Expert Urogynecology Care
Improving the Quality of Your Life
Keri Lowe, 46, a busy working mom, did what a lot of women do when they have annoying symptoms that aren’t life-threatening — she tolerated the discomfort. 
Her gynecologist had suggested seeing a urogynecologist for her stress incontinence and a feeling of pressure in the pelvic area, but Keri put it off. She was reluctant to take time out from her hectic life for a bladder sling surgery, the most likely solution, and thought coping with it would be easier.
Stress incontinence happens when movement – such as coughing, laughing, sneezing, running or heavy lifting – puts pressure on the bladder and causes urine leakage. Keri had experienced it off and on since delivering her first child 20 years earlier, and her symptoms increased as she got older. Keri needed to limit drinks and caffeine, scope out the bathrooms everywhere she went, and wear pads. Over the past few years, her symptoms also included heaviness and cramping in the pelvic area.
“Over time, I accepted it and learned to live with it,” Keri recalls. “I knew about the bladder sling surgery because my grandmother had one years ago and said it was lifechanging, but I guess I thought my symptoms weren’t bad enough. Then in the course of a month, if I had back-to-back shifts, I would feel significant discomfort for a couple of days at a time, and it got almost unbearable.” Attributing it to pressure on her bladder, Keri realized she couldn’t postpone the urogynecology consult any longer.
She scheduled an appointment with Diego Illanes, MD, a urogynecologist with Milford Regional Physicians Group Urogynecology, who is board certified in Obstetrics and Gynecology, as well as Female Pelvic Medicine and Reconstructive Surgery. She knew Dr. Illanes from her job working as an OR surgical tech at Milford Regional. On February 22, Keri became an OR patient herself when Dr. Illanes performed the bladder (mid-urethra) sling and a transvaginal hysterectomy.
Thanks to his expertise, Keri had learned that a second pelvic floor condition, unrelated to the stress incontinence, was causing her pain. After a physical exam, Dr. Illanes told her that she had pelvic organ prolapse, a disorder that involves one of the pelvic floor organs – including the bladder, uterus or bowel – dropping or pressing into the vagina. In Keri’s case, her uterus was drooping. The diagnosis shocked Keri as she had just expected him to recommend a bladder sling and perhaps physical therapy. Although he advised those conservative treatments also, his suggestion that she undergo a hysterectomy to remove her uterus and cervix caught her off-guard. (Note that in some patients, the prolapse can be performed without a hysterectomy.)
“I did not anticipate that at all,” says Keri, who lives with her family in Holden. “I was definitely surprised when he said hysterectomy, but it did explain the level of discomfort. After the shock wore off, I was relieved there would be a solution. Since I see Dr. Illanes all the time in the OR, I know his abilities and reputation and thought highly of him, as everybody does.”
Dr. Illanes explains that the pelvic floor muscles and surrounding tissues are supposed to keep the pelvic organs in place, but anything that puts increased pressure in the abdomen can lead to prolapse. It can be caused from pregnancy and childbearing – even years later – obesity, genetics, constipation, prior surgery in the pelvis, or an occupation that involves heavy lifting. According to Dr. Illanes, it’s estimated that more than 50 percent of women will suffer pelvic floor symptoms like Keri’s, and the symptoms will depend somewhat on which organ is drooping.
“The most common symptom is a sensation of fullness in the vagina,” says Dr. Illanes. “It can feel like they have something inside the vagina when they sit up or walk. There can be a sensation of incomplete emptying of the bladder and bowel, and some patients can have vaginal spotting and skin irritation. It’s all about how impactful it is on the patient’s quality of life. There are some people who it doesn’t bother at all, and we tend to be more conservative for those who don’t have an impact on their quality of life.”
Conservative treatment includes doing pelvic floor exercises at home – which Keri had already been doing on her own – or getting referred to a pelvic floor physical therapist. Patients can also try a removable device called a pessary, says Dr. Illanes. While this treatment helps more than half of patients, for others it’s less effective or they find it cumbersome. Dr. Illanes notes that about one third of pelvic organ prolapse patients choose to have surgery. Since Keri’s descending organ was the uterus, and due to the anatomy of it, he advised a hysterectomy. Although her menstrual cycle would cease after the procedure, her ovaries would remain intact, which would prevent early menopause.
“It’s one of the oldest pelvic surgeries we still do as it works very well,” explains Dr. Illanes. “It’s essentially removing the uterus and cervix through a small vaginal opening and reconstructing the tissue to the way it was before any pelvic changes happened, like chronic constipation or childbirth. Dr. Illanes also performs laparoscopic and robotic-assisted surgery, but the natural orifice/transvaginal approach was best suited for Keri. With this type of natural orifice surgery, there are no cuts or scars on the outside. The procedure takes about 90 minutes under general anesthesia. “They get to go home the same day.” Dr. Illanes relates that at Milford Regional, he applies several key guidelines for recovery known as Enhanced Recovery After Surgery (ERAS) protocol for natural orifice surgery. It’s a multidisciplinary approach involving anesthesiologists, recovery nurses, operating team members and other staff.
“We take pre-and post-operative measures to make sure patients are up on their feet and recovering fast and easily,” Dr. Illanes says. “The whole idea is to prevent other problems like infection and to decrease the use of narcotics or opiates.” Dr. Illanes performed the bladder sling and the hysterectomy at the same time so that Keri would only need anesthesia once and could address both problems simultaneously. Although the bladder sling wouldn’t have required general anesthesia on its own, she still would have needed sedation or local anesthesia. He describes the bladder sling as supporting the urethra (exit tube of the bladder) to the surrounding structures.
“We make a very small incision inside the vagina that deploys this little hammock-like shaped material next to the bladder and the urethra, the tiny tube where the urine comes from,” explains Dr. Illanes. “It is a physical support to the excessive movement of the bladder. It takes about ten minutes.” Since she has had nausea after anesthesia in the past, Keri was apprehensive and went over her concerns with the anesthesia team. To her relief, she felt fine when she woke up. “They were incredible and did so much to ensure not only my comfort and safety, but to make sure I had absolutely no nausea post-operatively,” states Keri.
When Keri got home, she alternated Tylenol and Advil for a couple of days, and then reduced it to as-needed. According to Dr. Illanes, after a sling surgery, patients are usually back at work the next day and exercising in two to three weeks. After a hysterectomy, they should refrain from exercise for four to six weeks. Those with a desk job can return to work in a couple of days, but he recommends taking off four to six weeks for a more physically demanding job. After her surgeries, the incontinence went away immediately, and so did her pain. Keri did physical therapy to retrain her pelvic muscles so she could go for longer intervals without urinating.
“It’s a drastic improvement,” she says. “I don’t have that pain and pressure at all, which is huge when I’m on my feet 12 hours a day. It’s a relief to just focus on what I’m doing. For anyone going through these symptoms, you don’t have to just adapt and live with it and revolve your day around it. It’s hard to accept that you’re going to have surgery and will need time to recover, but it’s just in the short term. For the long term, it’s going to be so much better. In hindsight, why I put myself through all that, I don’t know. It’s such a huge weight off and it’s truly life-changing.”
Appointments can be made with Dr. Illanes by calling 508-902-9753.
Read more about Dr. Illanes here.
