There’s No Need to Suffer in Silence — Seek Treatment for Pelvic Floor Disorders

When it comes to pelvic floor disorders, the symptoms get old fast. For example, some women experience a heavy feeling or severe pressure in the pelvis or a bulging in the vaginal or rectal area, creating the sensation that their insides are falling out.

Or when feeling a sneeze coming on, some must brace themselves, deliberately contracting pelvic muscles to avoid a few drops of urinary leakage. Worse yet, they may realize after a sudden cough or hard laugh that they’ve soaked their clothes.

As British actress and mother of four Kate Winslet admitted, “I just can’t jump on trampolines anymore. I wet myself.” If these scenarios sound familiar, you are not alone.

Admittedly, some circumstances and symptoms are part and parcel of the natural aging process, and adjustments are made for them as the “new normal.”

However, pelvic issues need not be categorized as acceptable and untreatable—discomforts you must simply “learn to live with.” Unfortunately, many women needlessly do just that because they are ashamed to discuss their symptoms and believe they are in the minority.

Dr. Vanessa Elliott, with Urology of Central PA in Camp Hill, says that because urology remains a predominantly male medical profession, with only 10-15 percent of urologists being women, female patients tend to be too embarrassed to discuss with male physicians a variety of what they perceive to be stigmatized conditions.

Yet, according to a study funded by the National Health Institutes, almost a quarter of women face pelvic floor disorders at some point in their lives, especially as they live into their 80s.
So what about the composition of a woman’s pelvic floor makes it a potential site for some fairly common issues?

Elliott describes the pelvic floor as a combination of muscles, ligaments, and connective tissues and nerves that create a support structure for the vagina, uterus, bladder, and rectal area. In essence, the pelvic floor muscles are what constitute the base of your core and consequently help these organs remain in their proper place, where they can carry out their corresponding functions.

When these muscles and ligaments of the vaginal walls weaken or tear, the pelvic floor, or support structure, becomes compromised, and that’s when issues can occur.

Elliott says some of the more common pelvic disorders that women may experience include pelvic organ prolapse, incontinence and bladder leakage, overactive bladder, painful intercourse, and bowel dysfunction.
She explains that pelvic organ prolapse is the result of damage or a tear in a layer of tissue in the walls of the vagina from which organs—such as the bladder, rectum, or uterus—can then protrude or herniate into the vagina.

Symptoms associated with POP may include a vaginal bulge, a sensation of pressure, pelvic pain, frequent urinary tract infections, pain during intercourse, problems emptying the bladder and evacuating stools, and sexual dysfunction.

“Risk factors for POP,” says Elliott, “include pregnancy and childbirth, chronic heavy lifting, a hysterectomy, chronic constipation, and genetics.”

Pelvic organ prolapse doesn’t just suddenly occur; it progresses gradually over time, and in some cases, if not unduly symptomatic, can be monitored until treatment becomes necessary.
Fortunately, there are successful treatments available for POP, and surgery is not the only option. For a minimal prolapse, Elliott says, “Physical therapy, along with the avoidance of chronic heavy lifting, is recommended to help reduce symptoms.”

Core-strengthening exercises, such as those practiced with Pilates and yoga, can also help promote a more robust pelvic area.

A second nonsurgical option is the insertion of a pessary. Elliott explains this is a flexible vaginal support device available in a range of shapes and sizes. Once inserted into the vagina, it helps support or hold the organs in place, thus enabling them to perform as required.

A third treatment option is a surgical pelvic-floor reconstruction procedure, in which either the patient’s own tissue or a soft, synthetic mesh material is used in the repair and lifting of the prolapsed or fallen organs.

Elliott explains that pelvic floor reconstruction restores the organs to their original position with surgery through either the vagina or the abdomen. The compartment(s) that need to be repaired and the severity and extent of the prolapse determine the type of surgery required. This is recommended when nonsurgical options have proven ineffective and symptoms have become progressively worse.

She says there are multiple repair techniques and that success rates vary, depending on the patient.
Another common type of pelvic disorder that Elliott treats is urinary incontinence, both the stress and urge types.

Stress incontinence has many possible causes related to the weakened, stretched, or damaged pelvic floor muscles, and identifying the reason for the leakage helps determine the most effective and least invasive treatment.

“Kegel exercises, along with physical therapy, can help strengthen the pelvic floor muscles and are recommended for reducing the symptoms of stress incontinence issues,” says Elliott. “There is no medication that can be prescribed for stress incontinence.”

If this more conservative approach does not prove successful, surgical options exist.

“Urethral sling surgery is an alternative,” says Elliott, “and involves the placement of a sling around the urethra to help lift it back into its normal position.”

The sling, which Elliott says can be composed of either surgical mesh or the patient’s own harvested tissues, acts as a hammock and helps restore the urethra to its normal position. This highly successful procedure allows pressure to be exerted on the urethra, thus enabling the retention of urine.

“Bulking agents,” she says, “can also be injected into the urethra to help with support.”

These injections bulk up the muscle valve that keeps the bladder closed and can be administered under local anesthesia.

Urge urinary incontinence, or overactive bladder, is different from stress incontinence, and although it affects both men and women, it is a more common issue for women. Its symptoms—including urinary leakage, frequency, and urgency—can contribute to an overall decreased quality of life.

Elliott says that medication can be prescribed for the treatment of OAB along with physical therapy, but additional options also exist for this condition.

More advanced alternatives include InterStim, an implant device that acts as a pacemaker for the bladder; Elliott says it delivers a 75-80 percent success rate. Injections of Botox to the bladder, which help relax the bladder muscle, can successfully reduce the spasms that trigger OAB symptoms.

Another treatment option for OAB is percutaneous tibial nerve stimulation, a nonsurgical form of electro-acupuncture that supplies electrical stimulation to the nerves responsible for bladder and pelvic floor function.

Over a series of treatments, bladder activity can gradually be changed, and studies report that 60-80 percent of patients improve with PTNS.

If you experience symptoms related to a pelvic floor disorder, there is no need to feel isolated and helpless, nor should you convince yourself to learn to live with symptoms that are both disruptive and embarrassing in your personal and daily life.

Above all, Elliott says, “Don’t suffer in silence. Whether your pain is dull and spread out or sharp and felt in a specific spot, whether it’s constant or comes and goes, [or] if your family doctor says what you describe is normal with childbirth and age and takes a dismissive attitude—don’t settle for that.”

Given the array of available options, she says, “If you feel you are not experiencing significant improvements, don’t give up.” BW