Our Bodies, Our Lives
By Dr. Tristi Muir and Dr. Catherine Hansen
Wilma comes into the gynecologist’s office. Like most women, she is nervous about going in, but today she is more nervous than usual.
She has noticed a mass that keeps getting larger and larger — coming from her vagina. She is scared. The word cancer keeps running through her mind.
When her examination is done, cancer is not found. What Wilma has is prolapse of the pelvic organ — a loss of muscular and connective tissue support leading to bulging of the internal organs into the vagina, similar to a hernia.
With Wilma’s worst fear relieved, she asks, “Why have I never heard of this? I had no idea.”
We learn that throughout our lifetimes the risk of developing breast cancer is 1 in 8.
We learn that the risk for diabetes and heart disease is higher if you have family members with these disorders and that diet and exercise can lower the risks.
However, there is something much more common than any of these disorders.
One in two women has pelvic floor dysfunction — problems related to the support and function of the pelvic floor.
The pelvic floor muscles support the outflow of the vagina as well as the bowel and bladder.
Urinary problems (leakage, retention or overactive bladder), bowel problems (leakage, constipation and difficulty with evacuation), prolapse and sexual problems (loss of sensation, discomfort and alteration of body image) are common when the bottom has dropped out of the pelvic floor.
With a mirror, Wilma is shown the vaginal hernia (“dropped bladder” or cystocele, uterine prolapse and bulging rectal support or rectocele).
“How did this happen?” she asks me.
The life event that affects the pelvic floor most significantly is childbirth. Two vaginal deliveries increase the chance of developing prolapse eight times. Four vaginal deliveries increase this risk by 12.
Other common life events that can cause more stress and strain on the pelvic floor (and can lead to or worsen pelvic floor dysfunction) include chronic cough, constipation and repetitive heavy lifting.
After a deep breath, Wilma focuses on what treatment options she has. We sit down and go over the options to improve pelvic support and relieve Wilma’s symptoms.
Modifications that Wilma can make in her life to improve her symptoms include treating constipation, avoiding bladder irritants such as caffeine — which increase trips to the bathroom — maintaining or achieving normal weight and treating a chronic cough — she is encouraged to quit smoking.
The pelvic floor can be strengthened through pelvic floor muscle exercises — kegels. There is even an app for that.
Nonsurgical — physical therapy and pessary — and surgical options are available if behavioral changes do not take care of Wilma’s problems.
Many women are frightened when any of these begin happening to them, while others think that pelvic problems are a normal part of aging — diapers as babies and diapers in old age.
Kegel exercises should be performed throughout life to keep our pelvic muscles in the best shape possible.
If you are experiencing leakage of urine, difficulty emptying the bowel or bladder or bulging in the vagina, get it checked out.
Pelvic floor dysfunction is common, but it doesn’t have to be a normal part of aging. There are solutions.
Our Bodies, Our Lives focuses on issues surrounding women's sexual, gynecological and emotional health. Drs. Tristi Muir and Catherine Hansen are gynecologists at the University of Texas Medical Branch. Learn more information at utmbhealth.com/pelvichealth.