The Power Of The Pelvic Floor

Most commonly associated with childbirth and ageing, incontinence can have a major impact on quality of life. But as Dr Geeta Singh explains, there are options for limiting the leakage.

Many women have only a vague idea of what the pelvic floor is, but keeping these muscles strong is important for avoiding problems with urinary incontinence. Acting like a diaphragm in the pelvis, the muscles hold the pelvic organs in place, so if there is damage or weakness, this is where you run into problems.

Childbirth is a common reason for these muscles to become damaged, but it can also happen due to a loss of oestrogen during perimenopause and menopause. This is often exacerbated by loss of moisture within the vagina, which causes a thinning of the vaginal wall. No matter what age or stage you are at, if you are experiencing incontinence at any level, it is important to check in with your doctor.

The first step is an assessment by a specialist to rule out any gynaecological problems or displacement of pelvic organs. If this is all clear, we will then refer you to a pelvic floor physiotherapist because, like any muscle, pelvic floor strength can be rebuilt with specific exercises.

While some like to attempt these exercises at home, it’s important they are performed correctly. We often see people who think they’re strengthening their pelvic floor but in fact it is their abdominals getting the workout. A specialist physiotherapist will ensure exercises are being done effectively.

In the case of displaced pelvic organs, we can often use a pessary to help lift the bladder back into place. This is a ring-shaped device that is placed into the vagina to support the uterus, bladder and rectum. It works by pressing against the wall of the vagina and urethra to help decrease leakage.

For some women, the weakening of pelvic floor muscles can cause the uterus or the vaginal walls to drop down, which is another form of prolapse that requires surgery. There are a range of surgical procedures available for prolapse.

If the threat of leaking urine is impacting your lifestyle – or even if it is just mildly annoying – there is no need to ‘grin and bear it’. See your doctor to learn about the options available for you.

Dr Geeta Singh is a specialist in urogynaecology with significant experience in the surgical treatment of stress urinary incontinence. An advanced laparoscopic surgeon, Geeta also has a special interest in managing endometriosis and fibroids and consults patients in need of specialist antenatal advice. coga.org.nz