Dr. Carl Klutke
Female pelvic health is a frequent topic in both the medical and popular press these days for two reasons. First, the baby boom generation has reached an age at which pelvic floor problems are common, and female baby-boomers are certainly not satisfied suffering in silence with problems their mothers and grandmothers had to accept without much choice. Second, gynecologic knowledge has grown tremendously in this field; and, along with that knowledge, treatment options have improved in both number and success rates.
“Pelvic floor disorders” refers to a group of vaginal support problems that affect millions of women and can cause considerable discomfort. As women age, tissues that support the uterus, vagina, bladder, and rectum can accumulate damage and weakness that causes hernias or bulges to protrude from the vaginal opening. Often, the original damage occurs during childbirth, but does not manifest itself for many years. Other contributing factors include smoking, chronic coughing, straining or heavy lifting, and a family history of similar problems. Symptoms can include pelvic pressure or pain, difficulty urinating or having bowel movements, sexual dysfunction, and a noticeable bulge protruding from the vagina. Many women suffer for years before seeking treatment.
Treatment of pelvic floor disorders has come a long way in the last several years, and we now have highly successful and durable repairs for these problems. For mild problems causing minimal discomfort, pelvic floor physical therapy can be an effective, inexpensive and very safe option. Fortunately, more physical therapists are trained in this subspecialty, and the St. Louis area is lucky to have several such specialists.
For women whose pelvic floor disorders are more advanced and uncomfortable, surgery is sometimes required to correct the problem. There are several minimally-invasive surgical options available with high success rates and durability as well as excellent safety profiles. Of course, it is important to choose a surgeon with considerable experience and success as well as low complication rates in this specialized field of pelvic surgery. After these procedures, most patients spend a night in the hospital and resume a fairly normal schedule of activities in two weeks. Lifting, straining, and sexual activity are not allowed for at least six weeks after surgery.
With the traditional surgical techniques, many women would have a recurrence of the same problems within months or years of their first surgery. However, with the modern techniques in use for the last several years, long-term success rates are above ninety percent and the results are much better than with old-fashioned techniques. Most patients are able to resume normal (or even improved) sexual activity within a few months of surgery.
Loss of bladder control (urinary incontinence) is another common pelvic floor disorder and can present in different ways. The most common complaint is leaking urine when coughing, laughing, sneezing, jumping, or doing any other activity that puts pressure on the pelvis. This is known as “stress incontinence.” Another type of leakage, “urge incontinence,” describes the symptom of having to urinate so badly that one cannot make it to the bathroom without leaking. This condition is also known as “overactive bladder” or OAB. Some women are unfortunate enough to have both types of incontinence. Stress incontinence usually results from a loss of structural support between the urethra and upper wall of the vagina. In most cases, urge incontinence (OAB) has no known cause.
Fortunately, almost all women with these problems can be cured or at least helped with current treatments. OAB can be treated with pelvic floor physical therapy, medication, behavioral and diet modification, or a combination of these approaches. Stress incontinence is curable with highly successful and durable repairs. Of course, not all patients require surgery. Mild stress incontinence can often be managed with pelvic muscle exercises or “Kegels.” If the problem is more severe and exercises are not successful, a minor surgical procedure is the best option. Surgical treatment of stress incontinence involves supporting the fallen urethra with an outpatient, twenty-five minute vaginal operation called a “sling.” This procedure has been established as the most successful treatment for stress incontinence and has an excellent safety profile when performed by an experienced surgeon. Postoperative discomfort is usually minimal and most patients return to work and normal activities in a few days. Long-term success rates are above ninety percent and do not decline over time.
As with most health and wellness issues, prevention is a key component of care as well. While not all pelvic prolapse and urinary incontinence problems can be prevented, women can take action to reduce the risks. Pelvic muscle exercises before, during, and after pregnancies can reduce the incidence of stress incontinence. Correct technique is important and can be taught by gynecologists or reviewed on one of many women’s health websites. Other preventive measures include: maintaining a healthy weight, avoiding smoking, controlling constipation, and avoiding heavy lifting.
842 Sunset Lake Boulevard, Suite 403
Venice, FL 34292