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Bladder Problems After Endometrial Ablation

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What Happens During Endometrial Ablation

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An endometrial ablation may be done in the office or in the operating room. Youll be given a gown and an IV. Youll situate yourself on a table as if youre having a pelvic exam. You may be given medicine about an hour before the endometrial ablation to help manage any discomfort after the procedure. Depending on the type of endometrial ablation, your provider may numb your pelvic area and give you sedatives so that you dont feel any pain or discomfort during the procedure.

During endometrial ablation, your healthcare provider inserts a delicate, wand-like device into your vagina. This device extends through your cervix and into your uterus, where it can reach the lining. Depending on the type of endometrial ablation, the device sends energy, heat or cold to destroy part of the lining. The technology makes things quick and you should have minimal or no discomfort during the procedure.

How To Choose A Treatment With Your Doctor

The first step is to talk to your doctor about your heavy bleeding problem. Your doctor will do a series of tests to find the cause of your excessive menstrual bleeding. Excessive bleeding by itself is not a disease. It is a sign or symptom of a number of possible medical conditions.

Using ultrasound and/or hysteroscopy , and some other medical tests, your doctor will find the cause of your bleeding.

Your doctor will then help you select the right treatment. Depending on the reason for your excessive bleeding, your doctor may suggest that you first try medications. If medications do not work, or you are not allowed to take them for other reasons, your doctor may suggest endometrial ablation using the Minerva device.

The following table shows common treatments used for excessive bleeding and the advantages and disadvantages for each.

Treatment Options

Mesh Removal And Revision

Mesh removal and revision refers to removing part or all of a piece of pelvic mesh. Most often, this is mesh that has eroded into the vagina or is causing pain in the vagina. However, it may also be mesh that has eroded into other organs or tissues. At times we cannot remove all of mesh, but regularly can remove all that is coursing through the vagina. This procedure usually requires a native tissue repair at the same time as mesh removal to attempt to minimize the recurrence of the prolapse.

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Can You Get Pregnant After Endometrial Ablation

Although not impossible, it is unlikely that a person will be able to get pregnant after endometrial ablation. This means that the procedure is not suitable for those who plan on having children, or those who have already had children but wish to have more.

Moreover, there is an increased risk of miscarriage or other pregnancy complications in people who have had the procedure.

However, as pregnancy is still a possibility, using contraceptives afterwards , is necessary.

When To Call Your Doctor

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Your doctors office will likely call you to check on you after your treatment. However, if after the procedure you are experiencing increasing pain, increased bleeding, greenish foul smelling vaginal discharge, or have a fever greater than 100.4°F, immediately call your doctors office. In rare cases, endometrial ablation can cause a serious injury that, if not treated promptly, can lead to death.

If you call your doctor at night or on a weekend, your doctors office will likely have an answering service that will put you in touch with your doctor or the doctor on-call. If you are not able to talk to your doctor, call 911 or go to the nearest Emergency Room.

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What Happens During Treatment

At the time of the procedure, the doctor will insert a speculum so that your doctor can see inside. The doctor may make your cervix numb so that you do not feel pain during the procedure. Based on this procedure, the doctor may determine that you are not a candidate for treatment with Minerva. In that case, the doctor will talk to you about other options to treat your heavy menstrual bleeding.

The doctor will gently dilate your cervix to insert the soft tip of the Minerva device into your uterus. The Minerva Controller will then provide energy to heat the inside of your uterus for 2 minutes. At the end of the treatment, the doctor will completely remove the device from your uterus. The entire treatment, from the time the device is inserted until the device is removed, usually takes less than 4 minutes.

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Is It Normal To Experience Discharge After Ablation

Its normal to experience a thin, watery discharge after ablation. The discharge may also be bloody or mixed with blood. It will likely be heavy for the first few days after your surgery. Any endometrial ablation discharge should stop after, at the latest, a few months. If your discharge changes in color or smell, call your doctor right away.

Why Is Endometrial Ablation Surgery Performed

Endometrial Ablation with Gynecologist Dr. Maryann Prewitt

The procedure is carried out in women with extremely heavy periods , which are affecting their everyday life. Women with heavy periods will lose a significant amount of blood each month, which often affects their physical and mental health.

Feeling anxious or embarrassed are all common in people with heavy periods, many of whom may begin to avoid going out or socialising for fear of leakage. Menorrhagia can also lead to iron-deficiency anaemia, which occurs when there are not enough red blood cells in the body to carry oxygen around it, due to excessive blood loss. This condition typically makes people feel extremely tired or out of breath.

A period is considered heavy when:

  • Bleeding lasts for longer than a full week
  • When the patient soaks through at least one sanitary pad or tampon every 1-2 hours
  • The patient needs to use double sanitary protection
  • The patient wakes up in the night to change their sanitary pad or tampon
  • Large blood clots are passed during menstruation
  • Heavy menstrual flow is interfering with their day-to-day life
  • The patient is experiencing anaemia and feeling extremely tired during their period

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What Happens During An Endometrial Ablation

You may have an endometrial ablation in your healthcare provider’s office,as an outpatient, or during a hospital stay. The way the test is done mayvary depending on your condition and your healthcare provider’s practices.

The type of anesthesia will depend on the procedure being done. It may bedone while you are asleep under general anesthesia. Or it may be done whileyou are awake under spinal or epidural anesthesia. If spinal or epiduralanesthesia is used, you will have no feeling from your waist down. Theanesthesiologist will watch your heart rate, blood pressure, breathing, andblood oxygen level during the procedure.

Generally, an endometrial ablation follows this process:

For Ablations Using A Hysteroscope

  • You will be asked to remove clothing. You will be given a gown to wear.
  • An intravenous line may be started in your arm or hand.
  • You will lie on an operating table, with your feet and legs supported as for a pelvic exam.
  • Your healthcare provider may put a catheter into your bladder to drain urine.
  • Your healthcare provider will put a tool into your vagina. He or she will use it to widen your vagina and see the cervix.
  • Your provider will clean your cervix with an antiseptic solution.
  • Your provider may use a type of forceps to hold the cervix steady for the procedure.
  • Your provider will open the cervix by putting in thin rods. Each rod will have a wider diameter than the previous one. This process will gradually make the cervix opening larger so your provider can put in the hysteroscope.
  • Your healthcare provider will put the hysteroscope through the cervical opening and into the uterus.
  • Your provider may use a liquid or carbon dioxide gas to fill the uterus. This will help him or her see it better.
  • Your provider will put the ablation tool through the hysteroscope. He or she will move a roller ball or wire loop with electrical current across the uterus lining. This will destroy it.
  • For hydrothermal ablation, your provider will put a heated liquid into the uterus through a catheter. The liquid is pumped around your uterus to destroy the lining.
  • After the procedure is done, your provider will pump any fluid out from your uterus and remove the instrument.
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    How Will I Feel Afterward

    As with any endometrial ablation method, you may experience some post-operative uterine cramping and discomfort shortly after the procedure.

    Some patients may experience nausea and vomiting as a result of anesthesia. Watery and/or bloody discharge is also common for several weeks after any endometrial ablation.

    What Happens After Endometrial Ablation Surgery

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    Typically, it only takes several days to recover from endometrial ablation and return to normal activities, though this varies from patient to patient. For a few days after the procedure, it is common to experience a dull ache and some discomfort in the abdomen, similar to normal period cramps. Over-the-counter pain medication can help relieve this pain. As a result of the anaesthetic, patients may also feel nauseous immediately after the procedure, but this will wear off quickly.

    Feeling lethargic for several days following the procedure is commonplace, so it is important to rest up and take a few days off from work. Most people will be able to return to work between 2-5 days after the surgery, depending on the type of job they have. If their job is particularly physically demanding, taking a few more days off is recommended.

    Vaginal bleeding and watery discharge are common for the first few weeks, but it is important to note that if the discharge becomes smelly or changes colour, consult your GP, as this can indicate an infection. Likewise, if you start to feel unwell or are in pain, you should seek medical attention.

    Patients should avoid using tampons for the first few weeks after the procedure, instead opting for sanitary towels. Sex should also be avoided until the bleeding or discharge has stopped.

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    Urinary Incontinence: Why It Happens How To Fix It

    If you suffer from frequent urination and the feeling that you might not make it to the bathroom in time, you are not alone. A condition called urinary stress incontinence is more common than you might think, but according to Los Angeles OB/GYN Dr. David Ghozland, the condition is treatable with non-invasive, stress urinary incontinence surgery.

    There may be many reasons why a woman suddenly develops urinary incontinence, including underlying health conditions like diabetes, urinary tract infections, obesity, undergoing a hysterectomy or even internal pressure from uterine fibroids. Still, one of the most common causes of urinary stress incontinence is having gone through a vaginal birth. The reason is that vaginal delivery can weaken the support system of the urethra and bladder. In a nutshell, less support equals diminished bladder control.

    Menopause is another common cause of urinary stress incontinence. When estrogen production ceases, it can result in a thinning of the urethra tissues and weaker muscles of the bladder. Obviously, when the bladder is not properly supported, urinary leaks are much more likely.

    There are many common symptoms of urinary stress incontinence, including urine leakage when you: Cough or sneeze Get in and out of a car Lift anything heavy Work out Have intercourse

    What Is Endometrial Ablation

    Endometrial ablation is a procedure that uses heat, cold or different types of energy to destroy the lining of the uterus. If heavy periods are a problem, your doctor may recommend an endometrial ablation as an option to treat them. Its less dangerous and has fewer limitations than a hysterectomy. However, many patients try medications to control their bleeding before having an endometrial ablation. After an endometrial ablation, you may have no bleeding, less bleeding or no change in your bleeding during your periods.

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    Laparoscopic Supracervical Hysterectomy Versus Endometrial Ablation For Women With Heavy Menstrual Bleeding : A Parallel

    • Kevin CooperCorrespondenceCorrespondence to: Prof Kevin Cooper, Department of Obstetrics and Gynaecology, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK
    • Health Services Research Unit, University of Aberdeen, Aberdeen, UKHealth Economics Research Unit, University of Aberdeen, Aberdeen, UK
    • John NorrieAffiliationsEdinburgh Clinical Trials Unit, Centre for Population Health Sciences, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
    • on behalf of theHEALTH Study Group
    • Members listed at the end of the paper

    What Is Heavy Or Excessive Menstrual Bleeding

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    This is a very common problem that affects about 1 in 3 women.12. The signs of heavy bleeding are most likely to start between the ages of 30 and 40. Many women also say that excessive menstrual bleeding makes it difficult to work, exercise, and be socially and sexually active. You may also feel weak, tired, and have no energy.

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    Which Symptoms Are A Cause For Concern

    These are warning signs of infections or complications after your endometrial ablation:

    • A fever
    • Increased pain and swelling after a few days
    • Trouble passing gas and/or stool
    • Being sick to your stomach
    • Trouble drinking fluids
    • A change in the vaginal discharge in color or smell
    • An increase in bleeding for longer than two days after the procedure
    • Large clots in the vaginal discharge
    • Signs of a blood clot in your leg
    • Persistent abdominal pain after the normal cramping

    If you are experiencing any other unusual symptoms, please contact your doctor.

    How Often Do These Type Of Late

    As of this writing there are over 500,000 endometrial ablations performed in the United States per year. To the best of our knowledge this problem affects more than 25% of women within the first 5 years of their endometrial ablation thats a minimum of over 100,000 late-onset failures per year. We know that it can happen up to 15 years following EA but the vast majority of them occur within the first 3 years. So if youve managed to make it 3 years without an issue it doesnt mean youre entirely out of the woods. However, statistically-speaking, most issues happen within the first 3 years.

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    What Are The Risks Of Endometrial Ablation

    You may not be able to get pregnant after endometrial ablation. You may bleed more than expected or get an infection in your vagina, urinary tract, or uterus. Your cervix, uterus, or nearby organs may be burned or damaged. You may get a blood clot in your leg or arm. A blockage may form over months to years and cause blood to pool inside your uterus. This blockage may cause severe pain and you may need a hysterectomy. You may also need a hysterectomy if endometrial ablation does not work.

    Why Is The Diagnosis Delayed Or Missed

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    Often the diagnosis is delayed or missed because the wrong tests are ordered. In other instances the correct test was ordered but was misinterpreted. For instance, in the women weve seen who present with the most troubling kind of endometrial ablation failure, many of them have had CT Scans and pelvic ultrasounds. CT Scanswhich are both expensive and time consumingare very good in the diagnosis of bowel and kidney disease or for an acute appendicitis. However, they are far less sensitive than an ordinary transvaginal ultrasound for the diagnosis of a late-onset endometrial ablation failure! However, a common issue we encounter in managing women with LOEAFs is that a surprising number of them have undergone ultrasound examination and told that it was normal. This is NEVER TRUE following an EA.

    Let me explain. Even if youve had an endometrial ablation and its worked perfectly, your uterine lining has been totally or partially destroyed and your ultrasound is never normal again! So if someone has told you that you have a normal vaginal ultrasound examination a red flag should go up. Often the ultrasound examination clearly displays the abnormality but the radiologist misinterprets the findings as they often dont understand what post-ablation ultrasounds typically look like.

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    So What Are The Benefits Of Ugrhs Compared To Hysterectomy

    The advantages of UGRHS include the following:

  • Its an office-based procedure performed with intravenous sedation.
  • Rapid return to workmost women can return to their jobs in 48 hours.
  • The complication rate of UGRHS is extremely low. Infection occurs about 1% of the time. Uterine perforation has occurred in 1 out of our 450 cases. This rate is FAR LESS than the incidence of complications that are associated with all forms of hysterectomy.
  • Its effectiveness in avoiding hysterectomy in approximately 85-90% of women. To be clear its not perfect. Failures are greater in younger womenthose under 35. The ideal age group for UGRHS is > 45 years of age.
  • Are There Any Risks Associated With Novasure

    Your physician will explain the surgical risks of all treatment options in detail. Some risks of endometrial ablation procedures are perforation of the uterus, bleeding, infection, injury to organs within the abdomen and pelvis, and accumulation of blood within the uterus due to scarring. A possible hazard may exist for women with cardiac pacemakers or other active implants.

    Another rare, but important, risk of any endometrial ablation procedure is that it may decrease your doctorâs ability to make an early diagnosis of cancer of the endometrium. The reason for this is that one of the warning signs of endometrial cancer is bleeding, and endometrial ablation procedures decrease or eliminate bleeding.

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