Pelvic floor problems and incontinence—autoprosthesis significantly improves quality-of-life

Due to their anatomical difference and also the particular stresses associated with pregnancy and childbirth, incontinence and pelvic floor problems are particularly prevalent in women. Apart from incontinence, women can also develop pelvic floor muscle weakness, overstretching of the pelvic connective tissue and displacement of the pelvic organs. Their quality-of-life can be significantly improved by surgical transplantation of endogenous tissue to strengthen the affected area of the pelvic floor.

22 jun  2018--"This is therefore a form of autoprosthesis," summarises Heinz Kölbl, Head of the Division of General Gynecology and Gynecologic Oncology at the Department of Obstetrics and Gynecology, MedUni Vienna/Vienna General Hospital. Kölbl is also head of the local organising committee for the 43rd Annual Meeting of IUGA (International Urogynecological Association), the largest conference in the world in this field, which will take place in the Austria Center Vienna on 27 – 30 June 2018.
In this surgical procedure – which is performed when conservative techniques or medications have failed to achieve the desired result – endogenous tissue is taken from an area adjacent to the affected area, tautened and allowed to scar over, thereby producing the desired strength. Says Kölbl: "On average that improves quality-of-life for affected patients by at least 30 percent." Research is also being conducted into the use of external stem cell tissue. Says Kölbl: "It is our vision that, in future, we will be able to insert external tissue that is even stronger and more functional, using minimally invasive techniques." Currently many patients still suffer a relapse, requiring a second or even third operation to strengthen their pelvic floor.
Researchers in Vienna are currently conducting studies using gene patterns to develop risk profiles for subsequent major pelvic floor damage. "So that we can potentially establish in advance that women from the high-risk group should not be allowed to give birth naturally, for example, in order to prevent subsequent incontinence or other pelvic floor damage," explains Kölbl, who is also a member of MedUni Vienna/Vienna General Hospital's Comprehensive Cancer Center. A similar risk profile already exists for women who are less than 160 cm tall: they should no longer be allowed to give birth naturally, if the embryo weighs more than 4,000 g. Says Kölbl: "That would give them a 100 percent risk of developing pelvic floor problems."
One in three women has bladder problems over the course of her life and one in 25 women experiences pelvic floor problems after childbirth. And around 3 percent of all women are affected by symptomatic forms of pelvic floor prolapse.


Provided by Medical University of Vienna

Comprehensive, nonsurgical treatment improves pelvic floor dysfunction in women

One in three women suffer from pelvic floor dysfunction (PFD), a range of symptoms which include bladder and bowel problems as well as pelvic pain, according to the American Urogynecologic Society. Now, University of Missouri researchers have demonstrated that a comprehensive, nonsurgical treatment significantly improves symptoms in women with PFD.

11 jan 2014--"Pelvic floor rehabilitation is effective in helping women overcome pelvic floor problems with little or no medication," said Julie Starr, a doctoral student in the Sinclair School of Nursing and a family nurse practitioner at the University of Missouri Women's Health Center. "The treatment involves muscle strengthening for improved bladder control and muscle relaxation for those with symptoms of constipation and pelvic pain."

Starr and other MU researchers analyzed data from nearly 800 women with symptoms of pelvic floor dysfunction who underwent therapy for bowel, urinary or pelvic pain, and sexual dysfunction. The researchers found patients who completed at least five comprehensive pelvic floor rehabilitation therapy sessions reported an average of 80 percent improvement in three main areas: urinary incontinence, defecatory dysfunction and pelvic pain.

"We attribute the success of our program to patients' regular contact with health care providers who provide biofeedback and vaginal electrogalvanic (e-stim) therapy as well as advice on behavior modification," Starr said. "The e-stim therapy, a painless treatment in which a stimulator is used to send electrical pulses to relax pelvic muscles, improves symptoms of bladder and bowel incontinence as well as pelvic pain and pain with intercourse. We rarely prescribe medications for these complaints; in fact, many women are able to stop taking their medications for bladder control and pain after therapy."

Starr says women of any age with bladder, bowel or pelvic pain symptoms could benefit from pelvic floor rehabilitation, as could women who experience tearing after vaginal deliveries.

"Most women are embarrassed to talk about these types of problems, or they don't think there is anything anyone can do to help them," Starr said. "Some women have been to multiple providers without relief of their symptoms, so they become discouraged and give up. A nurse practitioner who provides pelvic floor therapy will focus on decreasing all of the patients' unpleasant pelvic symptoms instead of referring them to multiple providers."

Many women are offered medication to treat their symptoms and are not aware that alternative treatment methods exist for their pelvic pain, Starr said.

"Non-operative management of pelvic floor dysfunction is a safe and effective way to overcome many pelvic floor complaints," Starr said. "Medication and surgical management are options that always will be available if pelvic floor rehabilitation does not provide the desired relief."

More information: "Outcomes of a Comprehensive Nonsurgical Approach to Pelvic Floor Regabilitation for Urinary Symptoms, Defecatory Dysfunction, and Pelvic Pain," was published in Female Pelvic Medicine & Reconstructive Surgery.

Provided by University of Missouri-Columbia

Survey Shows 37% Prevalence of Pelvic Floor Disorders

By Charles Bankhead
SAN DIEGO, March 3 -- More than a third of community-dwelling women have a pelvic floor disorder, and most have more than one disorder, according to a survey here. Overall 37% of women reported one or more pelvic floor disorders, Emily S. Lukacz, M.D., of the University of California San Diego, and colleagues, reported in the March issue of Obstetrics & Gynecology. Anal incontinence, defined as involuntary discharge of gas or fecal matter, led the way with a 25% prevalence, followed by stress urinary incontinence, overactive bladder, and pelvic organ prolapse. To the investigators' surprise, age did not predict an increased risk of the disorders in an adjusted analysis.
As many as 80% of women with one disorder had one or more coexisting pelvic floor disorders.
"The high co-occurrence of pelvic floor disorders suggests that physicians seeing women seeking care for one condition should inquire about symptoms of other disorders," the authors concluded. Recent studies have shown that pelvic floor disorders remain underreported and undertreated, complicating efforts to determine the prevalence of the conditions, the authors noted. Prevalence estimates have ranged from 10% to 58% for urinary incontinence and less than 1% to 39% for anal incontinence.
Moreover, they continued, despite nearly non-existent prevalence data, organ prolapse remains one of the most common indications for hysterectomy.
So with the approval and cooperation of Kaiser Permanente Southern California, the investigators randomly selected 3,050 female members of the health plan from each of four age groups: 25 to 39, 40 to 54, 55 to 69, and 70 to 84.
A validated survey of pelvic floor disorders was mailed to each of the 12,200 women originally selected for the study. Participants returned 4,458 surveys, and after exclusions for insufficient data, the investigators had 4,103 complete surveys for analysis.
The study population was 764 women ages 25 to 39, 981 ages 40 to 54, 1,187 ages 55 to 69, and 1,171 ages 70 to 84. About two thirds of respondents were married or living with a partner; fewer than 30% had no vaginal deliveries with birth weights of more than 2,000g; three-fourths had some college education, one-fourth were obese, and two-thirds were postmenopausal.
The survey showed that 15% of respondents had stress urinary incontinence, 13% had overactive bladder, and 6% had pelvic organ prolapse. Co-occurrence of two or more pelvic floor disorders was reported by:
About 80% of women with stress urinary incontinence or overactive bladder.
About 70% of women with pelvic organ prolapse.
Almost 50% of women with anal incontinence.
Although age did not increase the likelihood of a pelvic floor disorder, menopause had a positive correlation with all of the disorders except pelvic organ prolapse. The covariates most consistently associated with pelvic floor disorders were obesity, increasing vaginal parity, hormone use, and hysterectomy.
A limitation of the study noted by the authors was that the response rate, particularly among younger health plan members, was lower than anticipated. Younger members were hardest to reach; the likelihood of having the survey returned as undeliverable by the post office decreased with increasing age, from 11% of 25- to 39-year-olds to 3% of 70- to 84-year-olds.
The study was supported by the National Institutes of Health and Kaiser Permanente.

Primary source: Obstetrics & GynecologySource reference:Lawrence JM, et al. "Prevalence and co-occurrence of pelvic floor disorders in community-dwelling women" Obstetr Gynecol 2008; 111: DOI: 10.1097/AOG.Ob013e3181660c1b.