Don’t suffer in silence with pelvic floor issues

Pelvic floor issues affect up to 30% of women. But Joan Blomquist, MD, chair of the Department of Gynecology at GBMC HealthCare, says that doesn’t mean women have to live with those symptoms.

The two most common pelvic floor conditions are pelvic organ prolapse and urinary incontinence. Pelvic organ prolapse occurs when a person experiences a loss of support of their pelvic organs. This allows the organs (including the bladder, uterus, and rectum) to bulge into, or even outside of, the vagina.

“Women with pelvic organ prolapse can often feel a bulge or see something protruding in the pelvic area,” Dr. Blomquist said. “Depending on the severity, it can have an impact on bladder and bowel function.”

The biggest risk factor for pelvic organ prolapse is giving birth via vaginal delivery, Dr. Blomquist explained.

Even though the initial injury may occur at the time of childbirth, most women don’t have symptoms for many years. The pelvic floor muscles may compensate for a while, but over time they may fail. Most women present with symptoms more than 20 years after their first delivery.

There are several treatment options available for pelvic organ prolapse. Physical therapy and pelvic floor exercises are usually the first step, and Dr. Blomquist said patients often have great success with this. Some women opt to have a pessary – a vaginal support device – inserted to help hold the organs in place. Surgery is also an option and is individualized depending on the patient.

“Surgery can be done through the vagina or laparoscopically, depending on the individual patient’s anatomy, age, and physical activity level,” Dr. Blomquist explained.

GBMC recently started a postpartum perineal clinic for patients who experienced a more difficult vaginal delivery (for example, a large perineal tear or episiotomy).

“They have the option of being automatically referred to us and being seen a few weeks after delivery. This allows us to assess the patients to be sure everything is healing well. We also get them started with physical therapy and hopefully set them up to have a decreased risk of pelvic organ prolapse and urinary incontinence later in life.”

There are two types of urinary incontinence: stress incontinence and urge incontinence. Stress incontinence occurs when leakage happens because of something physical, like a cough, jump, or sneeze.

“Stress incontinence is pretty common in the first couple years after childbirth, but it can develop later in life, too,” Dr. Blomquist said.

Urge incontinence is also known as ‘overactive bladder’ and is more common as people age. Men can also have urge incontinence, but it happens more often in women.

Dr. Blomquist emphasizes that treatment varies depending on the type of incontinence, with one exception

“Physical therapy helps with both stress and urge incontinence,” she said. “A lot of times, it’s the first thing we recommend with either diagnosis.”

Other treatment methods for stress incontinence include inserting a pessary or a procedure called ‘bulking,’ where the urethra is injected with a material (such as a water-based gel) that creates cushions in the urethra, making it harder for urine to leak. Surgery is also an option, with the most common type being a ‘sling procedure.’

“The sling procedure is a relatively minor outpatient surgery,” Dr. Blomquist explained. “A small incision is made in the vagina, and special needles direct the sling into position. It takes about a half hour to perform and has around a 90% success rate. Studies show it works for many years.”

In addition to physical therapy, urge incontinence is usually treated with behavioral modifications, such as avoiding certain foods that irritate the bladder. Medications can also be prescribed for urgency, as well as additional treatments after physical therapy, like Botox injections and nerve stimulators.

Regardless of what type of incontinence or prolapse you suffer from, Dr. Blomquist wants everyone to know there are a variety of treatment options available to patients.

“Although pelvic floor issues aren’t necessarily dangerous to your health, they can impact your quality of life, and prevent you from doing the things you enjoy,” she said. “We offer very conservative to more involved therapies depending on your comfort level. You can call us and have a consultation without needing surgery or injections."