Home PELVIC FLOOR PROLAPSE AND
INCONTINENCE IN WOMEN
TREATMENT
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Medical: urinary tract and vaginal infections should be treated.
Local estrogen cream or tablets [in the vagina] may be recommended for women after the menopause. Medications are available to reduce/control stress and urge incontinence, so it is important to consult your doctor about your symptoms.
Vaginal ring: placed in the vagina to support the tissue, relieves symptoms. This can be used as a test to see if the symptoms are in fact due to the prolapse, or as a temporary measure until childbearing is complete, at which stage surgery can be done. If it relieves symptoms it may be left in place and be checked regularly by the gynaecologist.
Surgery: is the only potentially permanent cure available. It is only done once symptoms become unpleasant and the bulge in the vagina is uncomfortable or the lack of control in passing urine is embarrassing and unpleasant. The stretched muscle is shortened and the redundant tissue removed and the skin is stitched together.
Pelvic Floor Exercises: are important in prevention of prolapse during and after pregnancy. Used alone they have no effect on an established prolapse, but if the prolapse is mild it should help to reduce the symptoms of lack of control in passing urine.
They may be useful after surgery to improve the tone of the pelvic muscle floor.
Kegel’s Exercises:[2] are used to strengthen the muscles that surround the base of the penis in men, and the outer third of the vagina in women.
Kegel (pronounced Kay-gill) exercises were developed by Dr.Arnold Kegel to deal with urinary stress incontinence in his women patients. He discovered that his orgasmic patients developed a greater capacity for experiencing orgasms, and increased orgasmic sensations, and his non-orgasmic patients began experiencing orgasms.
The primary muscle involved is the PC [pubo-coccygeal] muscle which is attached in front to the pubic bone and at the back to the coccyx- at the bottom of the spine. This muscle circles around the opening to the bladder, the outer third of the vagina and the outer part of the rectum [back passage]. When exercised, it strengthens control of the flow of urine, and increases muscle tone of the vagina. These exercises are also used in the treatment of vaginismus [See: Sexual Pain in Women].
To identify the PC muscle: sit on the toilet and start and then stop the flow of urine, and also try and stop yourself from passing wind. The PC muscle is the only one that can accomplish this.
To avoid using the wrong muscles: don’t pull your tummy in, don’t squeeze your legs together or tighten your buttocks, and do not hold your breath. Nobody should be able to see that you are doing your PC exercises.
When starting to do the PC exercises, it is suggested that you insert one or two fingers into your vagina to feel the contraction’s pressure on your fingers. Then Kegels exercises can be done during daily activities e.g. driving, sitting, watching TV or lying in bed, talking on the phone.
[1] Contract the PC muscle, hold for 3 seconds, let go for 3 seconds, and repeat. These may be done as often during the day as you can manage, to build up gradually to 15 contractions 3 times a day. Because the PC is a muscle like any other muscle, with too strenuous exercise it can become sore if you build up to that number too quickly. If this happens, stop doing the Kegels for a day or two and then resume, but reduce the number done per day and gradually increase to 15, 3 times a day.
[2] Contract and release the PC muscle very rapidly, like a flutter-and build up gradually to 15 contractions 3 times a day. This exercise is rather like what the PC does involuntarily during orgasm.
[3] Push down in your pelvis for three seconds (to the count of three), relax, and repeat. Build up gradually to 15 times, 3 times a day. When you have your finger/s in the vagina you will recognise how the entrance to the vagina opens out while pushing. This exercise is particularly important in the management of vaginismus.
All these exercises can be continued as you get older, indefinitely. Increased muscle tone results in greater sensations during intercourse for both partners.
Get into the habit of tightening your PC muscles before you do anything that is likely to make you leak such as getting up off a chair, coughing, sneezing or lifting something.
Men can also do these exercises. It may help them to maintain their erection and delay ejaculation. Some men report that if they stop thrusting during intercourse and do several PC contractions as they feel themselves getting close to ejaculation it enables them to last longer before reaching climax.
Medical Devices Available
Devices to strengthen the pelvic floor muscles are effective, and can be used to prevent and treat stress incontinence and prolapse and after surgery for prolapse.
Vaginal cones are hollow and unscrew so that gradually increasing weights can be placed into the cone which is inserted into the vagina [just as a tampon is inserted] to help strengthen the weak muscles, as the PC muscle needs to be contracted to keep it in place. Use it for 15-30 minutes at a time while walking around the house morning and evening – this also helps you to do the Kegel’s exercises properly. As the pelvic muscles are strengthened the weights in the cones is gradually increased. In South Africa the Pelviflex is used by physiotherapists and gynaecologists, and is available in some pharmacies. It is a tampon shaped hollow cone with 8 weights which are gradually added by the woman as she increasingly tolerates the weights as her muscles strengthen.
If you are aware of the signs and symptoms described here then consult your doctor or a gynaecologist and discuss what management is suitable for you.
