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Pelvic floor disorder occurs when the pelvic organ drops from its usual place. We look at its symptoms and available treatments.
Patients will contract these muscles rather than relax them, which has an impact on the ability to pass stools. Organs that can be affected are the uterus, vagina, bowel and bladder.
Symptoms can be worse when the patient is standing, jumping, and lifting. The symptoms can be relieved when the patient is lying down.
Childbirth is a main cause of pelvic floor disorders. The risk is increased for women every time they go through childbirth. This is because it weakens and stretches the support structures in the pelvic area. Women who have a caesarean section, however, are at less risk of pelvic organ prolapse.
Significantly low levels of the hormone oestrogen is another cause of pelvic floor disorder. Women experience low oestrogen levels during and after the menopause. This leads to the body producing less collagen, a protein that helps the pelvic connective tissues stretch and revert to their usual positions.
Another cause is if the patient has had surgery to remove the uterus (hysterectomy) when treating other health problems. Such surgery can weaken support for other pelvic organs.
Other, less common causes, include: obesity, leading to long-term pressure within the abdomen; chronic coughing as a result of smoking or lung conditions; and conditions related to the spinal cord, that can lead to paralysis of the muscles of the pelvic floor.
The doctor may consider conducting a test called a defecating proctogram, during which the patient will be given an enema of a thick liquid that can be detected with an X-ray. The doctor will use a special video X-ray to record the movement of the muscles as the patient tries to push the liquid through the rectum. There is also a uroflow test which can be conducted to assess the patient’s ability to pass urine.
For more mild forms of prolapse, the patient may be referred for a course of treatment with a physiotherapist who specialises in prolapse. Vaginal hormone treatment (oestrogen), in the form of tablets or cream, may also be prescribed by the doctor.
One of the widely used treatments is a pessary, which is a plastic device that is fitted into the vagina to help support the pelvic organs and hold up the uterus. This is a non-surgical option and is used by patients who are thinking about having children in the future or are not able to undergo surgery due to an underlying health condition. There are different types and sizes of pessaries, but the most common is a ring pessary.
The other option is surgery, primarily used for the more severe cases. A pelvic floor repair might be undertaken, which involves tightening the walls of the vagina to support the pelvic organs. This may be done through incisions in the vagina, and involves being under general anaesthetic. There are also new operations in which mesh is sewn into the vaginal walls.
For patients who experience complete prolapse of the uterus (womb), the doctor may suggest removing the uterus, an operation known as a hysterectomy. This can provide better support to the whole of the vagina and reduce any chance of a prolapse returning. However, this procedure will only be considered if the woman wishes does not wish to have any more children, as she will not be able to get pregnant afterwards.
Whilst the majority of women treated with mesh respond well to the treatment, the risks and benefits of a mesh implant remain unclear. Patients have reported complications, including persistent pain, sexual issues, mesh exposure through vaginal tissues and occasionally injury to organs, such as the bladder or bowel.
Lifestyle changes can include: losing weight and avoiding obesity; avoiding constipation; managing a chronic cough if the patient has one; quitting smoking; avoiding heavy lifting; and avoiding physical activity like trampolining or high-impact exercise.
Patients will also be encouraged to do regular pelvic floor exercises in order to strengthen the pelvic floor muscles.