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Incontinence Stories From Experts & Real People | NAFC BHealth Blog

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Filtering by Category: Childbirth

Coming Out Of The Closet About Pelvic Organ Prolapse

Sarah Jenkins

This is a guest post from Betty Heath, of The Rejoicing Soul.

During the past twelve years I have shared much of my life’s journey with you. Well, today I am coming out of the closet.  Stunning isn’t it? I was recently diagnosed with Pelvic Organ Prolapse. How many of you can identify with me? The current estimate of the number of women in the U.S. with this condition is approximately 4.3 million. According to a recent study by the World Health Organization guestimates indicate that there are 36 million women world-wide with this condition. The reality is that it is difficult to know what the real numbers are because women are reluctant to be talk about it or be treated for it.

Pelvic Organ Prolapse (POP) is quite common among today’s female population. Many women have the symptoms but because they are embarrassed to discuss them with anyone they suffer in silence.  POP can occur when the pelvic floor muscles weaken and one or more organs shift out into the vaginal canal and even bulge outside of the body.

My journey with POP began sometime in the spring of 2016. I began having symptoms of POP which include pressure, pain and/or fullness in vagina or rectum or both; sensation of ‘your insides falling out’; bulging in the vagina; severe back pain and incontinence. Every time I went for a walk or even sneezed I thought my insides were going to fall right out onto the ground. I began staying home more often and said little about it to my friends. At first I attributed these symptoms to old age and laughed them off. After all, I am approaching the ripe old age of 80. We hear and see so many TV ads regarding incontinence and because the causes are never addressed we become oblivious to what they might be.

This past fall I finally decided I didn’t want to spend the rest of my life worrying about my insides falling out and was tired of dealing with this issue so I made an appointment with a gynecologist. After the initial exam I was referred to Dr. Alexander Shapiro who is a specialist gyn/urologist in Denver. That exam took place in early December and was one hour and thirty minutes.

After the exam I told him I never dreamed I would be sitting in a gyn/urologist office at the age of 79. He smiled and replied, “We do have ways to keep popping up in your lives, don’t we.”  I then told him this was the most disgusting, gross thing that has ever happened to me. He said, “Right now your insides are a total mess. This is a very intimate surgery and is a major surgery. This is who you are right now and you can’t allow this to define your life. I promise you I can repair the damage and relieve the pain and discomfort”.

The four-hour surgery took place on Monday, January 30. I told my physician that most women my age are having face lifts and here I was having a butt-lift. I went home Tuesday and Wednesday as I was having breakfast I suddenly realized that the fullness/pressure feeling and the back pain I had prior to surgery were totally gone. Oh, what a relief it is. I cried tears of joy. I’ve experienced minimal pain with this surgery.

Today, if you are a woman reading this (or a man who has a woman in your life with this condition) I urge you to make an appointment to at least talk with your physician about your problem. There is help and hope for women with POP. New treatment options evolve daily to control, improve and repair this cryptic health condition.

Join with me in taking Pelvic Organ Prolapse out of the closet and make it common knowledge for women of all ages. Don’t allow this condition to define who you are or how you live your life.  Don’t wait! Call for your appointment today.

Read our follow up story to see how Betty has been doing in the months following her surgery.


 Betty Heath

About The Author:  Betty Heath lives in Colorado with her husband. She is “retired from work, but not from living”, and has a weekly column called “As I See It”, which appears each Sunday in the Longmont Times-Call, owned by the Denver Post. She enjoys writing, cooking, gardening, and quilting. Betty also volunteers in the St. Vrain Valley School District, helping students learn how to write from their heart. For the past six years, she and her husband have volunteered as Santa and Mrs. Claus for the Holiday Festival in the Carbon Valley. You can read more from Betty at her blog, The Rejoicing Soul.

Prolapse After Pregnancy – It’s Not Your Fault.

Sarah Jenkins

 Prolapse After Pregnancy - It's Not Your Fault.

Around 6 weeks postpartum, I had expected to feel a bit more like myself.  I had avoided exploring anything in the vaginal area for fear of what I would find, but had felt a general heaviness since I had given birth.  Not knowing for sure if this was normal, I made an appointment with my doctor to get checked out. 

Upon examination, my doctor confirmed that I had a prolapsed bladder.  His tone was nonchalant, as if it was totally normal and something that just happened sometimes. 

I was completely shocked. What had gone wrong?  And why did I never hear that this was a possibility?  I immediately started blaming myself.  Why had I not done more kegels during my pregnancy?  Why didn’t I do more research to know that something like this could happen?  Did the decision to use a vacuum during the last bit of pushing influence this?  What could I have done to prevent this?

But the truth is, some women really are just more susceptible to prolapse.  While a prolapse can occur for many reasons, some women have more of a genetic risk for the condition due to the strength of the connective tissues.  It’s not your fault. 


That being said, there are some things that may help you either avoid a prolapse, or at least improve your symptoms if you have one:

  • Maintain a normal weight.  If you are overweight, you are more susceptible to a prolapse due to increased pressure inside the abdomen. 
  • Avoid constipation.  Becoming constipated can cause you to strain during bowel movements, increasing the chance of a prolapse.  Ensure you are eating a high fiber diet and drink plenty of water every day.
  • Keep active.  A regular exercise plan keeps your weight in check, and also helps promote healthy bowels.  Be sure to include your pelvic muscles in your daily workout routine too.
  • Avoid extra pressure inside the abdomen.  Things like lifting heavy objects, and chronic coughing, create persistent pressure, which can increase the likelihood of developing a prolapse, or making your symptoms worse if you have one.  Stay healthy and avoid strenuous lifting. 

Whatever you do though, don’t blame yourself for developing a prolapse.  Instead, use that energy to find out what you can do to improve your symptoms and treat the condition.  Talk to your doctor about your options, and find a qualified physical therapist to help you learn how to strengthen your muscles to improve symptoms.

The Mama Body: Physical Therapy During And After Pregnancy

Sarah Jenkins

A Guest Blog by Lizanne Pastore PT, MA, COMT

Eighty percent of the bodily changes occurring during pregnancy happen in the first trimester!  Isn’t that astounding?  A woman’s body must adjust quickly to a 40% increase in fluid volume, increased heart and respiratory rates and myriad other changes that may affect us in different ways.  The fluid volume increase, for example, can make our connective tissues weaker—our tendons can get a little mushy and our nerves and blood vessels a bit softer.  This extra fluid and tissue weakening makes us more prone to things like leg swelling, varicosities, tendonitis, carpal tunnel syndrome, or sciatica.  

The hormonal changes in pregnancy play a big role in our metabolism, mood, memory and, of course, ligamentous laxity.  Some pregnant women experience instability not only in the pelvis and hips, but also in the joints of the spine, elbows, and wrists.  Our musculoskeletal system is taxed by these changes even before the baby gets very big.  Then, as baby grows, we might begin seeing rectus abdominis separation (“diastasis recti,”) spinal problems from posture and center of gravity changes, even rib dysfunction as the ribs are forced out and up to make room for belly.  Foot pain from falling arches from the sudden weight gain can occur, and on and on. 

In the pelvic girdle, there is a list of other maladies that can be downright scary to a pregnant or postpartum mama.  And most women are not warned about these potential problems.   Pelvic girdle pain manifesting as coccyx, pubic or sacroiliac joint pain; groin or hip pain; pelvic muscle or nerve pain; plus urinary or fecal incontinence or pelvic organ prolapse are some of the more common things occurring during or after pregnancy. 

After birth, as Mom is busy caring for her newborn and any other children at home—schlepping heavy car seats, strollers, laundry baskets, breastfeeding through the day and night, lifting ever-heavier babies into and out of cribs—she wonders why everything hurts, or why she feels a clicking in her pelvic bones when she lifts her leg!  Well, she is busy performing exceedingly challenging tasks with a sub-optimal musculo-skeletal-neural system (not to mention sleep deprivation!) 

It is well documented that both pregnancy and vaginal birth increases a woman’s risk of developing pelvic organ prolapse or becoming incontinent later in life.  And many women think that leaking during or after birth is “normal” because their friends, moms, aunts, and sisters leaked, plus there are 20 different brands of incontinence pads to choose from in the drugstore, so it “must” be normal.   

But this is wrong; leaking and pelvic organ prolapse is common, but not normal or OK.   The same holds true for back or pelvic pain.  Sure pregnancy puts demands on our bodies, but there is no reason to “put up” with pain, leaking, prolapse, numb hands or legs!  There is a health professional who knows all about this—a physical therapist specially trained in women’s health issues and the pelvic floor.  These PT’s are special – they understand the pregnant and postpartum body and are experts in negotiating a path to health and strength for women with special concerns.

After an initial assessment, which often includes a thorough pelvic muscle exam and possibly even a biofeedback analysis, the woman is prescribed a home program.  This program may include a combination of postural or corrective exercises, motor training or strengthening exercises, bladder and bowel re-training, special instruction to change movement strategies to limit stressors on the body, and even self-care techniques for pain or prolapse, such as self massage for constipation, or gentle inversions for prolapse. 

Wouldn’t it be amazing if every pregnant woman and new mama could have a visit with a PT like this?  Guess what – they can!  If you are reading this article and are pregnant talk about this option with your doctor.  And if you have friends, sisters, aunts and co-workers who might be pregnant or new moms, talk to them about it.  Tell them to ask their doctors for a referral to woman’s health physical therapist!  

Need help finding a qualified PT? Visit the NAFC Specialist Locator to find one in your area.

About the author:  A physical therapist for 29 years, Lizanne has specialized in treating women and men with complex pelvic floor and pelvic girdle issues since 2005.  She has worked primarily in San Francisco and the Bay Area, running a successful private practice for the past 18 years. She writes, lectures, and teaches about pelvic health at the professional and community levels and is currently a board member of the NAFC.  

Postpartum Isn’t Easier When You’re a PT

Sarah Jenkins

….But it helps

Pregnancy can be a wonderful time of growth, change and anticipation.  As the baby grows, the mother’s body goes through normal musculoskeletal changes.  Muscles in the abdominal and pelvic region stretch, ligaments soften and joints loosen.  Some women handle these changes with ease but others may need the help of a physical therapist to manage pain and incontinence

After the birth of the baby, there are still changes. The postpartum (or post-birth) period can be a beautiful yet challenging time for the mom too. We call this time period the fourth trimester. 

As a PT and mom, I can attest to the challenges I listed above. I can also say that postpartum doesn’t get any easier or feel any better because you’re a PT and you intellectually understand the physiological changes in your body after having a baby. I’m a PT and I know what I need to do for myself and my recovery but knowing what to do and experiencing the discomfort and managing it are different.

Hormones greatly affect the mom emotionally and physically and the pelvic floor muscles are overstretched and weak.  The new mom likely has an incision to care for and may be experiencing some urinary leakage. Ligaments and joints gradually tighten as hormones begin return to pre-pregnancy levels.  However, muscles like the lazy.  If a muscle isn’t exercised it will remain loose and weak.

My prescription for healing after having a baby? Kegels, Tummy Time and Walks.

The secret sauce to making sure that prescription works? Repetition

Understand the purpose of kegeling. 

The pelvic floor muscles create a natural bowl or basket supporting our pelvic and abdominal organs.  The pelvic floor is vital in controlling our bowel and bladder, is part of our core muscles, assists in our sexual response and must stretch to allow for the baby to slide through the birth canal.

A kegel is the contraction of the pelvic floor muscles. You can learn more about how to kegel, here.

Mimic your baby + get on your tummy.

Use that tummy time to kegel from a new position and just take in the moments you have with your new little one.

Try to walk at least once a day.

You need socialization and your baby needs it too.  Lucky for you, walking is a great pelvic floor exercise.

At the end of the day, variety and repetition are key. As both a PT and a mom, I’ve found that strengthening the pelvic floor by challenging those muscles in a variety of ways will allow the muscles to become strong enough to maintain dryness. Eventually, your pelvic floor wall will become strong enough for a return to pre-pregnancy activities.

Although we all have to deal with this postpartum changes, being a PT certainly helped me have perspective. I hope this article can help you too!

P.S.  Remember that whatever you do in the name of healing your body is a way to take care of yourself. If you don’t take care of yourself, how could anyone expect you to take care of your little one? Take a deep breath and give these suggestions a try. If you need an extra boost to get you going, read this blog post for inspiration!

About the Author, Michelle Herbst:   I am a wife and mother with a passion of helping women live to their fullest potential.  I am a women’s health physical therapist and for nearly decade have helped women with musculoskeletal conditions during their pregnancies, postpartum period and into their golden years.

How a 'Birth Plan' Can Help Protect Your Pelvic Floor

Dawn Dingman

The relationship between urinary incontinence (UI), pelvic floor disorders, and vaginal birth is a hot topic. Popular magazines and some scientific journals claim that vaginal birth is a cause of urinary incontinence, which has fueled the debate about another equally hot topic: cesarean delivery by maternal request! The presumed logic is this: if vaginal birth leads to UI, then cesarean delivery should be done to prevent it. In fact, questions surrounding causes and prevention of UI, as it relates to vaginal birth, are far more complex. Scientific studies done to date have shown no conclusive evidence that vaginal birth causes UI or pelvic floor disorders. Until we have more answers, cesarean deliveries done to protect the pelvic floor are unwarranted.

What is a “Birth Plan”?

It is never too early to learn what you can do during childbearing years to protect your pelvic floor and bladder health. A Birth Plan is a paper document you develop that serves as a communication tool between you and your healthcare provider. It describes how you would like to be cared for during your pregnancy, labor, and birth.  A Birth Plan helps you and your provider focus on practices and procedures you believe are important to include or avoid. Everyone wants a healthy mother and baby – that is a given. However, there are many pathways to achieving a safe, normal vaginal birth, a healthy infant and a healthy, satisfied mother and family. A Birth Plan simply places these thoughts in writing. During the course of your prenatal visits, a Birth Plan encourages conversation with your provider about the processes and procedures that occur in the hospital during labor and birth that may affect your bladder and pelvic floor.

Tips For Determining a Birth Plan

During your pregnancy, ask your provider to teach you the correct method for doing Kegel exercises. When done correctly, Kegels help strengthen your pelvic floor during pregnancy and after birth.

The obesity epidemic in the United States has led to changes in recommendations about weight gain in pregnancy. Ask your provider about the optimal weight gain for you. The old adage, “eating for two” no longer applies. Obese mothers who give birth to excessively large infants are more likely to experience postpartum bladder troubles whether having a vaginal or operative birth.

Pregnancy provides the ideal time for women to quit smoking. Cigarette smoking is a risk factor for urinary incontinence. Your healthcare provider has many suggestions to help you quit once and for all.

Once in labor, being upright allows gravity to assist with your baby’s descent instead of working against it while lying on your back.

New evidence shows that “gentle pushing” or delayed, non-directed pushing techniques can minimize pelvic trauma and are more protective than “forced pushing.”

To protect pelvic floor muscles, nerves, and connective tissue, express your desire to avoid the use of episiotomy, forceps and/or vacuum extraction. There is more than a decade of research that an episiotomy need not be performed unless there are indications for such intervention (e.g., fetal distress). Episiotomy, especially midline, has been shown to increase a woman’s risk of anal sphincter injury and not to reduce the risk of other pelvic floor disorders. Patients should discuss whether or not to have an episiotomy and be certain that their doctor will not use one, other than in extreme situations. Sometimes however, these maneuvers may be necessary for you or your baby’s health.

For help in writing a Birth Plan that works for you, consult your library, pregnancy resources, your healthcare  provider, and the Internet. Your healthcare provider can guide you about trusted web sites.

What No One Told You About The 4th Trimester

Sarah Jenkins

 what to expect after you've had the baby

When you were pregnant, everyone joined you in counting down the days, weeks, and months until your baby would be born. Now that your little one is here, the countdown is over. But that doesn’t mean the woes of pregnancy are over.

The fourth trimester, or the recovery period and adjustment period of your body after birth, is a very formative time period. This month is filled with changes in your body, your household, and your baby’s body. Now that your little one is out of the safe cocoon of your womb, they’re learning to latch on to you for feedings and lay near you for warmth and comfort. All the while, your organs are resituating themselves and your hormone levels are skyrocketing to fuel these shifts.

Although everyone knows about the exterior changes that come after having a baby, many women are still surprised to feel so out of control with their bowels and bladder.

Childbirth—cesarean or vaginal—does a number on your organs. The trauma of childbirth weakens your pelvic floor muscles, often leaving them feeling like they had their own personal cross fit session.

Understand the level of work your body has done for you and react appropriately. The fourth trimester is a period of rest and recuperation. To treat yourself like anything else will only put you at risk for less than ideal symptoms in the long run.

Take time to map out a recovery plan for your bowels and bladder so you can ease your way back to a pre-baby stage. If you are experiencing urinary or bowel leakage, or a frequent urge to go often, start with a bladder and bowel diary. Fill it out and take note of what your body is responding to and then bring it to your doctor in your next postpartum appointment. 

Preparing Your Pelvic Floor For Pregnancy And Beyond

Sarah Jenkins

A guest blog written by Michelle Herbst, PT

Congratulations! As you prepare for your baby there is a lot to think about. Doctor’s appointments. Baby showers. Child care. Nervous talks with the Dad-to-be. And, don’t forget - YOU. When you start sharing your news - everyone will give you advice. Some stories will be embellished for the good and others will be overstated for how difficult their pregnancy was. But, keep in mind - this is your experience.

Realistic Expectations:

Some Moms-to-be have problems with leakage. Others do not. A positive pregnancy test does not mean you will develop incontinence or a prolapse - which is a descent of the pelvic organs into the vaginal canal. But, normal changes during pregnancy and the process of labor and delivery can set up the conditions for incontinence and prolapse to occur.  

So, here is my advice as a Mom and a physical therapist for preparing your mind and body for your big day.

Kegel:

You will read about these. Your OB Nurse will ask, ‘Are you doing Kegels?’ But, why are Kegels so important during pregnancy?

Performing Kegels during pregnancy can help you prevent or manage bouts of leakage, and will also help you tune in and tone the muscles that will help push and slide your baby out of the birth canal. Here are a more few reasons why Kegels are so important:

-        To establish a mind-body connection of how the kegel muscles feel when activated.

-        To help create stability of spine and pelvis as your baby grows.

-        To prepare for the arrival of your baby and protection of your pelvic organs during delivery.

 

Labor can be quick or long. Labor can be easy or difficult. You do not get to choose. But, with preparation of your mind and muscles, along with the skills of your birthing team, the end result will be you holding your precious new baby.

Thoughts on Kegels during Pregnancy:

Think of the pelvic floor as a muscular sling that is tethered between your pelvic bone and tailbone. During pregnancy and labor the pelvic floor muscles lengthen but also need to be able push. The goal of performing Kegels during pregnancy is to improve the strength and function of the pelvic floor as well as encourage lengthening of the pelvic floor muscles.

When performing a Kegel it will feel like a gentle tightening and lifting up and in of the muscles between the pubic bone and tail bone. You may also feel a slight tightening between the belly button and pubic bone. That is your abdominals helping out too. That is OK. Now, hold the Kegel as you inhale and exhale. Relax, and let your pelvic floor muscles return to a normal resting tone or sensation.

The Kegel is a cyclic contraction. It is a shortening of the muscle fibers followed by a relaxation and lengthening of the muscles. If you contract the pelvic floor, and follow that with another pelvic floor contraction without focusing on letting the muscles relax and lengthen, you are training the pelvic floor to become shortened strong muscles not the lengthened strong muscles needed to help push and slide your baby out.

Squat:

Yes – squat. Deep squatting is a normal position to void and give birth. Performing a deep squat as an exercise will help you prepare for the positioning and muscle work needed during delivery.  Deep squatting will open your hips, aide in lengthening the pelvic floor and strengthen your glutes. 

How do I do this?

Slowly work into a squat. You may want to or need to keep your squat shallow by holding onto the back of a sturdy chair or counter top as you start bending at your hips and knees. Keep your gaze forward. Work on keeping your knees behind your toes or stacked above your ankle. Think about keeping your shins perpendicular to the floor. If you are able to get into a deep squat, you may want to place your hands at your chest and gently push your elbows to the inside of your knees.

How long and how many?

This will depend on you. You may want to focus on working into and holding the deep squat. Once you have achieved a deep squat you can work on relaxing into this position. Or, you may want to perform slow repetitions of a shallow squat to standing position and put your emphasis on tightening the glutes when returning to standing.

There really isn’t a right or wrong way – just your way and your focus or intent of the exercise. Pay attention to how you feel and listen to your body.

Your Story:

There will be aspects of your pregnancy and the arrival of your baby that you will not be able to control. But, remember, this is your story. You can prepare your mind and body to set up the best possible set of circumstances to deliver a healthy YOU to motherhood. 

 Michelle Herbst, PT

Michelle Herbst, PT

Ask An Expert: Physical Therapy After Childbirth

Sarah Jenkins

Each month, we ask an expert to answer one of our reader's questions.  This month we're happy to welcome Victoria Yeisly, DPT as our expert contributor.

Question: I’ve heard that in Europe it is standard for most women to begin physical therapy to strengthen their pelvic floor as soon as they have given birth. Do you think women in the United States should be seeing a PT after having a baby, regardless of whether they are having symptoms or not?

Expert Answer: Absolutely!  I support this practice for any woman after having a baby, including both vaginal and C-section deliveries.  Think about it, during the pregnancy, the body changes so drastically, so quickly!  Ligaments loosen; alignment changes, hormones fluctuate, and anywhere from 20-50 lbs may be gained.  Then, you either push a baby out of your vagina or have a major abdominal surgery.  To think that the body just heals and is “back to normal” 6 weeks postpartum is just ridiculous.  In the OB practice where I work, there are 4 of us pelvic floor PTs integrated with the doctors and midwives to help serve this population so women can return to pre-baby function with greater ease and comfort.  In my opinion, this should be the standard of practice for all women.  At minimum, doctors and midwives should at least be making each woman aware of this treatment and let them decide if pelvic floor PT should be a part of their postpartum rehabilitation.  

Have a question you'd like answered? Ask us! Your question may be featured in an upcoming Ask An Expert post!

About Our Expert:  Victoria Yeisley, DPT, has been exclusively practicing pelvic floor physical therapy for the past eight years, with an emphasis on prenatal and post-partum care.  She currently lives in Chicago, IL, and practices at Northwestern Medical Group OBGYN, where she is integrated into the OBGYN healthcare team, as well as working at Chicago Physical Therapists, a private practice.  Victoria is passionate about the care and support of women during the childbearing years and her goal is to increase the awareness of the importance of women's health and treating pelvic floor dysfunction throughout the lifespan.  She is currently pregnant with her first child and expecting in June of 2016!

Misconceptions About Being A Mom And Bladder Health.

Sarah Jenkins

Becoming a mother is one of the most joyful things that can happen to a woman.  But it can also be challenging.  Not only are you dealing with the demanding task of raising a little one, your own body is undergoing constant change as well.  There are a lot of misconceptions out there about how our bodies should perform after we have kids - many of them false.  Take a read below and learn some of the most common misconceptions around bladder health and becoming a mother.  

Fact or Myth?  After having kids, it’s normal to pee a little when I laugh, sneeze, run, etc.

Myth. While this can happen for a few months after childbirth, it is not something that is “normal.” It should be dealt with.  Talk to your doctor or a trained physical therapist about some exercises that may help get you back to normal, and product suggestions that can help you manage incontinence in the meantime.

Fact or Myth?  If you’ve had kids, you can expect to have urinary incontinence or OAB when you become older.

Myth.  It’s true that sometimes incontinence does not rear it’s ugly head until well after you’ve had your children – often in your 40’s or 50’s.  But that doesn’t mean that it’s a sure thing you will suffer from incontinence – especially if you are proactive in getting your pelvic floor strong now.  It’s never too late to start incorporating your pelvic floor into your workout routine.

Fact or Myth?  I might as well get used to being incontinent – now that I’ve had a baby there is nothing I can really do about it anyway.

Myth.  As we mentioned above, incontinence is certainly not normal, and there are a host of things that you can do to manage, and even fix it for good.  For starters, absorbent products can help you manage immediate leaks that you may be suffering from post childbirth until you are able to build up your strength again.   When you schedule your 6-week postpartum check up with your doctor, schedule a visit with your physical therapist as well – it’s a great time for an initial evaluation and you can learn some good postpartum exercises to start right away.  And if you are still feeling like things are not quite right after a couple of months, talk with your doctor about what you can do.

Fact or Myth:  I don’t have to worry about working on my pelvic floor until after I’ve had the baby.

Myth.  One of the best things you can do to prepare yourself for childbirth is to start working out your pelvic floor today.  Not only will it make your delivery easier, but you will be that much stronger and your recovery in the postpartum days ahead will be much faster. Here are some great pelvic floor workouts for pregnant women.

Pessaries And Non-Surgical Options For Prolapse

Sarah Jenkins

I always wanted a large family.  After giving birth to and raising 4 children, I think I’ve pretty much fulfilled that dream.  My family is everything that I expected it would be.  What I never expected, however, was to have a prolapsed bladder.

I discovered it when I turned 63.  I had a feeling of heaviness “down there” for a while, but didn’t really think anything of it. I experienced a few accidents in the months before my birthday but thought they were just that – accidents. I was wrong. I went to the doctor for my usual check up, tried to explain what I was experiencing, and he told me I may have a prolapse. Prolapse is when the muscles supporting your bladder, rectum and uterus weaken. This weakening can cause your organs to fall into or through the opening of the vagina. This can happen to any woman with or without vaginal childbirth, but women who have had strain on their vaginal muscles (ahem, birthing 4 children) are at greater risk. After an examination, my doctor diagnosed me with a cystocele, or a prolapsed bladder.

At first I was horrified – the thought of an organ protruding, even slightly, sounded appalling.  What would this mean?  How would it affect my day-to-day life? Would things progress to a level greater than what I was already experiencing? ? 

Luckily for me, my prolapse is mild.  My doctor told me that as long as my symptoms were not causing me much harm, surgery was likely not necessary.  Some pelvic organ prolapse (POP) will improve on its own through watchful waiting, although my doctor said it is not possible to identify whose POP will improve with time. A common treatment option for those who do not want or need surgery is a pessary.

Pessaries are silicon devices that come in a variety of shapes and sizes and are placed in the vagina to provide support to the pelvic organs. Because each woman is different, the pessaries need to be fitted to the individual.  I decided to give it a try and was fitted three different times before the final size was decided.  I’ve had it in for 3 months so far and it is comfortable and seems to be treating the feeling of heaviness I had been experiencing very well.  It does require some upkeep and needs to be removed and cleaned on a regular basis, however this is easy to do and even if you have trouble, you can have the pessary removed and regularly cleaned by your provider. 

In addition to my pessary, my doctor also prescribed a vaginal estrogen.  This helps lubricate the area and reduce the risk of irritation or ulceration.  It also reduces the risk of getting a urinary tract infection.

Never in a million years did I think this would happen to me – I didn’t even really know it was possible to be honest. But thanks to my pessary, I’m able to easily manage my symptoms and live my life the way I want to.

Get That App and Get Active Again

Dawn Dingman

Once downloaded from iTunes®, Kegel Aerobics allows the user to progress at her own pace, training a woman in how to contract and release her pelvic floor muscles in order to tone and strengthen them. The benefits of routine exercises of these internal muscles have long been established by clinical researchers as a first line of treatment for both stress urinary incontinence, or leakage when coughing, laughing, or sneezing, and for controlling sudden urgency associated with overactive bladder. There is emerging research that pelvic floor exercises can have some limited effectiveness in addressing mild to moderate symptoms of pelvic organ prolapse, or when vaginal walls collapse allowing pelvic organs such as the bladder to descend. Men and women have recognized their value in supporting sexual function and vitality. In men, these are the very muscles that assist with achieving and maintaining a healthy erection, for example. (There’s a companion app for men called Prostate Aerobics.)

Like other muscles throughout our body, pelvic floor muscles are prone to weaken and atrophy if not exercised and used regularly. Women, more so than men, appear to be less motivated to stick with a pelvic muscle exercise routine. Women also have greater difficulty identifying these muscles. It’s estimated by clinicians that as many as half of all women who initially try to do the contractions without instruction do not do them correctly. Some people have let their muscles weaken to the point they cannot be readily identified and therefore need the help of a physical therapist and biofeedback to get “jumpstarted.”

This app takes away the guess-work and the need to post reminders around the house or in your car. Built into the function is a reminder signal right on the smart phone housing the app. Kegel exercises are described and anatomical drawings are supplied to facilitate understanding of where they are located. The series then takes you from level 1 to as high as 9 depending on the progress you make, each level aimed at holding contractions longer or doing a greater number of repetitions of short contractions, as we have both fast twitch and slow twitch muscle fibers.  And different positions take into account gravity to challenge your muscle strength in more advanced levels of instruction.

From iTunes, reviews offer such comments from users of the app as:
“Great app! Very challenging, but worth it.  Go Kegel Girl!” – Leemz, 27, January 30, 2013
“I am FINALLY getting a restful peaceful night’s sleep.” – Foodwatcher, February 5, 2013
“Wow!!! Love this app!! Can be done anywhere.  Very EZ……..” – MargieSams, February 21, 2013

If you received this free download at the conclusion of Bladder Health Week, we are interested in hearing from you. Let us know if you found the app to be useful by emailing us at memberservices@nafc.org. We are looking to share anonymous testimonials of what this app has done for you and how well you’ve liked its features and functionality.

Of course, if you don’t own an iPhone or are not into using apps, simply visit our friend and accomplished PT Tasha Mulligan to learn all you need to know to direct your own routine.