization method, which involves placing a small metallic implant into a section of each fallopian tube using a standard five-millimeter telescope (hysteroscope) and a disposable delivery system. Each implant consists of a spring-like coil with intertwining polyethylene fibers. The flexible coil expands when released in the fallopian tube, anchoring itself and conforming to the shape and diameter of the tube. John J. Zavaleta, M.D., medical director of Las Colinas ObGyn has found the technique to be both safe and highly effective. Typically patients are able to resume their normal activities within a day or two, at most, following surgery.

Compared with laparoscopy that typically requires general anesthesia and possible hospital admission, the Essure system offers advantages for the patient. It is a welcome addition for women who may be poor candidates for laparoscopic procedures, including those who are very obese or who have had multiple previous abdominal surgeries, in that it offers less risk than the more traditional approach. The Essure procedure is done in the office with mild sedation by board certified anesthesiologists.

Women who undergo the hysteroscopic sterilization procedure must continue to use some form of contraception while waiting for the painless scarring to close the fallopian tubes. After approximately three months, patients return for an evaluation including x-rays to verify proper localization of the device and complete tubal blockage. This visit typically results in the discontinuance of the need for alternate contraception. Essure is a simple, safe, office procedure covered by all insurance. Most require only your customary office co-pay.

Have sneezing, laughing, and getting a little exercise become the source of embarrassing situations? Are you keeping a secret about urinary incontinence? If so, and you’re too uncomfortable to talk to your doctor about it, you are not alone. Nearly 20 million women are living with urine leakage and often avoid situations that could reveal their condition, many women mistakenly believe that incontinence is just a part of getting older-but it’s not!
“Urinary incontinence is not an inevitable part of the aging process,” emphasizes John J. Zavaleta, M.D. of Las Colinas Center for Women’s Continence. “Urinary incontinence is no laughing matter. Here at the Center for Women’s Continence we restore the pelvic anatomy to its size and shape before damage occurred. Highly effective, minimally-invasive treatments are available, and most can be done in outpatient settings.”
“A lot of women aren’t aware that a specialty exists for management and care of pelvic floor and incontinence conditions,” Dr. Zavaleta adds. “Time and again, women will suffer unnecessarily with pelvic prolapsed and incontinence simply because they haven’t seen the right specialist and undergone the appropriate care,” he adds. “There is no reason to tolerate it. There are effective outpatient surgical procedures that restore your vaginal anatomy allowing the surrounding tissue to function again, normally.”
“However, with sophisticated testing mechanisms like urodynamics and cystourethroscopy, the precise nature of the problem can be identified, allowing treatment plans to be individualized for each woman’s unique condition.”
Advanced Improvements in Care
From pharmacologic management to pelvic floor rehabilitation and minimally-invasive reconstructive surgical techniques, effective solutions exist for virtually every form of incontinence and pelvic floor disorder.
“For women with overactive bladder conditions who have failed to improve conditions who have failed to improve with pharmacological management, we can now provide a new treatment option called InterStim therapy, which uses mild electrical pulses to stimulate the nerve that controls the bladder and surrounding muscles that manage urinary function,” says Dr. Zavaleta.
Tears in the connective tissue are another common problem that can lead to incontinence. Although many tears occur as the result of vaginal and C-section deliveries, tears may also be caused by obesity, poor nutrition, smoking, chronic cough, constipation, heavy lifting, or having genetically poor tissue strength.
“The surgical procedure to correct these defects is called a ‘site specific repair’,” Dr. Zavaleta explains. “By restoring the muscular structure of the vagina, this procedure can not only correct incontinence, but it may also enhance sexual pleasure, improve bowel function and alleviate low back pain.”
The Life You Deserve
“Our highest priority is to provide patients with a safe, welcoming environment.” Dr. Zavaleta says. “We want you to feel comfortable expressing your concerns and asking the questions that may feel awkward to discuss.”
“No woman needs to simply ‘live with’ incontinence. It is my personal commitment to ensure your quality of life through superior care and the most current procedures and resources available.”
An expert in the diagnosis and management of female urinary incontinence, pelvic organ prolapsed and fecal incontinence, Dr. Zavaleta, together with his staff, provides a complete range of treatment options for urinary incontinence and other pelvic floor disorders at Las Colinas Center for Women’s Continence in Irving, Texas. The physicians at the Center for Women’s Continence have done thousands of cases that have improves the quality of life of our patients. No more incontinence, better bowel habits, no longer living with low back pain. Improve your quality of life and improve your relationship.

John J Zavaleta, M.D., FACOG, a board-certified gynecologist with Las Colinas Obstetrics Gynecology-Infertility Associations, reports that as many as one in five American women (that’s an estimated 10 million women, so know you’re not alone) suffer from menorrhagia (excessive menstrual bleeding). This condition can limit their daily activities, impair quality of life and strain marital and family relationships. Many women with menorrhagia eventually receive hysterectomies, accounting for as much as 45% of all hysterectomies in the United States.

Women with menorrhagia experience protracted or unmanageable bleeding, often suffering in silence due to lack of awareness of treatments or reluctant to discuss the problem. Menorrhagia may also negatively impact a woman’s general physical health and mental well-being. “More than two-thirds of women who bleed excessively are anemic as a result,” pointed out Dr. Zavaleta. “Standard treatments like hormone therapy work with some women but are not tolerated well by others. Hysterectomy is a major surgery with a four-to-six week recovery period and long-term implications.” Fortunately, a new minimally invasive surgical procedure is now available; which promises relief and hope for these women.

The new therapy employs several devices recently approved by the U.S. Food and Drug Administration. The approach allows the uterus itself to be spared. “Therapy offers a safe, effective, less-invasive alternative to hysterectomy for women who have completed childbearing,” explained Dr. Zavaleta. “The therapy is performed with a local anesthetic or mild sedation if requested.”

Most women see a great decrease in their level of menstrual bleeding. In a clinical study 91% of women reported normal bleeding or less and 41% reported no bleeding at all. Many women also had significant reduction in painful periods and PMS symptoms such as irritability.

Studies show that following treatment, most women can expect lighter and less painful periods, or possible no periods at all. Nearly 9 out of 10 women treated had a reduction in menstrual pain and cramping 1 year after treatment. In addition, 2 out of 3 women treated experienced mild or no PMS symptoms 1 year after treatment. One year after treatment, 96% of women treated were satisfied with their results, and 99% would recommend the treatment to others.

Dr. John J. Zavaleta is board-certified by the American College of Obstetrics and Gynecology and has been a practioner of women’s healthcare for the past 24 years in Irving, Texas. He graduated from the University of Texas Southwestern Medical School in Dallas and completed his ObGyn residency at Baylor University Medical Center in Dallas. He has continued to perform many advanced procedures and has been instrumental in treatment advances through the years.