Pelvic Health

A woman’s pelvic region is an important part of her wellbeing. The pelvic region includes the vagina, uterus, and bladder. Pelvic problems are conditions associated with these structures such as urinary incontinence and pelvic organ prolapse. These conditions are very common, and each can significantly affect the quality of life.

Studies show that at least one–third of all women will experience one or more pelvic health conditions in their lifetime. Many women have incontinence, and most never describe symptoms to physicians. Up to 40% of women have some degree of prolapse. The good news, however, is that there are effective treatments available for these conditions and women can feel normal again.

St. Peter's Hospital's Women’s Health Institute offers assistance for Urinary Incontinence and Pelvic Prolapse

Urinary Incontinence—the loss of bladder control

There are two improtant terms associated with urinary incontinence—"urge" and "stress."

Urge means urine loss accompanied by urgency resulting from abnormal bladder contractions. 

Stress is urine loss resulting from sudden increased intra–abdominal pressure (e.g., laugh, cough, sneeze).

Urinary Incontinence Clinical Services Available:

  • evaluation/diagnosis
  • pelvic exam, urodynamic evaluation (e.g., stress test)
  • Lab tests:  urinalysis, urine culture, vaginal culture, wet mounts
  • behavioral programs

Treatment Options

  • medical (anti-cholinergics, topical estrogens)
  • biofeedback and electrical stimulation  
  • surgical options
  • sling procedure
  • bulking agents

Urinary incontinence is a common and often embarrassing problem. The severity of urinary incontinence ranges from occasionally leaking urine when you cough or sneeze to having an urge to urinate that's so sudden and strong you cannot get to a toilet in time. There are two main types of urinary incontinence, stress and urge.

Stress urinary incontinence, or SUI, is leaking of urine when laughing, coughing, or sneezing. While it is the most common form of incontinence in women—typically caused by pregnancy and childbearing, obesity, and menopause—it is significantly under–reported in women. It is more common in women under 65 years of age.

Urge incontinence involves an involuntary contraction of the bladder, usually with no activity. A strong urge to urinate will occur and then subside. However, in some women the bladder contraction will be strong enough to cause the bladder to leak before they are able to empty on a toilet.

If urinary incontinence affects your day–to–day activities, don't hesitate to see your doctor. In most cases, simple lifestyle changes or medical treatment can ease your discomfort or stop urinary incontinence.

Stress Urinary Incontinence

Stress urinary incontinence, or SUI, is the sudden, unintentional release of urine during normal, everyday activities. It affects 40% of all women and can happen at any age. Although it is very common, SUI is not a normal part of the aging process.

The most common cause of SUI is poor support of the urethra caused by a weakening of the muscles of the pelvic floor and connective tissue. Pelvic floor weakening can happened as a result of pregnancy and childbirth, chronic heavy lifting or straining, menopause, or obesity.

If you are experiencing sudden urine loss, take a moment to ask yourself:

  • Do you experience unplanned, sudden loss while laughing, sneezing, coughing, or exercise?
  • Do you limit or avoid any activities?
  • When planning a trip or event, does the availability of restroom facilities affect your decision?
  • Do you wear a pad to absorb urine leakage?

If you answered yes to even one of these questions, you may be experiencing SUI.

Treatment Options

Treatment choices for urinary incontinence range from lifestyle changes to surgery. Your treatment will depend on the underlying problems causing the incontinence. But keep in mind that no treatment works perfectly, and you may have to try more than one approach before you find the one that best suits your needs. Because there are a variety of options, your preferences are important in developing a plan.

Physical Rehabilitation

The latest in treatments for incontinence and pelvic pain are offered at the St. Peter's Hospital outpatient physical therapy clinic. Evaluation and treatment is done in the privacy of a separate exam room. Treatment goals are specifically aligned to meet individual needs.

Incontinence is a normal part of aging, pregnancy, or after delivery. It can be experienced when working out, lifting, sneezing, or laughing. Eighty percent of women experiencing these symptoms can cure or significantly improve through regular, targeted exercises.

The therapists work with their patients to teach pelvic floor exercises together with weight bearing exercises for improving the health and strength of the pelvic floor. This not only prevents incontinence but also relieves back, muscle and tissue pain. Biofeedback is also used to re–train muscles in some cases. The majority of incontinence patients begin to notice changes after two treatments, and most complete their treatment plan in four to five sessions.

Kegel Exercises:
How to Strengthen Pelvic Floor Muscles

If you do them the right way, Kegel exercises can help you prevent or control urinary incontinence and prepare for childbirth.

Kegel (KAY-gul or KEY-gul) exercises strengthen the pelvic floor muscles, which support the uterus, bladder and bowel. If you do Kegel exercises regularly and keep your pelvic floor muscles toned, you may reduce your risk of incontinence and similar problems as you get older.

Learning how to perform Kegel exercises properly can be tricky. How do you know whether you're working the correct muscles?

Here's a guide to perfecting Kegel exercises.

When your pelvic floor muscles weaken, your pelvic organs descend and bulge into your vagina, a condition known as pelvic organ prolapse. The effects of pelvic organ prolapse range from uncomfortable pelvic pressure to leakage of urine or feces. Fortunately, Kegel exercises can strengthen pelvic muscles and delay or maybe even prevent pelvic organ prolapse.

Kegel exercises are recommended especially during pregnancy. Well–toned pelvic floor muscles may make you more comfortable as your due date approaches. You may be less likely to develop urine leakage—common near the end of pregnancy and prone to persist after you've given birth.

Finally, Kegel exercises—along with counseling and sex therapy—may be helpful to women who have persistent problems reaching orgasm.

How to do Kegel Exercises

It takes diligence to identify your pelvic floor muscles and learn how to contract and relax them. Here are some pointers:

Find the right muscles

To make sure you know how to contract your pelvic floor muscles, try to stop the flow of urine while you're going to the bathroom. If you succeed, you've got the basic move. Or try another technique: Insert a finger inside your vagina and try to squeeze the surrounding muscles. You should be able to feel your vagina tighten and your pelvic floor move upward. Then relax your muscles and feel your pelvic floor move down to the starting position. As your muscles become stronger—and you become more experienced with the exercises— this movement will be more pronounced.

Don't make a habit of starting and stopping your urine stream. Doing Kegel exercises with a full bladder or while emptying your bladder can actually weaken the muscles. It can also lead to incomplete emptying of the bladder, which increases your risk of a urinary tract infection.

If you're having trouble finding the right muscles, don't be embarrassed to ask for help. Your doctor or other health care provider can give you important feedback so that you learn to isolate and exercise the correct muscles.

Perfect your Technique

Once you've identified your pelvic floor muscles, empty your bladder and sit or lie down. Then: 

1. Contract your pelvic floor muscles.

2. Hold the contraction for three seconds then relax for three seconds. Repeat 10 times.

3. Once you've perfected three–second muscle contractions, try it for four seconds at a time, alternating muscle contractions with a four–second rest period.

4. Work up to keeping the muscles contracted for 10 seconds at a time, relaxing for 10 seconds between contractions.

5. To get the maximum benefit, focus on tightening only your pelvic floor muscles or isolating your pelvic floor muscles. Be careful not to flex the muscles in your abdomen, thighs or buttocks. Also, try not to hold your breath. Just relax, breathe freely, and focus on tightening the muscles around your vagina and rectum.

Repeat three times a day

Perform a set of 10 Kegel exercises three times a day. The exercises will get easier the more often you do them. You might make a practice of fitting in a set every time you do a routine task, such as checking e-mail or commuting to work.
Vary your technique with one of these methods:

Try sets of mini-Kegels

Count quickly to 10 or 20, contracting and relaxing your pelvic floor muscles each time you say a number.

Visualize an elevator

Slow down the exercises, gradually contracting and releasing your pelvic floor muscles one at a time. As you contract, visualize an elevator traveling up four floors. At each floor, contract your muscles a little more until you reach maximum contraction at the fourth floor. Hold the contraction and then slowly release the tension as you visualize the elevator returning to the ground floor. Repeat 10 times.

Medications

Called anticholinergic medicines, there are a number of medicines available to help relax the bladder wall and decrease the urge sensations and frequency associated with urge incontinence. These are usually used in conjunction with physical therapy.

Surgery

Tension free vaginal tape (TVT) is a minimally–invasive, outpatient procedure. The procedure itself usually takes around 30 minutes. Recovery is quick and 90% of women treated with TVT are still dry seven years after the treatment.

Talking about SUI with your health care provider is the most important thing you can do to begin to take control of sudden urine loss.

Pelvic Prolapse 

There are four important medical terms that are associated with types of pelvic prolapse: They are "enterocele," "cystocele," "Restocele," and "uterine prolapse."

Enterocele means a prolapse or protrusion of the small intestine into a space between the rectum and vagina.   

Cystocele is a hernia or pouch from the bladder which protrudes through a weak spot in the anterior vaginal wall. 

Rectocele is a hernia or prolapse of the rectum through a defect on the posterior vaginal wall.

Uterine prolapse means the descent of the uterus into the vaginal canal.

Pelvic Prolapse Clinical Services Available

  • evaluation/diagnosis
  • pelvic exam
  • neurologic assessment
  • urodynamic evaluation (if incontinence is present)
  • lab tests: urinalysis, urine culture, vaginal culture, wet mounts

Treatment Options

  • physiotherapy (pelvic floor exercises, vaginal cones)
  • hormone replacement therapy (e.g., local estrogens)
  • vaginal pessaries
  • surgical options
    1. anterior/posterior repairs
    2. vaginal hysterectomy
    3. vaginal vault suspension

Pelvic organ prolapse occurs when one or more pelvic organs—the uterus, bladder or rectum—moves out of place and bulges into the vagina. It typically results from trauma sustained during labor or weakness in the connective tissue supporting the pelvic structure. It is more common in women who have had more than one baby and in postmenopausal women.

Key risk factors include: aging, pelvic surgery (hysterectomy), menopause, multiple vaginal births, obesity, chronic constipation, coughing or heavy lifting, uterine fibroids, and family history.

For More Information:

St. Peter’s Women’s Health Institute
Phone: (406) 495-6780

Helena OB/GYN Associates, P.C.
45 Medical Park Drive, Helena, MT  59601
Phone: (406) 442-1914
www.obgynoffices.com

Videos: 
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Urinary Incontinence
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Pelvic Prolaps
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