Treating a Pelvic Floor Disorder

After identifying the underlying problem, our care team will work with you and your referring physician to determine the best course of care. Depending on the type of disorder you have, this may include any (or a combination) of the following:

Behavioral changes

This could include:

• Losing weight: Being overweight puts extra pressure on your bladder. Weight loss will relieve some of that pressure and can help you regain bladder control.
• Avoiding certain types of physical activity such as heaving lifting: Heavy lifting can put extra pressure on your bladder and cause stress to your pelvic floor muscles.
• Voiding on schedule: Sometimes the message that the bladder is full comes without warning and often too late. In these cases, women find that they lose urine on the way to the bathroom. There is not enough time between the message and their ability to get to the bathroom before they start to leak. Voiding on a schedule may help prevent these leaking episodes.

Nutritional counseling

Depending on the type of disorder you have, you may benefit from dietary changes. For example, patients with chronic constipation may benefit from a high-fiber diet or medications to help soften stool. Or patients with bladder pain may be sensitive to certain types of drinks or foods; a modification in your diet may help alleviate symptoms. Some chemicals in our beverages can behave as diuretics and bladder irritants. If you are sensitive to these chemicals, they may cause you to make large volumes of urine or may aggravate bladder spasms resulting in a more frequent need to urinate. Some common bladder irritants include:

• Caffeine: Try to stop or at least reduce your caffeinated beverages like coffee, tea and cola to see if your bladder control improves.
• Artificial Sweeteners: Beverages that contain artificial sweeteners like aspartame or saccharin can also be a bladder irritant. Diet Pepsi, Mountain Dew or Coke then would be especially problematic because of the artificial sweetener and the caffeine.
• Citrus juices: Some people find that juices like orange or grapefruit juice can also irritate their bladder. Although there are no scientific studies to prove this, the best thing to do is to stop the suspected irritant for a week or two and see if it makes a difference.

Pelvic floor therapy

Pelvic floor therapy is a treatment intended to help patients learn to strengthen and relax their pelvic muscles in order to improve bladder and bowel function and decrease pelvic pain. A sensor is placed in the vagina to sense the contraction of the pelvic muscles. The system can also deliver a painless electrical stimulation to the pelvic muscles, which causes them to contract, and this stimulation both exercises the muscles and teaches the patient the sensation of pelvic muscle contraction. Pelvic floor therapy is done in the office on a weekly basis with a clinician who specializes in this type of therapy. Each session lasts approximately one hour, and most patients have six to twelve sessions during their initial treatment.

Medication

Certain medications are available to treat a variety of pelvic floor disorders, including overactive bladder, urogenital atrophy (thinning) and certain pain syndromes.

Pessaries

A pessary is a small plastic or silicone medical device inserted into the vagina or rectum to help support the uterus, vagina, bladder or rectum, when any of these organs fall, or are displaced from their original location. Pessaries are especially useful for women who are waiting for surgery or who cannot have surgery. The pessary can be placed temporarily or permanently, and must be fitted by your physician, advanced practice nurse or physician’s assistant. You will be taught how to insert and remove the pessary for cleaning, or if you prefer, you may come to the office periodically to have the pessary cleaned. Scheduled clinical follow-up appointments will be necessary.

Surgery

Surgery may be recommended if symptoms persist after you have tried other non- or less-invasive options. The surgery can usually be done minimally invasively, which offers less pain, less scarring and a shorter recovery. During surgery, the weakened area is located, and the tissues around it are built up to prevent the organ from dropping through the weakened area. For severe prolapse of the uterus or vagina, the surgery may require an incision in the abdomen. The upper part of the vagina is attached with stitches to a nearby bone in the pelvis. If urinary incontinence is present or would occur after prolapse of the uterus is repaired, surgery to correct incontinence can usually be done at the same time.