Everything You Should Know About Pelvic Floor Disorders

“Pelvic floor dysfunction” is a disease entity which is almost present in approximately 25-75 percent of Indian women. The burden of suffering the disorder in silence is roughly two-fold. Mostly “pelvic floor disorders” are socially distressing problems with a high degree of bother. These disorders severely impact the quality of life in women. Typically, women do not disclose it as they think that it is a passing problem or not a problem at all. Also, lack of knowledge, the feeling of shyness in sharing their problem, inability to decide whom to consult etc. are the factors because of which this disease entity remains untreated. In addition to all, the paucity of physicians specialized in treating pelvic floor disorders leaves the patients untreated which builds up a notion that pelvic floor disorders have “no treatment“.

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.

What Causes Pelvic Floor Disorders?

The more childbirth a woman undergoes the more chances she would have for Pelvic disorders. Women who are overweight or obese also have a greater risk for pelvic floor disorders. Having pelvic surgery or radiation treatments also can cause these disorders. For example, these treatments can damage nerves and other tissues in the pelvic floor. Other factors that can increase the risk include repeated heavy lifting or even genes.

The Pelvic Floor Disorders’ Symptoms Include:

• Generally, women feel uncomfortable talking about their personal problems related to issues of urinary difficulties, vaginal heaviness and symptoms such as incontinence. Most of these problems are common medical problems experienced by millions of people from across the world, which can be treated successfully. However, most of the women folk refrain from consulting and thus lead a “compromised” life.
• 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
• The symptoms of pelvic disorder include; constipation, straining or pain during bowel movements, urinary problems such as urgent feeling for urination, painful urination or incomplete emptying of their urinary bladder.
• Unexplained pain in the lower back, pelvis or rectum
• Painful intercourse for women

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 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 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. A major chunk of women population suffering from pelvic disorders can be trained and guided to take specific actions on self to reduce or ease the symptoms. By regularly practicing pelvic floor training; Kegel exercises, which involves squeezing and relaxing the pelvic floor muscles, the symptoms can be improved drastically.

When other treatments are not helpful, surgery is the best option. Some of these surgical procedures can be performed as outpatient procedures.

The surgical interventions will be aimed at repairing a damaged anal sphincter muscle or certain types of prolapse. “Combination treatments” are also done in women needing treatment for more than one type of pelvic disorder- prolapsed and urinary incontinence etc. “Bulking agents” are injected near the bladder neck and urethra to make the tissues thicker to close the bladder opening. Repeat injections are needed in some cases, over time. Sometimes medicines are prescribed to treat certain bladder control problems to overcome conditions like frequent bowel movements and loose stools.

Mainly Two Types of Treatments are Available for Pelvic Floor Disorders:

1. Surgical Treatment:

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 the 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 comorbidities and requirement of the patient problems.

For Bladder Control Problems.

Problems holding in urine that occur because of the 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 forms 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

Combination Treatment:  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.

2. Nonsurgical Treatments Include

Vaginal Pessary. A 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 select women. A pessary is inserted into the vagina to support the pelvic organs. The Urogynaecologist/gynaecologist secures the vaginal pessary according to the requirement, shape and size assessed for the patient.