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There is help for pelvic floor problems

August 22, 2017 | UCI Health
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Millions of women suffer silently from pelvic floor disorders. They may leak urine or be unable to fully control their bowel movements. Or they may be feeling discomfort if the organs in their pelvic area have shifted.

But they don't mention their symptoms to doctors because they're embarrassed or because they don't think help is available.

The ultimate irony is that pelvic floor disorders affect about one-third of women — no need to be embarrassed or think you're alone! — and doctors today have safer and more effective treatments than ever to help their patients, says Dr. Felicia Lane, UCI Health urogynecologist.

"There is quite a bit that can be done and done effectively," she says. "Research and development in this field have really increased and as a result, treatments have catapulted."

What is the pelvic floor?

In women, the pelvic floor is a complex structure of muscles, ligaments, connective tissues and nerves that support the uterus, vagina, bladder and rectum.

Pelvic floor disorders not only include incontinence and prolapse, they also can be painful and lead to problems with sexual function, such as:

  • Reduced sex drive
  • Infrequent orgasm
  • Decreased arousal
  • Pain from sexual intercourse

Treatment is frequently effective 

Treatment for pelvic floor disorders addresses the full range of symptoms and often restores patients to an excellent quality of life, says Lane.

Many treatments are noninvasive – including specialized physical therapy. At UCI Health, urogynecologists work closely with physical therapists specially trained in pelvic floor disorders.

"Physical therapy is generally the first-line treatment because it's the least invasive," says physical therapist Patricia Morita-Nagai.

"People think physical therapy is sports-related, or they think I'll just teach them Kegel exercises. But it's much more comprehensive than that. The physician and the physical therapist work as a team."

Pelvic prolapse

Pelvic prolapse, which consists of weakness in the tissue that supports the pelvic organs, affects 20 percent of women by age 80. Treatments include:

  • Physical therapy to strength the weakened tissue
  • Vaginal pessary, which is a removable device placed into the vagina to support the pelvic floor
  • Surgery

"There is a whole host of surgeries for pelvic prolapse and most can be done through the vagina, laparoscopically or with the da Vinci robot," says Lane. "The downtime is minimal."

Urinary incontinence

Stress incontinence involves urine leaking during laughing, sneezing, coughing or exercising, while urgency incontinence (or overactive bladder) is caused when the bladder muscle contracts too easily. Numerous treatments are available for urinary incontinence, including some new options, Lane says.

For stress incontinence, the options include:

  • Physical therapy
  • Injections of silicone or collagen into the urethra to make it stronger (an in-office procedure that carries no downtime)
  • Implantation of a sling, an outpatient procedure in which the doctor creates a sling under the urethra to support it and keep it closed.

There are numerous sling products, some of which do not involve mesh, Lane notes.

For urgency incontinence, treatments include:

  • Physical therapy.
  • Botox injection to relax the bladder muscle.
  • Nerve stimulation, an in-office procedure that involves 12 once-a-week treatments to stimulate the nerve responsible for bladder function with gentle electrical impulses, thus altering bladder activity.
  • Interstim® a bladder pacemaker, which is implanted under the skin on the hip and stimulates nerves to keep the bladder relaxed and reduce urgency and incontinence.
  • Medications. A new class of medications that most patients have never tried is called beta-3 agonists, says Lane. "The old class, called anticholinergics, can have side effects. Approximately 70 percent of patients are improved with these new medications, and there are no side effects like dry mouth, constipation or confusion."

Fecal incontinence

Fecal incontinence is also common and is often caused by trauma from vaginal childbirth. It affects between 19 percent to 25 percent of women by age 80.

Physical therapy is the first-line treatment, but other options include surgery to tighten the sphincter, and a medication called Solesta, a hyaluronic acid injected into the anal canal to make it stronger. Moreover, a type of pacemaker is also available for anal incontinence.

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