Do you leak a bit when you laugh? Do you have a feeling of fullness or bulging “down there”? These symptoms are often dismissed as normal parts of childbearing or aging, but they are indicators of pelvic floor dysfunction, an umbrella term for disorders in the pelvic region. Gynecologic surgeons Raymond Foster, MD, and Lisa Brennaman, MD, at Women’s and Children’s Hospital share some important information below about two of the most common pelvic floor disorders: pelvic organ prolapse and urinary incontinence.
The symptoms are usually easy to spot
Pelvic Organ Prolapse
“Typically, women will complain of a sensation of vaginal fullness or pelvic pressure,” says Dr. Foster. “It's not really painful, but they feel like they’re sitting on a lump, or they’ll say it feels like they have a tampon in, but there’s nothing in their vagina.” When this happens, what you’re actually experiencing is one of your pelvic organs — such as the bladder or uterus — pushing against the walls of the vagina. Prolapse is caused, in part, by a weakening of the pelvic floor muscles. Two common causes are the normal aging process and vaginal childbirth. Other causes include constipation, obesity, smoking, neurologic disease, and occupational heavy lifting.
Urinary Incontinence
A major symptom is stress incontinence, or leaking urine when you put light stress to your body, “like with coughing, sneezing, laughing, bending, stooping, running, jumping, etc.,” Dr. Foster says. Another common complaint is frequent urination, also called “overactive bladder,” which is associated with sleep disruption caused by the need to empty the bladder at night.
Treatment options
Pelvic floor dysfunction is not something you just have to live with. “If you’re wearing a pad to go play tennis, you know you have a problem,” Dr. Foster says. “Most patients are relieved to hear about minimally invasive treatment options for stress incontinence.”
Surgical and nonsurgical options exist for incontinence and prolapse, and these treatments can help you get back to a higher quality of life. “Many patients that undergo treatment for prolapse or incontinence can return to a higher activity level,” Dr. Brennaman explains, “like jumping, exercising…”
“And sexual activity,” Dr. Foster adds.
Nonsurgical treatment
About half of those with pelvic floor dysfunction can manage or cure their condition through nonsurgical treatments. “Patients that have early-stage prolapse [or urinary incontinence] can often be treated with pelvic floor therapy or pessary use,” Dr. Brennaman says. A pessary is a small device inserted into the vagina to hold the pelvic organs in place. Julie Starr, FNP, and Debra Ritchie, FNP, GNP, both nurse practitioners trained in urogynecology, work with patients eligible for nonsurgical options.
Surgical treatment
For stress urinary incontinence, Dr. Foster and Dr. Brennaman can perform a short, minimally invasive procedure. “You’re back at work in a week and a half, it’s an incision about an inch long, and it’s got a 97 percent cured or satisfied rate,” Dr. Foster says, which means the procedure either mostly or completely cures the condition in 97 percent of patients.
With prolapse, Dr. Brennaman says: “It has a very slow progression, so patients can take their time in deciding when their quality of life is impacted enough to warrant surgery. We have many patients that establish a relationship with us, elect for nonsurgical treatment for months or years, then ultimately choose surgery when their quality of life becomes affected. You don’t have to make the decision in one appointment.”
