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Health Matters: Providence Mission Hospital | 7 What You Should Know About Your Pelvic Floor Pelvic floor problems can be troubling, but there is a wealth of effective treatment options. The key is to seek help. A lthough you might not be sure exactly where or what your pelvic floor is, you will know when it's giving you trouble. Unpleasant symptoms of pelvic floor dysfunction (PFD) include problems with bladder and bowel control, pain during intercourse, and organ prolapse. Unfortunately, about half the people who experience these conditions fail to see a doctor, out of embarrassment or the mistaken belief that nothing can be done for them. The pelvic floor is made up of layered muscles and ligaments that stretch front to back from the pubic bone to the tailbone and side to side from one sitting bone to the other. Like a trampoline, this muscular floor supports the bladder and bowel and, in women, the uterus. The muscles contract or relax together to control bladder and bowel functions. When these muscles and ligaments are damaged and weakened by childbirth, surgery, aging, obesity or other causes, one of the results can be stress incontinence, in which urine leaks when you cough, exercise, laugh or sneeze. "PFD is more common in women than men," says urologic surgeon Poone Shoureshi, MD, "although we do see it in men after the removal of the prostate." NONSURGICAL OPTIONS FOR HELP "It's unfortunate that people assume incontinence is normal," says Dr. Shoureshi. "Just because it's common doesn't mean you should have to live with it. If it's affecting your day-to-day life, it's time to do something about it." She notes that nonsurgical treatment options for urinary incontinence include medications and pelvic floor therapy. For both stress incontinence and uterine prolapse, another type of PFD, a device known as a pessary can help. Susan Stensby Adams, a physical therapist whose interest in PFD therapy was sparked by her own experience with pelvic floor issues after the birth of her daughter, says, "Pelvic floor physical therapy helps patients manage their symptoms better on their own." She explains that the therapy is customized to the patient and may include pelvic floor muscle retraining, sometimes combined with biofeedback. Even if the patient ultimately decides on surgery, the physical therapy is still beneficial, says Adams. "Before surgery, pelvic floor physical therapy will help strengthen pelvic floor muscles and improve recovery." Doing pelvic floor PT post-surgery also helps, she says, because "after surgery it helps restore weak pelvic floor muscles." Adds Dr. Shoureshi, "Everyone can benefit from pelvic floor therapy. It's like any workout routine in that way." SURGICAL OPTIONS "Depending on severity, patients can try conservative therapies like PT or a pessary first," says Dr. Shoureshi. "The next option would be surgery." For stress incontinence, one minimally invasive procedure is the injection of a bulking agent into the wall of the urethra. Narrowing the passage through which urine exits the bladder discourages leakage. The effect can last as long as seven years. Another option is reinforcing the pelvic floor with a mesh or grafted sling. Surgery with mesh can be used to repair both organ prolapse and stress incontinence, although the procedure differs depending on the problem. Surgical repairs with mesh for incontinence and prolapse typically last 10 and 15 years, respectively. For urge incontinence, aka overactive bladder, surgeons can implant a pacemaker-like device such as the InterStim device, which sends electrical impulses to the nerves of the pelvis. It is also approved to treat fecal incontinence. "There are many treatment options for pelvic floor problems," says Dr. Shoureshi. "It's up to the patients to determine the degree of intervention they want." Think you might benefit from pelvic health physical therapy? Join our team of therapists for a webinar as they discuss ways to strengthen the pelvic floor. To find the next webinar, call 844-943- 1060 or scan the QR code.

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