Q&A: Understanding Pelvic Floor Health
Pelvic organ prolapse is such a common problem that many women think it’s a natural part of aging that can’t be treated. The truth is there’s plenty that can be done to correct it. Maria Canter, MD, MSc, FACOG, urogynecologist and Co-Director of the Center for Pelvic Floor Health, explains what causes this condition and the various treatment options.
Q.: What is prolapse, and what organs can be involved?
A: The muscles that support the bladder, uterus, vagina and rectum can weaken or tear. When that happens, the organs can drop into the vagina.
Q.: What causes pelvic organ prolapse?
A: In many cases, it is due to vaginal childbirth. Chronic straining with constipation also can be a cause, as well as previous pelvic surgery. Menopause can contribute because the body stops producing estrogen, which helps maintain the health of the vaginal muscles that support the bladder and uterus. Genetic conditions can play a role, too. If an immediate relative, such as your mother, has prolapse, your risk increases fourfold.
Q.: What are the symptoms?
A: A feeling of pressure in the pelvic area, difficulty passing urine or stool, or problems with urinary incontinence (bladder control). There may be discomfort with intercourse.
Q.: What can be done to prevent prolapse?
A: Kegels and pelvic floor exercises, as well as Pilates, can help strengthen the muscles.
Q.: What are the non-surgical treatments?
A: A pessary is a plastic device fitted for the vagina. It comes in different shapes and sizes and supports the vagina just like a brace would support a hernia. In conjunction with the pessary, I recommend physical therapy to prevent progression of the prolapse or incontinence.
Q.: What are the surgical treatments?
A: The gold standard for pelvic organ prolapse is sacrocolpopexy. This procedure uses synthetic graft to reconstruct and support damaged muscles and ligaments. The success rate is more than 90 percent at five years. At Virginia Hospital Center, we use the da Vinci® Robotic Surgical System to perform sacrocolpopexy laparoscopically. This method results in fewer complications, less post-operative pain, and less blood loss, which means an overall quicker recovery.
Q.: What’s the recovery time?
A: Patients go home from the Hospital the day after surgery and can go back to work in one to three weeks, depending on what other procedures are done at the same time, such as a hysterectomy. There’s no lifting for 12 weeks. After a few weeks, my patients tell me they feel fantastic.
Virginia Hospital Center Physician Group - Urogynecology Luis E. Sanz, MD, FACOG, Director, Urogynecology & Pelvic Surgery Center, Virginia Hospital Center;
Maria P. Canter, MD, MSc, FACOG, Co-Director, Center for Pelvic Floor Health, Virginia Hospital Center.