Restoring your pelvic floor: treatments for relaxation and accidental bladder leakage.

by Andrew Ian Sokol, MD, Female Pelvic Medicine and Reconstructive Surgeon
July 23, 2021

Women today face many contradictions about how to handle their personal health, especially when it comes to common—but not normal—pelvic floor disorders such as pelvic organ prolapse and urinary incontinence (UI).

Society says these conditions are a “normal” part of aging or an expected outcome of having children. So, many women avoid getting help because they’re embarrassed or don’t feel good about getting care “just to feel more comfortable.”

It’s true that prolapse and UI are common. Approximately half of women will develop a pelvic floor disorder in their lifetime, and 20-50% of them will have symptoms that disrupt their daily life.

But these conditions aren’t normal or inevitable. You have options to reduce or eliminate uncomfortable, isolating symptoms such as:

  • A bulging sensation in the vagina
  • Pelvic pressure
  • Constipation due to reduced pelvic support
  • Low-back pain
  • Urinary leakage, urgency, or frequency
  • Urinary tract infections or skin irritation from frequently wearing pads

If your symptoms don’t bother you, treatment isn’t necessary. But if symptoms keep you from exercising, doing errands, or spending time with friends, it’s time for a change.

The urogynecologists at MedStar Health are internationally recognized experts in pelvic floor disorders. We are one of just 66 urogynecology fellowship training sites in the U.S., which means we teach the latest, most advanced medical and surgical treatments.
As an academic medical center, all the specialty care you might need is available under one roof.

Today’s treatments are safer, more effective, and less invasive than ever before—there have been at least 2,000 studies on UI treatments since the 1990s. Most patients don’t need surgery, and those who do can get minimally invasive outpatient procedures with no need for a hospital stay.

Let’s discuss the causes, symptoms, and risk factors of prolapse and UI, as well as treatment options to help you get back to doing what you love.

You don’t have to live with annoying, uncomfortable #PelvicOrganProlapse or urinary #incontinence. Get safe, effective treatment options from an expert #urogyn team that cares about you: https://bit.ly/3xY0fR4.

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Pelvic organ prolapse.

What it is.

Prolapse is a weakening of the walls of the vagina. Sometimes this condition is called “bladder prolapse” because the bladder presses into the vagina—in severe cases, it protrudes from the vaginal opening. Approximately 3% of women develop pelvic organ prolapse in their lifetime.

Non-surgical treatments.

Maintaining a healthy weight is important, and so is controlling diseases such as diabetes that reduce your ability to heal. Many women get substantial symptom relief by using a pessary, which is a device (much like a diaphragm) you insert in the vagina to help support the vaginal wall muscles and hold up the bladder. A pessary can relieve symptoms, but it will not cure the underlying vaginal wall weakness.

Having a strong pelvic floor can help reduce urine leakage and prolapse symptoms. Your pelvic floor muscles are the muscles you squeeze when you are trying to keep yourself from urinating or passing gas. You can tone these muscles by doing Kegel exercises—squeezing and releasing the pelvic floor muscles several times per day. Kegels only work if they’re done properly. Your urogynecologist can refer you to a pelvic floor physical therapist who can teach you the proper way to do Kegels.

Surgical treatments.

The most common procedure we do is native tissue repair. We elevated the vaginal walls to their normal position, and we use dissolvable stitches to hold the tissue in place. As the stitches dissolve, the tissue naturally heals in its proper place.

Other procedures are performed laparoscopically (with keyhole surgery). While grafts may sometimes be used, these are different from “vaginal mesh” procedures (which are no longer performed). Many studies have shown that quality of life significantly increases after prolapse repair surgery, including physical, emotional, and sexual health.

Tired of dealing with pelvic pressure? Request an appointment.

Urinary incontinence.

What it is.

More than 40% of women will develop urinary incontinence in their lifetime. There are two main types of urinary incontinence, and some women have a mix of both:

  • Urgency incontinence: An overwhelming urge to urinate RIGHT NOW. Urgency UI may be a result of excess fluid intake or complications with diabetes, stroke, or constipation that increases abdominal pressure. However, it can be caused by abnormal communication between the bladder nerves and brain, making you feel like you constantly have to go when your bladder is not full.
  • Stress incontinence: Leakage when you cough, jump, laugh, or sneeze. Stress UI is caused by extra abdominal pressure and improper closure of the bladder sphincter—the ring that opens and closes to the urethra. Half of women with UI have stress incontinence.

Non-surgical treatments.

Urgency incontinence is frequently treated without surgery. Behavior and habit changes can go a long way toward improving symptoms. Your urogynecologist will work with you to establish good habits for:

  • Managing fluid intake—most people don’t need to drink eight glasses of water a day, even though we’ve heard that all our lives!
  • Using the bathroom on a schedule to avoid that “gotta go now!” feeling.
  • Avoiding diuretics such as excessive alcohol and caffeine.
  • Empty your bladder fully, even if it takes a little longer in the bathroom.
  • Achieving and maintaining a healthy weight.
  • Kegel exercises.

Medications can help reduce the sensation of having a full bladder when you don’t. Other nonsurgical options include BOTOX injections to relax the bladder muscles (giving you more time to get to the bathroom) and acupuncture in the tibial nerve of the ankle to control overactive bladder symptoms.

Stress incontinence symptoms may be relieved by using a pessary. However, pessaries do not address the underlying cause of incontinence.

Surgical treatments.

For urgency incontinence, a small, implanted bladder pacemaker (such as InterStim II) can help alter abnormal messages between the bladder nerves and the brain.

Stress incontinence is often treated with an outpatient “sling” procedure, and we do thousands of these surgeries each year. The urethra (the tube you urinate through) extends from the bladder like a short garden hose, and the sling holds it in the proper place. When you cough, laugh, jump, or sneeze, the urethra bends around the sling like putting a kink in a garden hose, reducing leakage.

Struggling with UI? Request an appointment.

Causes and diagnosis.

It’s easy to see why so many women think prolapse and UI are normal after childbirth. Vaginal delivery does stretch the pelvic muscles and nerves, as well as the urethral sphincter.

However, giving birth is just one of a list of risk factors for these conditions. Other common causes include:

  • Aging
  • Collagen disorders, such as Ehlers-Danos syndrome, which relax the tendons too much
  • Family history—if your mom or grandma had prolapse or incontinence, your risk is higher
  • Forceps- or vacuum-assisted childbirth
  • Long-term conditions that cause abdominal pressure, such as chronic coughing
  • Obesity—even a 10% weight loss can drastically improve symptoms
  • Pregnancy in general, with more pregnancies increasing the risk

Diagnosing prolapse and UI does not involve fancy tests or equipment. For most patients, a physical exam and thorough discussion of your symptoms is all we need to diagnose your condition.

See a urogynecologist for problematic symptoms.

Thousands of women struggle with uncomfortable, annoying prolapse or UI symptoms that keep them from doing what they want and need to do. But you don’t have to live that way.

Most women who come to us wish they had come to us years sooner. MedStar Health urogynecologists are specially trained to help you discover the cause of your condition. Our dedicated pelvic floor experts will listen to you and help you find the best treatment to reduce or eliminate prolapse and UI symptoms.

Tired of dealing with pelvic pressure and leaking urine?
Visit a urogynecologist for expert care and get back to doing what you love!

Pelvic organ prolapse.

Bladder leakage.

Category: Living Well     Tags: pelvic organ prolapseurinary incontinence