Pelvic Floor dysfunction

Pelvic Prolapse and Urinary Incontinence

The pelvic floor consists of the muscle (called Levator Ani), the ligaments ( Cardinal and Uterosacral) and the supporting fibrous tissue surrounding them. The role of the pelvic floor is to support the organs inside the tummy. In pregnancy the womb enlarges considerably as the baby grows. With childbirth there occurs

  • stretching of the muscles as the baby descends through the birth canal
  • pressure and damage on the nerves supplying the muscles
  • tearing of muscles due to delivery, episiotomy or foceps delivery

Whilst some healing can occur, commonly the damage is permanent. Long term this can lead to incontinence (urinary or bowel) and prolapse. Initially this is not noticed but with repeated trauma (more children), time and menopause, the muscle gets weaker. Ultimately symptoms appear many years later leading to distress and the need to seek care.

The common problems I encounter relate to:

  • Urinary stress incontinence – leakage of urine with activities like running,sneezing
  • Urge incontinence- leaking of urine due to not being to get to the toilet in time
  • Urgency – sudden need to go which is uncontrollabl
  • Waking up at night to pass urine
  • Incomplete emptying of the bladder, taking a long time to pass water
  • Frequency – going very often
  • Waking up at night to pass urine
  • Prolapse – the appearance of a lump in the vagina

In my practice, I see a lot of women with varying degrees of these symptoms which can be debilitating. For many this can be debilitating. Affecting their daily lives leading to social isolation due to emotional fears or realised embarrassment. Inability to partake activities with their children cause stress and loss of bonding. In severe cases, sexual dysfunction can occur, fracturing long term relationships. In many instances, these symptoms have been present for a long time, commonly years. They have been set aside due to demands of family or work. Many suffer in silence believing this to be the natural outcome for womanhood.

Treatment begins with the woman devloping an understanding of the reasons and cause of the problem.  The knowledge that she is not alone with this problem and that there are many options for treatment goes a long way to helping a woman deal with this. Each treatment has to be individualised due to the myriad of combination of symptoms and anatomical abnormalities found.

Initial investigations will include:

Urodynamics: this checks the function of the bladder
Bladder and Pelvic floor ultrasound: this checks the support of the bladder
Urine testing

Once the cause and severity of the problems have been determined then common treatment options include

Physiotherapy
Bladder training
Magnetic therapy
Medications for control of overactive bladder
Surgery to correct prolapse and or incontinence
Vaginal pessary as an alternative to surgery

If surgery is required, I use a minimally invasive approach to achieve a faster recovery.
Important to treatment is physiotherapy and bladder training. I work closely with a Pelvic Floor Physiotherapist and Continence Nurse to improve the outcomes for my patients. Whilst their roles can overlap, each brings a different perspective and expertise.

Whatever the problem, there are treatments available to help improve a woman’s symptoms and to ensure a better life.