When you begin to experience incontinence or prolapse symptoms, there are several treatment options to consider. These options range from non-invasive exercise programs aimed at strengthening the pelvic floor muscles to surgical procedures that include inserting a mesh into your body to assist in appropriately supporting your abdominal organs. A recent article in the New York Times, http://www.nytimes.com/2009/05/05/health/05tape.html?_r=1&ref=todayspaper , highlights the risks associated with the latter.
My personal belief is that there is a lack of information readily available to women to help them better understand both the causes of incontinence and prolapse and the various solutions available. The below is my attempt to help educate women on the options for dealing with incontinence or prolapse (see prior blogs for discussion about the causes of incontinence and prolapse).
Option 1: Purchase a physical therapist-guided DVD or book or attend an exercise class focused on guiding you through a pelvic floor exercise program. This option provides you with a program that you can perform in the privacy of your own home and is aimed at strengthening you pelvic floor and surrounding muscles. The program would need to be performed three times per week, for four to six weeks to see improvement or elimination of symptoms. To maintain symptom resolution, you would have to perform a maintenance exercise program thereafter. There are no risks associated with this option.
Option 2: A slightly more invasive approach involves inserting weighted cones or other tampon-like weights into your vagina and receiving instruction on how to perform pelvic floor contractions. It is also aimed at strengthening the muscles that have become weak within your pelvic floor. Again, one should expect to see improvements in approximately four to six weeks with regular exercise. A maintenance program should be continued thereafter. This also can be performed in the privacy of your own home and there are no risks associated with this approach.
Option 3: See a women’s health physical therapist in your area. This option involves receiving an internal evaluation and then the therapist giving you both verbal and manual feedback as you work to strengthen your pelvic floor muscles. The advantage of this approach is that you have a one-on-one coach to guide you through your exercise program, helping ensure that all your muscles are firing as they should. With this approach, you have to take the time to make and attend regular appointments with your physical therapist but, again, there are no risks associated with this approach.
Option 4: See your OB/GYN or family practice physician to insert a pessary device within your vaginal canal. The pessary device is designed to help hold up or give support to your bladder or uterus, which helps relieve prolapse symptoms and may improve or resolve incontinence symptoms by giving better support to the bladder. This approach should also be followed by an exercise program, otherwise you are simply putting a band-aid on your problem and not addressing the cause which, again, is usually muscular weakness. There are some disadvantages and risks associated with inserting a pessary device, namely changes to your vaginal canal, infection, and bleeding. For more information on pessary devices, go to this link: http://www.med.umich.edu/1libr/wha/wha_vagipess_crs.htm.
Option 5: Surgery to insert a mesh into your body, giving support to your bladder or uterus. The details of this surgery should be discussed with your surgeon. The following two sites address surgical treatments for incontinence and prolapse respectively in greater detail:
Many urologists that I have talked with have a strong opinion that an exercise-based program should always be a patient’s first course of action because of the risks associated with surgery. They have cited the risk of infection, the lack of long-term studies to show exactly how long the mesh will last, and the unknown of how many surgeries a women should expect throughout their lifetime to correct the same problem. As a physical therapist, I always recommend a non-invasive, exercise-based program first and a surgical procedure as a last resort due to the risks associated with any surgery.