Aging and Pelvic Floor Strength
Pelvic floor disorders, such as pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are common issues in older women. These conditions generally have their roots in a slow, gradual weakening of the pelvic floor throughout a woman's lifetime. The largest contributors to that deterioration are usually pregnancy and childbirth, but other factors can contribute as well, such as obesity, heavy lifting, high-impact sports, frequent constipation and a chronic cough, or anything else that increases pressure on the pelvic floor muscles.
Then, in the menopausal phase of life, the drop in estrogen levels can lead to less elasticity, further weakening the pelvic floor, which can be the last straw in the development of pelvic floor disorders.
Common Pelvic Floor Problems
SUI and POP are the most common pelvic floor problems that women face. Women 50 or over are at highest risk, although symptoms can appear earlier for some. Both conditions are related to diminishing pelvic floor function, typically due to a slow, steady accumulation of damage to the pelvic floor muscles, nerves and tissues caused by years of stress and hastened along by the aging process.
In SUI, that weakness can lead to urine leakage when pressure is put on the bladder by activities such as coughing, laughing or lifting. In POP, weakness in the pelvic floor allows pelvic organs, such as the bladder, to fall lower in the pelvic cavity and place pressure on the vagina. This can cause pain and pressure in the pelvic region, bleeding, urinary incontinence, difficult bowel movements and a lump in the vaginal area. In severe cases, tissues may protrude from the body.
Treatments
Physical therapy can be very effective in treating the problems that can result from pelvic floor weakness. Typically, Kegel exercises are used to strengthen the pelvic floor muscles, often combined with biofeedback to monitor muscle performance and specialized weights to maximize the benefits of the exercise regimen. Weight loss is recommended, since excess weight strains the pelvic floor.
Dietary adjustments can also help, such as added fiber and fluids to treat or prevent constipation, since constipation can aggravate the symptoms of stress urinary incontinence and pelvic organ prolapse. Corrective surgery is an option that has worked well for many women with SUI or POP symptoms that could not be resolved with less invasive treatments.
Cautions
Women who have SUI or POP and are considering a surgical solution should be aware of serious problems associated with procedures that use transvaginal mesh to correct these conditions. The Food and Drug Administration (FDA) has released alerts questioning the safety and effectiveness of transvaginal mesh implants, citing high rates of serious complications, such as mesh erosion, protrusion through vaginal walls, organ perforation, mesh contraction and infection.
Many women have had to undergo more surgery to have the vaginal mesh removed, which is a painful process that can require multiple procedures. According to the FDA, those risks come with little benefit, since mesh procedures have not been shown to provide better clinical results than traditional procedures to correct SUI and POP.