You're Not Alone: Solutions for Managing Pelvic Floor Disorders
Hollywood actress Kate Winslet made headlines when she admitted to having occasional urinary incontinence, confessing that “I can’t jump on trampolines anymore; I wet myself,” and “Two sneezes, I’m fine. Three, it’s game over.”
While Winslet’s candor is uncommon, her condition is not. Pelvic floor disorders — which can cause urinary leakage, accidental bowel leakage and pelvic organ prolapse — affect one in four women under the age of 40 and more than half of women over 65. Men can also develop pelvic floor disorders, though not as often as women. Anything that puts pressure on the pelvis, including pregnancy and childbirth, chronic cough and chronic constipation, can lead to a pelvic floor disorder. Genetics can also play a role.
Many women assume that a little leaking after childbirth is normal, but for others, symptoms of urinary or bowel leakage bring a lot of embarrassment and shame. Some patients are so embarrassed they’ll stop leaving the house and visiting with friends and family, says Dobie Giles, MD, chief of Female Pelvic Medicine and Reconstructive Surgery in UW Health’s Division of Gynecology.
Part of the problem is that people rarely talk about these issues, Giles says.
“There’s a social stigma,” he says. “Some random stranger in the grocery store will talk to you about their hangnail or heart murmur, but it’s uncommon for someone to share that when they sneeze they leak urine.”
Unfortunately, the stigma prevents many patients from getting the help that could resolve their symptoms. One study showed that 33 percent of women with urinary incontinence waited one to five years to talk to their doctor about it, and 26 percent waited more than five years before seeking help.
“I think another big barrier is a lack of awareness that there are good solutions that are minimally invasive,” says Heidi W. Brown, MD, a UW Health urogynecologist who has researched barriers to seeking care for pelvic floor disorders.
Even simple lifestyle modifications can improve or completely cure these disorders. Read on for tips on how to manage some of the most common problems and how to avoid them if you don’t already have pelvic floor issues.
How to Manage Common Pelvic Floor Problems
Stress Incontinence or Overactive Bladder Syndrome
Problem: You leak urine when you sneeze, cough or laugh really hard. Or you don’t make it to the bathroom in time because of a sudden, urgent need.
What it is: There are two main types of urinary leakage: stress incontinence and overactive bladder syndrome. The former is when you leak urine after activities that put pressure on the pelvis, such as sneezing or coughing. Patients with overactive bladder syndrome may find themselves going to the bathroom every 30 minutes to an hour and getting up at night to urinate, and the urge may come on so suddenly that they lose control of their bladder. Urinary leakage can happen five or six times a day, causing a real disruption to patients’ personal and professional lives.
Solution: The doctor may ask you to keep a bladder diary for two to three days, tracking everything you drink. “If we find a patient is drinking a pot of coffee and eight Diet Cokes a day, that’s not good,” Giles says. “Some patients are drinking five liters of water a day. Sometimes we just have to do diet and behavior modifications, and that can fix the problem.”
Pelvic floor physical therapy is the next step. “A lot of patients will say, ‘I already do my Kegel exercises,’ but the best, most effective way is to work with a physical therapist who is specially trained in the pelvic floor,” Giles says. “Behavior and diet modifications combined with pelvic floor physical therapy can have a dramatic impact.”
For stress incontinence, the doctor might also recommend you wear a ring-shaped device called a pessary. Inserted into the vagina, this device can help control leakage by supporting the bladder and urethra. For overactive bladder, medications may be helpful. “With overactive bladder, it’s kind of like your bladder is not listening to your brain anymore. The medicine can act on the bladder to tell the bladder to calm down,” Giles explains.
If urinary leakage persists after physical therapy and other treatment approaches, your doctor may recommend surgical options. Surgical options may include a sling to support the urethra, an injection into the bladder or urethra, or a pacemaker device to stimulate the muscles and nerves that control bowel and urinary function.
Accidental Bowel Leakage
Problem: You soil your underwear, either because of an unexpected and urgent need to defecate or because you didn’t even realize it was happening.
What it is: Accidental bowel leakage. “Patients may leak stool once a month, but that can be way more stressful than urine leakage, even if the urine leakage happens daily,” Giles says.
Solution: “You want to start with optimizing the consistency of the stool and doing pelvic floor muscle therapy with biofeedback,” Brown says. “Imagine holding water in your cupped hands versus something solid like a rock or pebble. You want to get your stool consistency to something that’s more solid.”
Getting the recommended 25 grams of daily fiber can help bulk up your stool. At the same time, you want to avoid constipation, which can cause a pelvic floor disorder in the first place. “If you become very constipated the rectum becomes like an overstuffed closet,” Brown says. Your doctor may refer you to a dietician for guidance on dietary modifications. Caffeine, artificial sweeteners, spicy foods and foods containing lactose are common triggers for accidental bowel leakage.
If the problem stems from a tear or weakness in the pelvic floor, a pelvic floor physical therapist can help you learn how to strengthen and coordinate the muscles, and the physical therapist may use biofeedback if you’re having trouble sensing the muscles of the pelvic floor. “It’s like wiggling your ears: There are tiny muscles in the pelvic floor you don’t know how to work,” Brown says. “So they’ll stimulate those muscles and then show you on the screen when you’re using them correctly.”
Other therapy options include inserting a bulking injection into the rectum, a pacemaker for the pelvic floor, and a new device worn in the vagina that inflates to prevent accidental bowel leakage. UW Health is one of only 15 sites in the nation able to offer the new inflatable device as part of a clinical trial. Most cases can be resolved without surgery, Brown says, but there are also surgical options to treat resistant cases.
Pelvic Organ Prolapse
Problem: You suddenly feel pelvic pressure or fullness, almost like you have a golf ball between your legs.
What it is: Pelvic organ prolapse, which is when the pelvic organs slip out of place. “The pelvis is a bowl-shaped bone lined with muscles. When those muscles are torn or weakened due to pregnancy or other causes, it can let the structures slip through the vagina,” Giles says. Depending on the severity of the prolapse, some patients might only feel a pressure or fullness, while others might actually see tissue hanging out. Most often, it’s the uterus slipping or the vaginal tissue turning inside out. “Sometimes patients feel better in the morning because they’ve been resting and there’s no pressure, but they notice it more as the day goes on,” Giles says. Prolapse can also cause bleeding and urinary and bowel problems.
Solution: The first step is education about what’s happening and how to minimize symptoms. Patients may not realize that heavy lifting and straining during bowel movements can exacerbate the problem, Giles says. The next step is to see a pelvic floor physical therapist to strengthen the muscles. A pessary, which can be inserted nonsurgically into the vagina, can help hold up the pelvic organs. In some cases, surgery may be warranted.
If you don’t have a pelvic floor disorder, there are things you can do to prevent one from occurring. Avoid constipation by consuming ample fluids and fiber and exercising regularly; maintain a healthy weight; don’t smoke; and do pelvic floor exercises (both relaxation and strengthening/coordinating exercises).
Unfortunately, your odds of developing a pelvic floor disorder go up as you age, and you should talk to your primary-care doctor or OB-GYN as soon as you notice symptoms. “The key thing to remember is you’re not alone,” Giles says. “The one thing I hear every day is, ‘I thought I was the only person.’ We can’t cure everybody, but we can make it better. And that’s what we love to do.”
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Date Published: 08/30/2016