Pregnancy and childbirth can change many things in a woman’s body, including a decrease in the strength of the pelvic floor. According to estimates, around 13% of new mothers will experience pelvic floor problems after vaginal delivery. The risk of pelvic floor problems increases with the more children a woman has. This weakening of the pelvic floor can lead to many issues, including urinary incontinence and pelvic organ prolapse. According to some statistics, around 30% of new mothers experience urinary incontinence after pregnancy and delivery.
What causes pelvic floor issues?
As a pregnancy advances, the pressure on the pelvic floor increases, often causing it to weaken. The extra strain involved in vaginal childbirth can cause both tears in the pelvic floor and nerve damage, weakening the pelvic floor further. Because of this, It is common for pregnant women and new mothers to develop pelvic organ prolapse. Pelvic organ prolapse is when one or more of the pelvic organs descends into the vagina causing a woman to see or feel a bulge. It also can cause the sensation of pressure on the vagina and rectum.
Symptoms of pelvic floor issues
Many of the common symptoms of pelvic floor issues are due to weakened support of the bladder, uterus, or rectum. The severity of the pelvic floor symptoms often depends on the extent of tissue damage during labor and childbirth. Many women may find that they have an overactive bladder or even loss of bladder control or fecal incontinence. Alternatively, they may experience constipation or difficulty fully emptying their bladder. Sexual intercourse may also become painful or less satisfying for mothers with pelvic floor issues post vaginal childbirth.
Treatment Options for Pelvic Floor Issues
Physicians who treat pelvic floor disorders – including gynecologists, urologists, and female pelvic medicine specialists – are able to offer treatments to women depending on their symptoms and disorder.
Observation
If a woman has mild pelvic floor weakness and has minimal symptoms, she may choose to observe her symptoms and intervene if they become bothersome.
Kegel Exercises
Kegel exercises are pelvic floor muscle exercises used to strengthen the muscles and tissues of the pelvic floor that support the bladder, bowel, and uterus. These pelvic floor exercises can often help lessen the symptoms of pelvic floor issues and are often used in conjunction with biofeedback therapy (see below). Like any exercise, it takes time to see results and they need to be continued on a regular basis.
Biofeedback Therapy
Biofeedback therapy (BFT) is an alternative to Kegel exercises alone. BFT is usually done by using special equipment to monitor how the pelvic floor muscles are responding to electrical stimuli. From this, a pelvic floor physical therapist can recommend certain practices that can help to improve the condition.
In the case of pelvic floor issues, this will involve seeing what happens when the pelvic floor muscles are clenched and relaxed. This monitoring helps highlight the muscles in and around your pelvic floor that are tight or malfunctioning. The therapist can then devise a program to help improve muscle coordination.
While BFT is still considered an effective treatment method, only 60% of patients with pelvic floor disorders experienced a long-term improvement in controlled clinical trials.
Medications
Medications are used as a supplement to other treatment methods. Nonetheless, they play an important role in treating pelvic floor issues. The medicines include treatments for overactive bladder symptoms and stool softeners that help alleviate symptoms such as constipation and reduce the strain on the pelvic muscles.
Pessaries
Pessaries are a non-surgical way to deal with pelvic organ prolapse. They are soft and flexible devices inserted into the vagina to stop the organs from protruding through the pelvic cavity into the vagina. These are similar to diaphragms that were used in the past for birth control. Pessaries are not usually considered a cure for prolapse but can help to avoid or delay surgery as an option.
Surgical Treatment
Pelvic organ prolapse that cannot be improved using BFT, kegel exercises, or pessaries may require surgery. The type of surgery recommended depends on what organ is prolapsed and the degree of prolapse. Mild prolapse can often be repaired as a same-day surgery through the vagina while more advanced prolapse may require a more complex reconstructive surgery.
Surgery is not indicated for pelvic floor dysfunction that causes pain and is not due to prolapse as this is a functional, not anatomic, condition. Suppose BFT and kegel exercises are not working. In that case, other treatments such as pelvic floor physical therapy, trigger point injections that use a numbing or relaxing agent to loosen tense or painful pelvic muscles may be used.
Pelvic floor issues are a common side effect of pregnancy and childbirth. If you experience any issues post-childbirth that are worrisome or bothersome to you, it is important to speak to your doctor about what procedures may help you.
References
- Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques
- Roughly One Quarter of U.S. Women Affected by Pelvic Floor Disorders
- Two surgeries for pelvic prolapse found similarly effective, safe
- A Practical Guide to Biofeedback Therapy for Pelvic Floor Disorders
Learn More About Pelvic Floor Health
For more information about pelvic floor health, check out Dr. Karyn Eilber’s book “A Woman’s Guide to Her Pelvic Floor: What the F*@# Is Going On Down There?” on Amazon and Doctorpedia
