On March 16, 2017 at 7pm we will be kicking off our spring semester of pelvic health education class, we call Pelvic Health 101 (PH101). In our first class we will be introducing you to the pelvic floor muscles, where they are, what they do, and how they relate to the health and function of your bowel, bladder, and sexual functioning. We will also be covering how things such as alignment, posture, muscle tone and nerves can affect your symptoms. This course is a great starting point to help you understand your pelvic floor and pelvic floor symptoms.
Pelvic Health 101 is back with some old favorites like, “Something’s wrong with my what?” and “Why is pooping so difficult?” We have also added a new course on pediatric pelvic floor issues.
If you have questions, we have answers. Join us for lectures and question and answer opportunities with expert pelvic health physical therapists, childbirth educators, and nutritionists. Please reserve your spot early at pelvichealth-101.eventbrite.com. Remember spots fill up quickly. As always, light refreshments will be served.
June marks Pelvic Organ Prolapse Awareness Month. Pelvic organ prolapse (POP) is a descent of the uterus, bladder, and/or rectum. It is often associated with stress urinary incontinence or bowel dysfunction. Patients often report a feeling of fullness in the vagina or the feeling of a tampon falling out.
Multiple factors affect the development of POP, including genetic predisposition, number of previous pregnancies and deliveries, age (ex. post-menopause), and ethnicity. Furthermore, women who have worked in professions that involve heavy lifting and increased intra-abdominal pressures (ex. flight attendants) are at a greater risk of developing prolapse.
A woman’s chances of developing prolapse increase significantly with her third child’s pregnancy and delivery. Furthermore, women with a connective tissue disorder (ex. Ehlers-Danlos or Marfans Syndrome) are at increased risk of developing POP.
Research has shown that pelvic floor physical therapy targeted at STRENGTHENING the pelvic floor muscles can help reduce the severity of prolapse. Therefore, pelvic floor physical therapy is an appropriate and minimally invasive treatment. The best position for Kegel exercises is with hips elevated (ex. on a wedge or stacked pillows- refer to picture). This position takes advantage of the gravitational pull which naturally reduces organ descent. It sure beats having to do your Kegels standing on your head!
Should physical therapy alone not suffice, a pessary may be an appropriate device to help provide additional support to the system’s laxity. In more severe cases, surgery may be the appropriate intervention. One should speak to their doctor if they think that either of these options may be appropriate.
Pelvic Organ Prolapse (POP), organ descent of the bladder, uterus, or rectum, is an all too common problem which affects many adult women. There are several treatment approaches proposed by medical care providers, including physical therapy to strengthen the pelvic floor muscles that rest beneath and support the organs. Should physical therapy alone not sufficiently reduce POP symptoms and discomfort, surgical intervention may be indicated. However, there is a large debate within the medical community regarding what is the best surgery to perform. Not all surgeries are created equally, and different surgeries use different materials to stabilize the pelvic floor (ex. sling vs. propylene mesh). Women’s bodies respond differently to these variations, and some require a revision several years later if the prolapse returns. In addition, open surgery itself puts the individual at risk of sustaining a vaginal or bladder injury during the procedure itself, and some women experience post-surgical complications such as bowel obstruction.
The traditional sacrocolpopexy procedure involves removal of the uterus followed by attaching the vaginal vault to the periosteum of the sacrum with polypropylene mesh. This open procedure involves a vertical or horizontal abdominal incision above the pubic bone. The incision is closed with dissolvable or removable stitches. Fortunately, a recent study in Belgium discussed in European Urology (June 11, 2013) revealed promising results regarding a NEW technique. The study compared the previously aforementioned technique with a minimally invasive robot-assisted sacrocolpopexy (RASC) procedure. The RASC procedure was performed with the da Vinci Surgical System (created by Intuitive Surgical Company) on 95 women between April 2006 and December 2011. On average, the procedure took 101 minutes to perform, and at the 34 month follow up, only 4 women (4.2%) were still experiencing POP symptoms. Only 10.5% of participants experienced urinary urgency symptoms after the surgery, all of which resolved naturally within several weeks post-surgery. No new bowel or sexual dysfunction symptoms were reported. Therefore, if a surgical route is indicated, speak with your doctor about whether this safe and effective approach is appropriate for you!
Mild prolapse may be asymptomatic, and POP may only first become noticeable at later stages of the dysfunction. The signs and symptoms of bladder or urethral prolapse include urinary incontinence, urgency (sudden strong urge to urinate), urinary frequency (voiding more frequently than normal, generally assumed to be more than 8x/day). It may also be associated with difficulty initiating the flow of urine (hesitancy). Signs of rectal prolapse include difficulty with passing bowel movements and/or constipation. Signs of uterine prolapse include a feeling of heaviness in the pelvic floor, and women often describe it as if they feel their “insides are falling out.” They may even feel or see a pinkish colored lump at the vagina, especially at the end of the day or after hours of prolonged standing or walking. There may also be pain with intercourse.
The first line of treatment for POP is pelvic floor physical therapy. By strengthening the pelvic floor muscles, additional support can be provided to the organs from below. If that alone is insufficient, some women find a pessary helpful. This is a device which is inserted vaginally to support one or multiple pelvic floor organs. When physical therapy and pessary are not enough, some women may decide to undergo surgery to bolster the lax pelvic floor. One of the most common surgical techniques is transvaginal placement of synthetic mesh for POP. Research about the mesh materials are mixed, and it is important to discuss further details with one’s physician regarding what the best options are for them.
A few more words about Pelvic Organ Prolapse, from Riva Preil.
June is Pelvic Organ Prolapse Awareness Month. Pelvic organ prolapse (POP), descent of any of the pelvic floor organs, is one of the most common indications for gynecological surgery. Usually, the organs in the pelvic floor (bladder, uterus, and rectum) are held in their proper position by a series of ligaments. In addition, the pelvic floor muscles serve as a “backup support” the ligaments and support the organs from below. As women age, the ligaments and muscles have a harder time holding the organs in their upright proper position against gravity, and each previous pregnancy and delivery further contributes to increased likelihood of developing weakened structures over time. In fact, the physical weight of the developing fetus along with the physical trauma of labor and delivery add further stress to the pelvic floor muscles and ligaments, and some of these damaged structures may never fully return to their previous strength and level of structural support. In addition, certain birthing related complications (ex. prolonged labor, large birthweight of the baby, and vaginal delivery which requires forceps extraction) increases a woman’s risk of developing prolapse. It is unclear whether or not an episiotomy affects POP development. In women above age 50, it is reported as the most common reason for hysterectomy (removal of the uterus). It is estimated that in the United States, almost double the amount of surgeries are performed to treat prolapse compared to treating urinary incontinence. The reason for this is that it is often not diagnosed until later stages of the dysfunction at which point conservative, non-surgical interventions would not suffice in treating the POP.
Naturally occurring age-related changes, mainly due to decreased estrogen levels in the bloodstream, increase the likelihood of developing prolapse. Furthermore, women who are overweight are more likely to develop POP due to increased abdominal and pelvic floor pressure. Furthermore, chronic coughing (due to bronchitis, asthma, or smoking) as well as chronic constipation and straining predispose an individual to developing POP due to prolonged history of added stress and pressure to the pelvic floor structures. Furthermore, women who have worked for many years at a job that involves heavy lifting (ex. flight attendants) are at greater risk of developing POP for the same reason. The pelvic floor structures contain collagen, a connective tissue that provides support and elasticity. Therefore, any systemic disease such as Marfans or Ehlers-Danlos, which are associated with impaired collagen production, predisposes an individual to developing POP. Research has shown that prolapse is most prevalent amongst white and Hispanic women.
Pelvic organ prolapse in women is when a pelvic organ drops from its regular placement in the body and pushes against the walls of the vagina. This is not uncommon in women nor is it necessarily untreatable or progressive. The most common type of pelvic organ prolapse occurs with the bladder, though it can also happen with the urethra, uterus, vagina, small bowel, and rectum.
Often pelvic organ prolapse happens because of a strain put on the organs in that region, as in childbirth or hysterectomy. As listed on WebMD, here are some typical symptoms of pelvic organ prolapse:
Pressure from pelvic organs against the vaginal wall.
Feeling full in the lower belly.
Feeling like something is falling out of your vagina.
Feeling a pulling or stretching in your groin area or pain in your lower back.
Since June is Pelvic Organ Prolapse Awareness month, make yourself aware of the causes and symptoms of POP. It’s nothing to be ashamed of and it’s something we at BBPT can help you with! Take a look at this video from POP Advocate Sherrie Palm’s POP Awareness Month series about POP and PT, and let us know how we can help you!