The Importance of Pelvic Floor Health

by KegelsPelvic Floor MusclesPelvic Floor WeaknessPelvic Organ ProlapsePessaryPOPStress Urinary Incontinence

Guest Post by Linda Grayling

A healthy pelvic floor serves as the supporting structure for the pelvic organs, which include the uterus, bladder and rectum. It supports the weight of the baby during pregnancy, and plays a role in core strength and posture. A strong pelvic floor can make childbirth and recovery easier, enhance sexual sensation, and help prevent pelvic floor disorders.

The extra pressure placed on the pelvic floor from supporting the baby throughout pregnancy and the strain of delivery can weaken this support system. This can lead to pain during or the inability to have sex, urinary incontinence, trouble with bowel movements, and prolapsed or displaced pelvic organs.

High-impact activities, heavy lifting, chronic coughing, frequently straining to produce a bowel movement, obesity, and smoking can also contribute to a weakened pelvic floor and increase the chance of developing a pelvic floor disorder.

Stress Urinary Incontinence
Stress urinary incontinence (SUI) is a common pelvic floor disorder that affects at least a third of all women at some point in their lives. It occurs when the stress from normal activities–like exercise, coughing or sneezing, laughing and even sex–triggers accidental urine leakage.

Many women experience minor issues with bladder control every now and then, but when incontinence becomes more frequent or interferes with daily life, they should talk to a doctor. Incontinence is directly related to the strength of the pelvic floor. Weakened pelvic floor muscles increase the odds of developing SUI.

Performing Kegel exercises daily can resolve symptoms of incontinence in just a few weeks. Not only will women stop experiencing embarrassing leakage during sex, but Kegels also heighten sexual sensation and help achieve orgasm.

Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the pelvic floor is no longer strong enough to hold the pelvic organs in their proper place, allowing them to sag against the vaginal walls–and in severe cases, protrude from the vaginal canal. Prolapse occurs in half of all childbearing women, but is frequently without symptoms, making it a non-issue.

For women who do experience symptoms, they can include a pulling feeling or pelvic pressure, low back pain, problems with bowel movements and urinary problems, pain during sex, and unusual spotting or bleeding. Symptoms can worsen over time.

Women should always try conservative treatments before considering surgery. Strengthening the pelvic floor throughout pregnancy and after childbirth is especially important in avoiding pelvic organ prolapse later in life.

Physical therapists can offer personal instruction on locating, isolating and strengthening the pelvic floor, and may employ biofeedback therapy, pelvic massage or the use of vaginal weights. Doctors may also recommend the use of a vaginal pessary to keep pelvic organs in place.

In recent years, many women have had corrective surgical procedures using transvaginal mesh to strengthen the pelvic floor. The complications associated with transvaginal mesh are not always reversible, and include organ perforation, mesh erosion and the need for revision surgery.

These complications have prompted the Food and Drug Administration (FDA) to issue a warning stating that most cases of prolapse can be corrected without mesh and that mesh can expose patients to greater risk.

Women should ask their doctors about all of their surgical repair options, which can include using the patient’s own tissues or biologic products.

Linda Grayling writes for Drugwatch.com. Linda has a number of professional interests, including keeping up with the latest developments in the medical field. Join the Drugwatch community on our Facebook page to find out more.

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Women’s Urinary Incontinence: What You Gain When You Seek Medical Help

by Find the Right DoctorGeneral Urinary IncontinenceOveractive BladderPelvic Organ ProlapsePessaryPOPStress Urinary IncontinenceUrge IncontinenceUrge Urinary IncontinenceUrinary Incontinence

In our last article, we discussed all the quality of life aspects that go out the window when women with urinary incontinence fail to seek medical help for their condition. In this follow-up article, we take a look at all the benefits you gain when you seek medical help for women’s urinary incontinence. Yes, we know, seeking medical help involves having that “red-faced” embarrassing conversation with your doctor about urinary urgency, frequency, and leakage. But after you read through all the benefits you will gain once you get through that conversation, our bet is that you will be willing to ask your doctor for help (if you haven’t already)!

Benefit #1: A Medical Diagnosis
A lot of women with urinary incontinence know that they have a problem, but they don’t know exactly what the problem is. They know they suffer from urinary urgency or frequency or leakage, but may not necessarily know the causes of these symptoms. This lack of knowing “what’s up down there” can create a sense of tension and stress for many women. Therefore, one of the biggest benefits of getting help from your doctor is that you get a true and medically-correct diagnosis about your condition. You will find out if you have stress, urge, or mixed urinary incontinence … or just a mild form of urge incontinence called overactive bladder (OAB). You will discover whether your pelvic organs have “fallen” out of place, causing some of your symptoms. Whatever the cause of your urinary incontinence symptoms, you will emerge from your conversation with your doctor with the knowledge of what is happening with your body. Since “knowledge is power,” you will emerge from your appointment with a new sense of self-empowerment. That is a pretty neat benefit.

Benefit #2: Knowledge of Treatment Options
Once your healthcare provider discovers the cause of your symptoms, such as urinary urgency or leakage, the next step is obviously to discuss treatment options. Depending on the type and severity of your symptoms, your doctor may recommend either conservative or surgical treatment options. Conservative options may include lifestyle changes, such as smoking cessation, weight loss, and dietary changes. Other conservative therapies include bladder retraining, pelvic floor muscle rehabilitation, acupuncture, pessaries, and percutaneous tibial nerve stimulation.

If your condition is more severe, especially if one or more of your pelvic organs has fallen out of place (a condition called pelvic organ prolapse, or POP), then your doctor may recommend some surgical options to treat your condition. The good news is that most of the surgical procedures for women’s urinary incontinence are minimally-invasive, plus have a high rate of success.  Most healthcare providers will recommend that you start with the most conservative therapy possible, and consider surgery only if your condition is not treatable with conservative approaches.

Benefit #3: Support on the Journey Back to Health
While talking to your doctor about your urinary symptoms may be embarrassing, you will find that most medical professionals are quite knowledgeable and compassionate about women’s urinary incontinence. By seeking help from your doctor, you will not only get the help you need to restore yourself to continence, but you will gain the knowledge that you are not alone. As the baby boomer generation ages, more and more doctors are helping women with urinary incontinence issues. Your doctor will not only provide you with solutions that will treat your condition, but can also reassure you that you are not alone. Your doctor may even be able to recommend resources, both online and offline, where you can find additional support from women dealing with the same kinds of symptoms.

Big Benefits from Seeking Help
As you can probably tell, seeking help from your doctor will yield some pretty major benefits for you. Not only will you be able to address your physical symptoms, but you will also be able to ease your mind as you gain knowledge about urinary incontinence. The more you know, the more control you will have over your condition. The more control you have, the less stress you will experience. All of these are major contributors to a good quality of life. Doesn’t that make a short conversation with your doctor worthwhile?

 

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Women’s Urinary Incontinence: Overcoming Your Fear of Surgery

by Find the Right DoctorGeneral Urinary IncontinencePessary

When it comes to women’s urinary incontinence, embarrassment tops the list of reasons that affected women don’t seek help. Another major reason these women don’t seek help is this: fear of surgery. Affected women are afraid that seeking a medical diagnosis from a physician will automatically lead to surgery. Many people, not just women with urinary incontinence, have a fear of surgery. Luckily, these fears are mostly unjustified.

Women’s Urinary Incontinence: Try Conservative Methods First
Do you suffer from women’s urinary incontinence, and are you afraid that your doctor might suggest that you have surgery? If so, then we have good news for you. Unless your condition is very severe, most physicians will suggest that you try the least invasive and most conservative therapies first. These include pelvic floor retraining, lifestyle changes (such as weight loss, diet changes, and smoking cessation), bladder retraining, taking medication, using a pessary, and acupuncture. They may even suggest you try a combination of these therapies until you find what works to relieve your symptoms.

An interesting note about these conservative therapies is that they are more effective when used early on–that is, as soon as you notice the first signs of pelvic floor weakness. These therapies are effective for relieving symptoms of all three types of women’s urinary incontinence, as well as alleviating symptoms of pelvic organ prolapse and decreased sexual sensation. This information should definitely motivate you to seek medical help as soon as you begin experiencing problems with your pelvic health.

Overcoming Your Fear of Surgery
But what happens if conservative therapies are not effective for relieving your symptoms? In that case, you may need surgery to address the problem. If your condition is severe, such as when one or more of your pelvic organs have significantly shifted out of position (prolapsed), your physician may recommend surgery as the first step towards curing your condition. Or you may find that conservative therapies are effective for many years, but cease to work over time. This can occur because of aging, menopause, and the continued downward pull of gravity on your pelvic organs. In this case, you may also need surgery to alleviate symptoms that were formerly relieved by conservative therapies.

If your physician does recommend surgery, don’t hit the panic button just yet. We have some statistics about women’s pelvic surgeries that should help you breathe a sigh of relief, especially if you have a fear of surgery. We have categorized the different types of surgeries according to the condition treated, and we describe the level of invasiveness for each procedure as well as the success rate. Minimally-invasive surgeries are usually done as outpatient procedures, and you often go home the same day. Surgical procedures with a moderate level of invasiveness may require a short stay in the hospital.

Surgeries for Stress Urinary Incontinence
Number of Procedures: 6
Names: Transobturator tape, single-incision transobturator tape, tension-free vaginal tape, pubovaginal sling, Burch procedure, Marshall-Marchetti-Krantz procedure
Invasiveness: The first three procedures are minimally invasive, the last three are considered moderate.
Success Rates: No procedure has less than a 66% success rates, and most have success rates between 70% and 95%.

Surgeries for Overactive Bladder, Urge Urinary Incontinence, Urge-Dominant Mixed Incontinence, and Urinary Retention
Number of Procedures: 1
Name: Sacral neuro-modulation
Invasiveness: Minimal
Success Rates: 31% to 65%

Surgeries for Pelvic Organ Prolapse
Number of Procedures: 4
Names: Cystocele repair (bladder hernia), rectocele repair (large intestine hernia), enterocele repair (small intestine hernia), sacral colpopexy (vaginal vault prolapse)
Invasiveness: All are considered moderate
Success Rates: 80% to 96%

As you can see, almost all the surgeries have a very high success rate, and the majority are minimally-invasive. This list of women’s pelvic surgeries should give you a starting point for discussing your surgical options with your physician. If you have a significant fear of surgery or simply want to avoid surgery for any reason, you may wish to seek a second opinion from another specialist. Additionally, you may want to ask your physician whether a different type or a different combination of conservative therapies would be useful to try before having surgery. For many women, the first few conservative therapies tried are not completely successful at relieving symptoms. The women who have the most success with conservative therapies are those willing to try multiple approaches or multiple combinations of therapies until they find something that works. Persistence is often the key to success when working with conservative therapies.

If you ultimately decide to undergo surgery for your pelvic health condition, rest assured that success rates are high and most procedures pose a fairly low risk. Be sure to discuss any questions or concerns with your physician until you feel completely comfortable with any proposed surgery. In this case, educating yourself about your condition and your options is the best medicine!

 

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Have Pelvic Organ Prolapse? Consider Using a Pessary

by Pelvic Floor WeaknessPelvic Organ ProlapsePessaryPOPWomen's Healthcare
Are things “popping” out down there? If you suffer from pelvic organ prolapse, otherwise known as POP, then chances are that you are far from comfortable. Women with POP can experience symptoms such as a falling sensation in the pelvis, backaches, painful intercourse and more.

Click HERE for a more complete list of POP symptoms.

There are four common types of POP: cystocele (bladder prolapse), rectocele (prolapse of the rectum or large bowel), enterocele (prolapse of the small bowel), and uterine prolapse.

Luckily, there is a conservative solution for women suffering from POP.

It’s called a pessary.

“A pessa-what?” you ask. A pessary-and it’s not as weird as it sounds. A pessary is a plastic or rubber ring-like device that is placed in the vagina to support the bladder, uterus, or rectum. In other words, it’s an artificial support for those internal structures that are a bit saggy because of childbirth, gravity, or aging.

Some women find that wearing a pessary helps alleviate the discomfort caused by POP and helps empty the bladder. A gynecologist can fit you with a pessary in the office. If you have a pessary, once a month you need to remove the pessary or have your physician remove it to have it cleaned and re-inserted. Pessaries rarely cause problems but can increase the chance of developing vaginal irritation or infection. It’s important to have a pessary that fits properly.

The use of a pessary is a great non-surgical treatment for POP and is useful for women who either don’t want surgery or still want to have more children. Plus, pessaries are very effective. Studies show that women with POP find improvement with a pessary and for some women symptoms go away completely.

Sound good? Check in with your healthcare provider to see if a pessary is the perfect solution for your POP problems!

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