Pelvic Floor medicine or Urogynaecology is a gynecology sub-specialty which deals with dysfunctions / diseases & their respective treatment for women pelvic floor.
What exactly is Pelvic Floor?
In women, inside the bony pelvis the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum constitutes the pelvic floor. The muscular content act as a hammock within the pelvic bone and physically supports the organs.
Are these problems serious?
Most women feel uncomfortable talking about personal problems pertaining to issues related to urinary difficulties, vaginal heaviness and symptoms such as incontinence. But these are actually very common medical problems that can be treated successfully. Millions of people have the same issues and they keep compromising their quality of life as they hesitate in seeking treatment for the same.
How do I know about pelvic floor disorder?
Pelvic floor disorders occur when the “sling” or “hammock” that supports the pelvic organs becomes weak or damaged.
The symptoms include:
Urinary problems, such as an urgent need to urinate, painful urination or incomplete emptying of their bladder
Sense of heaviness / dragging sensation in the pelvis
Bulge in the vagina or rectum
Feeling of mass coming out of vagina
Pain or pressure in the vagina or rectum
Constipation, straining or pain during bowel movements
Unexplained pain in the lower back, pelvis or rectum
Painful intercourse for women
How are pelvic floor disorders commonly treated?
Many women do not need specific treatment for their problems. Treatment is required when symptoms are bothersome, restrict a woman’s activities or disturbs her quality of life. In major percentage of cases women can be guided to take specific actions (which she can be trained to perform on self) to help reduce or ease symptoms.
Mainly two types of treatments are available for Pelvic floor disorders: 1. Nonsurgical treatment & 2. Surgical treatment
Nonsurgical treatments :
Pelvic floor muscle training: It is also called Kegel exercises. Pelvic floor muscle training involves squeezing and relaxing the pelvic floor muscles. If performed correctly and routinely it may improve the symptomatology.
Injections for problems with bladder control. “Bulking agents” can be injected near the bladder neck and urethra to make the tissues thicker and close the bladder opening. At times repeat injections are needed over time.
Medicine. Medicine is sometimes prescribed to treat certain bladder control problems, to prevent loose stools or frequent bowel movements.
Vaginal pessary. Vaginal pessary is a device made up of plastic, rubber or silicone. This device is used to treat some types of prolapse and improve bladder control in selected women. Pessary is inserted into the vagina to support the pelvic organs. The Urogynaecologist / gynaecologist secures the vaginal pessary according to requirement, shape and size assessed for the patient.
In some cases, surgery is the best treatment option, especially when other treatments are not helpful. Some surgical treatments can be performed as outpatient procedures.
For prolapse. Surgery involves repairing and building back pelvic floor support. Women with uterine prolapse may also have the uterus removed (hysterectomy) in addition to pelvic floor muscle repair. Women who have surgery to repair prolapse often have surgery at the same time to prevent bladder control problems. Traditionally pelvic floor surgeries are conducted from vaginal approach. These surgeries can also be performed laparoscopically / with keyhole approach. There are various other surgical procedures which are performed according to age, associated medical co-morbidities and requirement of the patient problems.
For bladder control problems. Problems holding in urine that occur because of weakness of bladder neck and relative increase of pressure on the bladder (stress incontinence) can be treated with surgery. Most commonly performed surgery is mid-urethral sling in which a mesh strap or “sling” is inserted to hold the bladder neck in its normal position. In other form of surgeries, the bladder neck is put back in its correct position by securing it to the vaginal wall and pelvic floor tissues.
For bowel control problems. Surgery may be needed to repair a damaged anal sphincter muscle or repair certain types of prolapse.
“Combination treatment” means a woman is getting treated for more than one type of pelvic floor disorder, such as a treatment for both uterine prolapse and urinary incontinence. Combination treatment is quite common as most of the pelvic disorders have associated problems. Usually the approach consists of different treatments together to address pelvic floor disorders, such as using Pelvic floor muscle training and a surgical treatment to treat the symptoms.