Treatment Options

Pelvic Floor treatment optionsThere are several treatment options for pelvic floor disorders. The treatment used will depend on the severity of your condition and according to what your doctor prescribes. In addition, there are both nonsurgical and surgical treatments. Often times, the best success rates come from using more than one treatment option, together.

Nonsurgical Options

  • Kegel muscle-building exercise has been found to be extremely helpful for pelvic floor conditions of a mild degree. Biofeedback can help train and strengthen the pelvic muscles.
  • A Pessary can be inserted in the vagina. It is similar to a ring and can stay in the body all day to help give support to the pelvic floor organs. This custom device can help slow the deterioration of the muscles for several years, and it is especially good for women who still want to have children in the future or those who are not good candidates for surgical repair.
  • Electral impulses can be sent through the rectum or vagina to help control and stimulate the pelvic floor muscles. However, this treatment must be done several times over a few months.
  • A bowel management program and stimulated defecation (enemas, suppositories, medications) are other nonsurgical options.

Surgical Options

Transvaginal Pelvic Floor Repair
These procedures treat pelvic prolapse through a vaginal incision to restore the normal anatomy of the pelvic floor. When anatomy is restored, function of the organs involved is improved. This usually can be done through incisions in and around the vagina.

Laparoscopic Pelvic Floor Repair
Laparoscopic pelvic floor repair is a surgical option for prolapse. Doctors use the laparoscope to restore the anatomy of the vagina and its structural supports. In this procedure, surgeons insert a tiny telescope (laparoscope) through a small incision. The laparoscope is attached to a camera-television setup, giving the surgeons a magnified view of the pelvic floor. After making several "keyhole" incisions in the abdomen, the surgeons use specially designed instruments to lift and attach the prolapsed organs back in their normal positions with permanent sutures. There are numerous benefits to having pelvic floor defects treated laparoscopically.

They include:

  • Providing an accurate identification of the pelvic floor defects because of the laparoscope's excellent view of the pelvic floor from above.
  • Minimizing the need and extent of vaginal repair, thus reducing the risk of painful internal scars.
  • Avoiding or deferring hysterectomy for uterine prolapse.
  • Allowing the patient to enjoy a shorter recovery time and to experience less postoperative discomfort.

Urinary Incontinence

Nonsurgical Options
Depending on the reason for a person's incontinence, there may be behavioral changes that can help with some of the urinary symptoms. Bladder training and scheduled urination can help to rid your bladder continuously instead of waiting for the feeling of having to go. It also may be necessary to change your diet by lessening alcohol and caffeine intake, as well as acidic foods and liquids. Medication can be prescribed to help control the bladder. Commonly prescribed drugs are: antimuscarinicsc-for overactive bladders; imipramine-an antidepressant to relax the bladder muscle; antibiotics-when your condition is related to a urinary tract infection; Alpha blockers and other medicines to relax your urinary sphincter muscle or shrink the prostate.

Surgical Options

  • Overactive bladder or retention of urine can be treated by the placement of electrodes in the spinal region that sends electrical stimulation to the nerves of the bladder.
  • A "sling" can be inserted during a minimally invasive procedure in the urethra to support it into its natural position. This can be performed in patients with urinary incontinence or sphincter dysfunction.
  • The tissue surrounding the urethra can be surgically enhanced or "bulked" around the urinary sphincter to help tighten the sphincter.
  • Bladder neck suspension surgery can be performed by making an incision into the abdomen and securing the bladder to a ligament near the pubic bone.
  • An artificial urinary sphincter muscle may be inserted to help control the pelvic floor muscles. This doughnut-shaped ring is inserted around the urethra. It stops the flow of urine, and when pressed manually, will release it.
  • Sacral nerve stimulation: electrodes placed to stimulate spinal nerves.

Fecal Incontinence

Surgical Options
Most people with fecal incontinence will not be candidates for surgical correction. Yet, selected individuals may benefit. A variety of surgical procedures and techniques exists for the treatment of fecal incontinence:

  • Sphincteroplasty: direct repair of a muscle defect.
  • Artificial bowel sphincter: an implanted inflatable donut placed around the anal muscles.
  • Sacral nerve stimulation: electrodes placed to stimulate spinal nerves.
  • Colostomy or ileostomy.

Pelvic floor disorders are treatable and controllable. However, successful therapy requires active patient participation both for diagnosis and therapy. Only you can determine just how bad the symptoms are and their impact on your quality of life. It is up to you to monitor your progress and your response to management.

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