After ChildbirthMar 2009
Q: I’ve heard many women experience pelvic floor disorders after childbirth. What might these include and how can they be treated?
A: Childbirth is, by far, one of the great miracles of life. Remarkable changes take place in a woman’s body during pregnancy and delivery, and although every woman is different, it is all too common for those changes to lead to distressing health disorders. Oftentimes, these disorders result from damage caused to the pelvic region during vaginal childbirth.
During childbirth, the reproductive organs and their support structures are displaced from their normal positions in the pelvis. In many cases, these organs return to completely normal functioning; but it is also common for them to be permanently stretched or displaced, which can alter their functions. When the pelvic organs fail to resume their normal position and function, distressing symptoms can arise.
Pelvic floor disorders can include anything from urinary or fecal incontinence and overactive bladder to pelvic organ prolapse, which is defined as the weakening of the structures that support or separate a woman’s pelvic organs. Often, these disorders result in displacement or falling of the pelvic organs, including the uterus, and can occur in combination with one another, so a visit to a specialist is essential.
What many women do not realize is the fact that these conditions may not become apparent until years or even decades after childbirth. A frequent misconception regarding pelvic floor disorders is that they are an inevitable part of the aging process or that these conditions cannot be corrected.
The fact is, more than one in three women will suffer from some type of pelvic floor disorder during their lifetime, and more than half will experience a form of incontinence.
Many women, unaware of the specialized treatments available today to help, are burdened with these conditions, which can drastically affect overall quality of life, especially when the disorders are moderate to severe. For example, more than half of all admissions to long-term health care facilities are related to incontinence issues.
Diagnosing a pelvic floor disorder starts with a detailed look at a woman’s medical history, followed by a comprehensive specialized pelvic exam. If necessary, specialized testing may then be conducted and can include a cystoscopy (looking into the bladder with a small telescopic device) or urodynamics (a computerized test to measure the two main functions of the female bladder, storage and emptying).
Depending on the diagnosis, both surgical and non-surgical treatment options are available. A common non-surgical option is biofeedback, a computer-assisted technique to help women locate and learn to correctly contract the pelvic floor muscles, thereby increasing the support they provide to other pelvic structures. Another non-surgical option is to insert a vaginal pessary, a bendable device that provides internal support to various pelvic organs.
Advanced surgical options are also available and are recommended on a case-by-case basis. Modern technologies enable urogynecologists to use advanced, minimally invasive vaginal surgical techniques as well as robotics and laparoscopy, the practice of inserting a thin tube through the abdomen to look at the pelvic organs. Natural tissue grafting is also frequently recommended to replace damaged tissue or to reinforce weakened tissue for increased support to a given area. Sometimes, several procedures may be done in one visit to the operating room, especially if multiple disorders occur simultaneously, such as incontinence and prolapse.
The bottom line is that, because the female organs are so complex, women with pelvic floor disorders have special needs. Many of these disorders are more common than most women think or admit; but due to recent advances in the subspecialties of urogynecology, pelvic medicine and reconstructive surgery, for the first time there are ways to properly diagnose and effectively, definitively, treat these problems. With these state-of-the-art solutions more readily available, it is no longer necessary for women to simply cope with the inconvenience of life-changing pelvic floor issues.
One of approximately 110 fellowship-trained urogynecologists and reconstructive pelvic surgeons in the country, Dr. Christopher Walshe offers advanced diagnostic and treatment programs for pelvic floor disorders at his private practice, located in Harbour View Medical Arts Facility in Suffolk.