Dr. Milena Weinstein describes the symptoms and treatment options available to women with pelvic floor disorders such as urinary incontinence. Dr. Weinstein is an OB/GYN at Massachusetts General Hospital.
Pelvic floor disorders are incredibly common. In fact, one out of three women may experience one or more pelvic floor disorders. One of the most important things for women is overcoming embarrassment to actually talk to at least the primary care doctors, initially, about these conditions.
Women who experience pelvic floor disorders could have many predisposing conditions. One of those conditions by far most common one would be prior vaginal delivery, which could potentially weaken the pelvic floor support structures.
The other risk factors include things like being overweight, smoking, perhaps prior surgeries. There are some genetic factors that are also known about this; probably more known ones would be things like connective tissue disorders, like Marfan syndrome.
Pelvic organ prolapse is a condition when pelvic organs weaken in their support structures and slip out of place. Sometimes it feels to women as a sensation of a vaginal bulge. Sometimes it actually could be a bulge that comes completely out of the vagina.
Women have many treatment options to treat the prolapse. Sometimes a perfectly reasonable initial step would be to observe your prolapse and perhaps do pelvic floor exercises to strengthen the muscles. Sometimes women choose to use support devices to elevate the prolapse to help them with the symptoms that they experience.
Certainly surgery is an available treatment option for the patients. Usually we like to wait until the woman completed childbearing prior to undergoing surgery for prolapse.
Here at Mass General we have different surgical approaches to the treatment of prolapse. These may include, depending on the condition, vaginal approach, abdominal laparoscopic, or robotic approach to repair the prolapse.
Urine incontinence is a very common condition and it affects one out of three women. The urine incontinence itself is involuntary leaking of urine, which can happen while the woman experiences an urgent sensation. Sometimes it can happen during a physical activity, coughing, sneezing, or laughing.
Treatment of urine incontinence will certainly depend on the different types of urinary incontinence that we may encounter. Sometimes the initial evaluation may include examination as well as the urodynamic testing to guide the treatment options. Certainly initial treatment options may include conservative measures including working in pelvic floor strengthening, bio feedback, pelvic floor physical therapy, sometimes retraining the bladder maybe an option. Sometimes medications are needed to treat the urinary incontinence and again, depending on the different type, surgery may be an option.
Here at Mass General, we have a team of pelvic floor disorder service specialists who are physicians in different disciplines that together perform evaluations and treatments necessary for different aspect of pelvic floor disorders. These disorders commonly coexist. For example, prolapse commonly coexists with the urinary fecal incontinence. So the diagnostic procedures necessary can involve different modalities, and then the treatments are individualized to different patients if needed.