Raise your hand if you know what pelvic floor disorders (PFDs) are. What are PFDs, you ask? Well, it’s a blanket term covering conditions that are caused by weak or dysfunctional pelvic floor muscles. PFDs are far more common in women than in men due to factors like anatomical differences and childbirth, among others.
In the United States, according to a study published in the National Library of Medicine, approximately 25% of women reported at least one symptomatic PFD, with urinary incontinence, at 17.1% being the most common outcome. This prevalence increases with age and childbirth history.
Pelvic floor disorders and urinary incontinence frequently occur together, especially in women who are postmenopausal or have given birth. According to another National Library of Medicine publication, up to 50% of women will experience some form of pelvic organ prolapse during their lifetime, while one in three women over 60 struggles with urinary incontinence.
In this article, we discuss the complex interplay between pelvic organ prolapse and incontinence, exploring their individual and combined impacts, available treatment options, and ways to cope with these conditions holistically.
Understanding Pelvic Organ Prolapse and Incontinence
Pelvic Organ Prolapse occurs when one or more pelvic organs—such as the bladder, uterus, or rectum—descend from their usual position due to weakened or damaged pelvic floor muscles. This can lead to a sensation of bulging in the vagina, pelvic pressure, and discomfort during activities like intercourse or exercise.
Urinary Incontinence involves the involuntary leakage of urine. The two most common types associated with POP are:
- Stress incontinence, triggered by physical activities like coughing, sneezing, or lifting that increase pressure on the bladder.
- Urge incontinence, a sudden and strong need to urinate, often without warning.
The connection between these two conditions stems from floor dysfunction. When pelvic organs shift due to prolapse, they often disrupt the bladder and urethra’s normal alignment and function, leading to incontinence. Conversely, the stress caused by frequent leakage can worsen the strain on an already weakened pelvic floor.
The Compounded Impact
When pelvic organ prolapse and incontinence occur together, their effects tend to compound, creating a disagreeable set of physical, emotional, and social challenges.
Physical Discomfort
Pelvic organ prolapse often causes persistent pelvic pressure, a sensation of fullness, or visible bulging at the vaginal opening. These symptoms, combined with the constant need to manage urinary leakage, can lead to:
- Reduced mobility due to discomfort while walking, sitting, or standing.
- Increased skin irritation or infections caused by prolonged exposure to moisture from leakage.
Emotional and Mental Health Impacts
Incontinence and prolapse can significantly affect self-esteem and mental health. Women may feel embarrassed by leakage or the physical presence of prolapse, leading to isolation. Studies have found that women with prolapse are twice as likely to experience symptoms of depression and anxiety, often stemming from the unpredictability of their symptoms.
Social and Lifestyle Limitations
The fear of accidents or discomfort often discourages women from engaging in social activities, exercising, or even traveling. High-impact physical activities can worsen prolapse symptoms, while the fear of leakage may limit participation in low-impact activities as well. Intimacy can also be negatively affected, with women avoiding sexual activity due to discomfort or self-consciousness.
Financial Costs
Managing both conditions involves ongoing expenses, from purchasing incontinence products to attending multiple medical appointments. According to the National Association for Continence, incontinence products alone can cost women an average of $900 annually without factoring in costs for prolapse-related treatments.
Treatment Options
Fortunately, a range of medical, surgical, and lifestyle interventions can improve symptoms of both conditions and help women regain control over their lives.
Non-Surgical Interventions
- Pelvic Floor Therapy
Pelvic floor muscle exercises, also known as Kegels, are fundamental in managing both conditions. Strengthening the pelvic floor can reduce urinary leakage and provide better support for prolapsed organs. Physical therapists can offer guidance and biofeedback devices to enhance effectiveness. - Pessaries
A pessary is a removable device inserted into the vagina to support prolapsed organs. This non-invasive solution can alleviate pelvic pressure and improve bladder control. It is a safe and effective option for women who are not ready for or cannot undergo surgery. - Bladder Training and Behavioral Modifications
Structured bladder training, which involves scheduling bathroom trips and gradually increasing the time between voids, can help manage urge incontinence. Avoiding bladder irritants like caffeine, alcohol, and spicy foods may also reduce leakage episodes.
Medications
Certain medications are helpful for managing urinary incontinence, such as:
- Anticholinergics, which calm overactive bladder muscles.
- Topical estrogen creams, which improve the elasticity of vaginal tissues and may alleviate prolapse symptoms in postmenopausal women.
Surgical Options
For women with severe prolapse or persistent incontinence, surgery may be necessary.
- Pelvic Organ Prolapse Repair
This procedure involves repositioning prolapsed organs and reinforcing the pelvic floor with sutures, mesh, or graft materials. Minimally invasive approaches, such as laparoscopic or robotic surgery, have shorter recovery times and high success rates. - Sling Procedures for Incontinence
This common surgery involves placing a sling under the urethra for additional support, effectively reducing stress incontinence. - Combination Surgeries
If both prolapse and incontinence are present, surgeons can perform corrective procedures for both issues simultaneously. While this option is effective, it is essential to discuss potential risks, such as mesh complications or recurrent prolapse, with a healthcare provider.
Lifestyle Adjustments
Small but consistent lifestyle changes can help reduce symptoms and improve overall quality of life.
- Weight Management
Excess weight increases abdominal pressure, worsening both prolapse and incontinence. Losing even a small percentage of body weight can relieve pelvic pressure and improve symptoms. - Low-Impact Exercise
While high-impact activities like running can worsen prolapse, low-impact exercises such as yoga, swimming, or walking help strengthen the body without straining the pelvic floor. - Dietary Changes
Preventing constipation is crucial, as straining during bowel movements can worsen prolapse and incontinence. A fiber-rich diet combined with adequate hydration promotes regularity and reduces pelvic strain. - Supportive Clothing
Wearing specially designed pelvic support garments can alleviate discomfort and make daily activities more manageable.
Conclusion
Neither pelvic organ prolapse nor incontinence are particularly serious conditions. They’re both very inconvenient, though, and can affect dignity and self-esteem. Occurring together, they can be an uphill battle, each condition amplifying the challenges of the other. This is, however, not an insurmountable situation.
At LL Medico, we have been supporting customers with incontinence and pelvic organ prolapse for almost three decades. With our extensive range of adult diapers, urology products and catheters, and other incontinence products, we can help you regain control and restore your quality of life. Call us at (855) 422-4556 or email support@llmedico.com for an in-confidence discussion of your options.