Pelvic floor problems

Treatment for Urinary Incontinence and Prolapse

Lifestyle

Both types of urinary incontinence can be improved by ensuring a normal fluid intake and avoiding drinks containing caffeine, fizzy drinks and alcohol. Weight loss in overweight women can also help.

Physiotherapy

For women with stress incontinence symptoms physiotherapy is a safe and effective treatment which increases the strength of the pelvic muscles. Physiotherapy can also help women with mild vaginal wall prolapse and women with urge incontinence.

• Pelvic floor exercises
Women who tend to go to the toilet to pass urine frequently and those with detrusor overactivity benefit from bladder exercises that help them to go to the toilet less often. The exercises can dramatically reduce and often eliminate problems altogether. Your Physiotherapist will guide you through a programme and show you how to improve bladder symptoms once your muscle power is improving. When pelvic floor exercises are performed correctly with guidance many women find that this is all that is needed to reduce their symptoms.

• Biofeedback
This is a piece of computer equipment which picks up a signal from the pelvic floor muscles and shows you on a screen how your muscles are working. This can be very effective to help you do your exercises well and you can quickly see results in retraining the muscles.

• Bladder retraining
Women who have problems of urinary urgency (needing to rush to the loo before the bladder is full) or urge incontinence can benefit from bladder retraining in combination with physiotherapy. This is an effective treatment that teaches the bladder to hold more.

• Electrical stimulation
This can be used to improve pelvic floor strength and reduce urgency. Many women notice a difference in their pelvic organs after giving birth. They may feel that their vaginal area is numb or slack and this can affect their sex life. Many of these women believe they have vaginal prolapse but this is usually not the case. The problem results from the injury to the pelvic nerves caused by pregnancy and childbirth. A small electrode is placed inside the vagina and a gentle electrical current stimulates the pelvic floor muscles to work. This is a gentle safe way to help the muscle power improve. You may need several treatment sessions with electrical stimulation to see a substantial effect.

Pessaries

For women with a prolapse of the womb or prolapse of the vaginal wall a range of devices called pessaries are available which can be placed in the vagina to hold the womb or vagina in their normal position. This can be useful for women who have not finished their families, who wish to avoid surgery or are not fit for an anaesthetic.

Surgery for Urinary Incontinence and Prolapse

Surgical treatment for urinary incontinence is useful for women who leak frequently and for whom physiotherapy and other treatments have failed. More extensive tests called urodynamic tests are usually necessary before considering surgery for urinary  incontinence. It is important to understand that operations for incontinence do not have a 100% success rate. A few women are unable to empty their bladder properly after surgery and may experience new or worsening urgency and urge incontinence as a result of their surgery.

The commonest procedures performed in the UK for women who experience urinary incontinence due to a poor tap mechanism (sphincter incompetence) is a mid–urethral tape insertion. These procedures can be performed as a day case or with an over night stay and involve only minor cuts in the body. We know that most women are dry or almost dry after this and recurrence in the 10 years following this is low.

An older operation for sphincter incompetence is colposuspension. This is an effective operation but needs a larger cut into the tummy than a mid-urethral tape. This is a “bikini line” cut. Because this is a more major operation, recovery takes longer. It is useful for women who dislike the idea of a foreign body (tape) being left in their body. The chance of cure is similar to mid-urethral tape but it may have a higher recurrence rate.

A more minor operation for a poor tap mechanism is a peri-urethral injection of a bulking agent. This is an injection into the urethra (water pipe) and can be done with local anaesthetic only. Fewer women are completely dry after this than after a tape operation or a colposuspension but the procedure involves less risk. The results may be short-lived but the procedure can be repeated. It may be suitable for women who do not want a major operation or who are not fit for an anaesthetic.

For women who have detrusor overactivity and have not responded to simpler treatments, Botox injections into the bladder can be considered. Detrusor overactivity is a condition where the bladder contracts at times other than when the woman is on the loo. This is a minor operation performed by passing a telescope into the bladder via the urethra. The procedure is effective but only lasts 9 to 12 months although it can be repeated. It can cause incomplete emptying of the bladder.

Drug Treatment for Urinary Incontinence

Drug treatment for urinary incontinence is also available. For urge urinary incontinence there are a number of drugs available. These are called anti-cholinergics. They help reduce bladder contraction at an inappropriate time. These drugs are available as tablets or patches. They work for around 60% of women who use them. They have some side-effects so physiotherapy is always recommended first. The common side-effects are a dry mouth, constipation and heartburn.

Duloxetine is the only drug available to help stress incontinence. It makes the bladder neck contract more strongly. It only works while it is being taken. Again it has some side-effects particularly nausea, constipation, dizziness and headache.  The side-effects tend to lessen with time. Generally it is used for women for whom physiotherapy has not worked and wish to delay surgery or who are not fit for surgery.

Oestrogen, used as a vaginal cream or pessary, can be a useful treatment in menopausal women with bladder problems. This treatment can help with urgency, recurrent bladder infections, difficulty emptying the bladder, soreness and dryness in the area and sexual function. It can also improve the condition of the vaginal skin in this area which promotes healing after prolapse or bladder surgery. Oestrogen given as a tablet or patch does not help bladder problems.

Further information

Tel 0845 290 3244

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