Pelvic Floor Disorders: Which Treatment Is Right for Me?

 

While several conditions fall under the heading of “pelvic floor disorders,” this clinical term most frequently refers to pelvic organ prolapse, which occurs when the pelvic floor—the muscles and connective tissue that suspend the abdominal cavity when standing—is weakened and the pelvic organs (the cervix, uterus, bladder, urethra and rectum) begin to bulge into the vagina.

Many factors can contribute to these conditions: vaginal childbirth, hysterectomy, repeated lifting of heavy objects or a prior surgery, among others. No one best treatment exists for all women who have a pelvic floor disorder. Treatment should be individualized to meet the patient’s goal for therapy, according to James Whiteside, MD, a UC Health urogynecologist at West Chester Hospital and associate professor of obstetrics and gynecology in the Division of Female Pelvic Medicine and Reconstructive Surgery for UC College of Medicine. He also serves as director of the UC Health Obstetrics and Gynecology residency programs.

 

Surgical Versus Non-Surgical Treatment?

A variety of non-surgical and surgical treatments are available to women, and patients should evaluate all options carefully in conjunction with their doctor, urges Dr. Whiteside.

Surgical Mesh

“Many people have heard of transvaginal mesh,” says Dr. Whiteside, a medical device that is inserted surgically to provide extra support to weakened or damaged tissue. Most surgical mesh devices are made from synthetic materials or animal tissue, with the applications focused on management of vaginal prolapse or stress urinary incontinence (when the bladder leaks urine during physical activity or exertion). In most contexts, states Dr. Whiteside, no reliable studies exist to demonstrate that surgical mesh is consistently superior to non-mesh surgical options for the correction of most vaginal prolapse.

Native Tissue Repair

Prior to the introduction of mesh treatment, surgeons employed a so-called “native tissue” approach, using the patient’s own tissue to re-suspend the pelvic organs. In recent years, several high-quality studies have offered a better understanding of the risks and effectiveness of native tissue repairs relative to repairs using mesh, Dr. Whiteside says. These studies demonstrate comparable rates of effectiveness, with overall less risk, than repairs using transvaginal or abdominally inserted mesh.

Pessaries

The pessary is a silicon device that is inserted into the vagina to support the pelvic organs. Available in many shapes and sizes to suit individual needs, the pessary is regarded as an effective, non-surgical option for a variety of pelvic floor disorders.

Medication & Physical Therapy

Medications can be prescribed for some relief of pelvic floor dysfunction, and physical therapy specifically designed for women with pelvic floor disorders can also be effective in managing the condition.

Watchful Waiting

Active surveillance, or watchful waiting, may be a reasonable option for some women. “A fair number of women who possess less than perfect vaginal support are not bothered at all,” says Dr. Whiteside. “They aren’t experiencing prolapse symptoms and only became aware of the condition during a regular health check up.”

Dr. Whiteside strongly recommends that those who are suffering with pelvic floor dysfunction talk with their health care provider about all possible treatment options.

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