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Pelvic Floor
Dysfunction
Pelvic Floor Dysfunction
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What is Pelvic
Floor Dysfunction?
Pelvic floor dysfunction,
also called pelvic floor
relaxation and pelvic organ
prolapse, is also referred to as outlet obstruction or outlet delay, refers to a
condition in which the pelvic floor muscles of a woman's lower pelvis - that
surround the rectum, do not function normally. It is not known why these muscles
fail to work properly in some women, but they can make the passage of stools
difficult even when everything else seemingly is normal.
What Causes Pelvic
Floor Dysfunction?
Women with pelvic floor
dysfunction find that muscle pain occurs when muscles are tense, strained,
traumatized and/or otherwise inflamed. Their pelvic muscles are no exception.
Causes of pelvic floor dysfunction can include:
* Chronic faulty posture with weak core musculature
* Trauma (fall on tailbone, old tailbone fracture, auto accident)
* Inflammation or infection
* Pelvic organ disease (endometriosis, irritable bowel syndrome,
interstitial cystitis)
* Repetitive motion injuries such as those from gymnastics, volleyball,
soccer, ballet or ice skating
* Abdominal muscle wall weakness or hernias
* Chronic constipation
* Pregnancy or complicated vaginal delivery
* Abdominal or pelvic surgery such as a hysterectomy
Do I have Pelvic
Floor Dysfunction?
Women with pelvic floor
dysfunction often have changes in their spine and/or pelvis. Symptoms
or conditional might include; scoliosis, short leg, swayback or a "torsioned"
sacrum. The most common symptoms of pelvic
floor dysfunction
include one or more of the following:
* Vaginal pain
* Pain with urination
* Urinary urgency and frequency
* Rectal pain
* Pain during vaginal intercourse
* Pain with sitting, standing, walking
* Pain and/or difficulty getting up from a seated or lying down position
* Hip pain often with loss of range of motion in hips
* Deep pain in lower back radiating to legs, thighs, groin, hips
* Abdominal and lower abdominal/intestinal pain
* Pelvic pressure or a feeling like your vagina or uterus are
"falling out."
* Involuntary loss of urine or stool
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What
is Pelvic Reconstructive
Surgery?
Pelvic reconstructive surgery, also known as "reconstructive pelvic surgery," "pelvic reconstruction" and "pelvic floor reconstruction," is an area of surgery dealing with a woman's pelvis, and includes gynecology and gynecologic urology, also known as "uro-gynecology" and is the typical protocol to correct a woman's "pelvic organ prolapse."
* About half of all women over age 50 suffer from some degree of Pelvic Organ Prolapse.
*
One in 10 women undergo pelvic
reconstructive surgery for correcting their
Pelvic
Organ Prolapse before the age of 80.
Pelvic
reconstructive surgery is many times very complex surgery that may require
not just the removal of certain organs or tissues in a woman's pelvis, but may
also include the resection of areas and putting her organs and tissues back
together in a way that makes her more functional, with less/no pain and feels
better.
What is Pelvic Inflammatory
Disease?
Pelvic inflammatory disease, or "PID" is an infection of a woman's pelvic organs which include the uterus, fallopian tubes, and ovaries.
Bacteria
causes pelvic inflammatory
disease. Bacteria can move upward, from a woman's vagina or cervix - which
is the opening to the uterus, or womb - into her fallopian tubes, ovaries and
uterus, which then cause an infection. Many types of bacteria can cause pelvic
inflammatory disease. But bacteria found in two common sexually transmitted
diseases - chlamydia and gonorrhea - are the most frequent causes of pelvic
inflammatory disease.
After a woman becomes infected, it can take from a few days to a few months to
develop pelvic inflammatory
disease.
The major symptoms of pelvic inflammatory disease are lower abdominal pain and abnormal vaginal discharge.
Other symptoms of pelvic inflammatory disease may include one or more of the following; fever, pain in the right upper abdomen, pain during vaginal intercourse, and irregular menstrual bleeding.
Pelvic inflammatory disease, particularly when caused by chlamydia, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs.
Untreated,
pelvic inflammatory disease
causes scarring and can lead to infertility, tubal pregnancy, chronic pelvic
pain, and other serious problems.
Pelvic inflammatory disease
is more common and more aggressive in HIV+ women than in uninfected women. Pelvic
inflammatory disease may become a chronic and relapsing condition as a
woman's immune system deteriorates.
Women can play an active role in protecting themselves from pelvic
inflammatory disease by following these steps and precautions:
* Call your doctor if you have discharge with odor or bleeding between
cycles.
* Use either male or female condoms during sex.
What
is Gynecologic Urology?
Gynecologic
Urology, also referred to as
Uro-gynecology, is a subspecialty within the field of
Obstetrics and Gynecology. Uro-gynecology's specialty is female pelvic disorders such as
pelvic organ prolapse (bulges that extend from the uterus into the vagina or extend out of the vagina), urinary incontinence, fecal incontinence and constipation.
Doctors that complete their residency in Obstetrics and
Gynecology, then go onto complete fellowship training in Uro-gynecology, where they spend several years focusing only on Uro-gynecology and female pelvic
disorders.
What
is Pelvic Organ Prolapse?
Pelvic Organ Prolapse
or Pelvic Prolapse, is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of
Pelvic Organ Prolapsee in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by
Pelvic Organ Prolapse is unknown.
Pelvic Organ Prolapse may also be called; genital
prolapse, pelvic relaxation,
pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor
dysfunction, urogenital prolapse or vaginal
vault prolapse.
What
is Pelvic Prolapse?
Pelvic Prolapse
is another
term used for "Pelvic Organ Prolapse."
Pelvic Prolapse is a very common condition, particularly among older women. It's estimated that half of women who have children will experience some form of
Pelvic Organ Prolapse in later life. Many women, particularly because they may no longer be sexually active, and fail to continue receiving their annual pelvic exams, don't seek help from their doctor. Therefore, the actual number of women affected by
Pelvic Organ Prolapse is unknown.
Pelvic Prolapse may also be called; genital
prolapse, pelvic relaxation,
pelvic prolapse, uterine prolapse, uterovaginal prolapse, pelvic floor
dysfunction, urogenital prolapse or vaginal
vault prolapse.
What are the symptoms that
indicate a woman is suffering from Pelvic
Organ Prolapse?
Loss of bladder control.
Loss of bowel control.
Increasing need and frequency to urinate - and then difficulty in completely emptying your bladder.
The feelings that your of pelvic or vaginal heaviness, bulging, fullness and/or pain, or a feeling that something is "dropping."
Recurrent bladder infections.
Excessive vaginal discharge.
Pain or lack of sensation during sex
But Pelvic
Organ Prolapse is a real, common and treatable problem. Consider this:
About half of all women over age 50 suffer from some degree of Pelvic
Organ Prolapse.
One in 10 women undergo surgery for Pelvic
Organ Prolapse by age 80.
What is Pelvic Reconstruction?
Pelvic Reconstruction is a surgical procedure
performed by gynecologists or uro-gynecologies to repair pelvic
organ prolapse and vaginal vault prolapse, among types of prolapse, and to
correct the problem(s) and relieve the symptoms.
Typically,
Pelvic Reconstruction is performed
vaginally and uses an implant to reinforce the strength of the weakened pelvic tissues.
What is a Prolapsed Uterus?
A
Prolapsed Uterus
refers to a collapsed uterus, or descended uterus, or other change in the
position of the uterus in relation to the surrounding structures within the
pelvis. The pelvis contains many soft tissue structures vital to normal body
functions, supported primarily by the diaphragms, layers of muscles, fibrous
coverings called fasciae, and various ligaments and tendons. These soft tissues
of the pelvis derive their ultimate support from the bony pelvis.
A Prolapsed Uterus may be one of three types, depending on the severity:
First-degree prolapse occurs when the uterus sags downward into the upper
vagina.
Second-degree prolapse occurs when the cervix is at or near the outside of
the
vagina.
Third-degree prolapse (sometimes referred to as total prolapse) occurs when
the entire uterus extends outside the vagina.
What
is Colpopexy?
Colpopexy is the surgical suturing of the prolapsed vagina to a surrounding structure - such as the abdominal wall or the sacrum, which is then called Sacral Colpopexy or Sacrocolpopexy
What
Is Sacral Colpopexy (Sacrocolpopexy)?
Sacral Colpopexy, also referred to as also referred to as also referred to as also referred to as Sacrocolpopexy, is the preferred surgical procedure for treating and correcting Vaginal Vault Prolapse with excellent results. Sacral Colpopexy (Sacrocolpopexy) has a very high rate of success and the surgical procedure involves suturing a synthetic mesh that connects and supports the vagina to the sacrum, or tailbone. The Sacrocolpopexy operation is performed from the abdomen to support the vagina to the ligament on the spine (after previous or present surgery to remove the uterus) by using a synthetic mesh.
Why
Is Sacrocolpopexy Performed?
Sacrocolpopexy is performed to treat
severe protrusion or bulge(s) of the vagina after removal of the uterus.
A woman's vagina that has one or more of these vaginal protrusion(s) may
experience one or more of the following:
The vaginal lump/bulge or protrusion feels uncomfortable or causes pain.
Difficulty with urination (e.g. unable to completely empty the bladder)
Bowel difficulties (e.g. constipation, incomplete emptying of bowels)
Pain
Infection
Bleeding
The objective of the Sacrocolpopexy
operation is to relieve the woman's symptoms and to restore her vagina and her
vaginal anatomy (as much as possible) and recover her sexual function.
Are there any risks associated with Sacrocolpopexy
surgery?
Sacrocolpopexy surgery is a very
common and relatively safe operation with excellent prognosis and outcomes.
However, like any surgical procedure, there are complications which may occur.
Possible complications from Sacrocolpopexy
surgery may include:
Bleeding
Infection
Injury to surrounding tissues (e.g. nerve or blood vessels, ureter,
intestines)
Formation of blood clot(s) in the legs or lungs
Recurrence of problem
Slow return of bowel or bladder function
Erosion of synthetic material through vaginal mucosa
What Happens Before Sacrocolpopexy
Surgery?
1. Blood tests, electrocardiography (ECG) and chest X-ray may be done to ensure
that you are in optimal health for Sacrocolpopexy
surgery.
2. Your doctor may prescribe oral or vaginal estrogen (hormone) if you are
already menopausal. It is important to comply with this medication as it ensures
that your vaginal tissues are optimal for surgery and healing.
3.
You will be admitted to the hospital one day before Sacrocolpopexy
surgery.
4. You will be given preparations to clear your bowels.
5.
Your pubic hair surrounding your vulva will be shaved.
6. You will not be allowed to eat or drink after midnight on the day before the
surgery.
7. All your medical and surgical conditions, if any, must be made known to the
doctor and must be optimally controlled.
8. If you are on aspirin, please keep your doctor informed. You must stop taking
aspirin at least one week before Sacrocolpopexy
surgery.
What happens during the Sacrocolpopexy
surgery?
The surgery is done under general or regional anesthesia. The anesthesiologist
will discuss with you the advantages and disadvantages of both methods.
An
abdominal incision is made. The synthetic mesh is stitched to the posterior
surface of the vagina and to the ligaments in front of the spine.
A tube / drain may be inserted into the abdomen to monitor the bleeding.
Another tube will be inserted into the urethra as there may be difficulty in
urination after the Sacrocolpopexy
procedure.
Painkillers, laxatives and antibiotics would generally be prescribed after the
procedure.
What happens after Sacrocolpopexy
surgery?
1.
Immediately after the operation, you may experience one or more of the
following:
Tiredness - You should rest and gradually increase your mobilization until
you feel fit to return to your normal activities.
Discomfort - In the lower part of the abdomen, over the incision. This is to
be expected and painkillers should help to relieve the discomfort.
Vaginal bleeding - Mild to moderate amount of reddish watery discharge after
surgery is quite normal. You will need to wear a menstrual pad during the
recovery period, but you will not be permitted to use tampons for obvious
reasons.
2. One day after surgery, you will usually be allowed to drink and eat. You will
be encouraged to move around. Blood chemistries and normal follow-up visits will
be performed.
3. The catheter that was placed in your urethra is usually removed the day after surgery. The drain is usually removed two days after the operation.
4. You may be discharged on the third or fourth day after surgery if the doctor is pleased with your progress and the outcome of the Sacrocolpopexy procedure.
5.
You should refrain from:
Strenuous exercise for 2 months. You may return to normal activity after
that, or upon clearance by your doctor.
Using tampons, douching, sexual intercourse and driving for 4 weeks.
Carrying heavy weights (> 10 pounds) for 6-8 weeks after Sacrocolpopexy
surgery.
6. You should (immediately) return to the hospital or notify your doctor if you
notic any of the following:
Heavy vaginal bleeding
Foul smelling vaginal discharge
Severe abdominal distension and / or pain not relieved by painkillers
High fever
Pain associated with passing urine
Difficulty in passing urine
Constipation
Follow-up doctor visits after Sacrocolpopexy
surgery
You will be examined by your doctor (at your doctor's office) at approximately;
2 weeks, 4 weeks, six months and and one year after Sacrocolpopexy
surgery.
It is important to keep your follow-up appointments to ensure the best possible results.
What
is "Colposuspension"
surgery?
Age and vaginal childbirth takes it toll on women's pelvic organs.
"Female Urinary Incontinence" is one of the problems most (over 50%) women who have delivered babies vaginally have to contend with. Women with Female Urinary Incontinence "leak" urine when they strain, cough, laugh or run. This condition is also called "stress urinary incontinence" meaning the stress of physical activity, not emotional stress is causing her to "leak" urine.
The problems associated with female urinary incontinence are corrected in the the "floor" of the woman's pelvis by several methods or types of surgeries - one of which is called Colposuspension.
A woman's pelvic floor is a sheet of special muscles and ligaments that stretch across the inside of the female pelvis. Women can feel it "tighten" when they try to hold back the flow of urine - or when they strain, cough, laugh or run. The uterus and bladder are located above the pelvic floor. The vagina and the opening of the bladder (the urethra) pass through the pelvic floor. If the pelvic floor weakens, the uterus and bladder "drop" down. The control of the urine is thereby weakened.
Colposuspension surgery strengthens the pelvic floor to lift, or "suspend" the uterus and bladder back up to their correct position within the woman's pelvis
Colposuspension comes from the Greek word for vagina - "colpos."
What is "Urethropexy"?
Urethropexy is a surgical procedure
where the support of a woman's urethra is re-supported through sutures that
surround the urethra's pelvic floor and vaginal tissues to her pubic bone.
What is the Vaginal Vault and Where is the Vaginal Vault Located?
As previously stated, Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons. Vaginal Vault Suspension is the surgical procedure that corrects and repairs Vaginal Vault Prolapse.
What
is a Vaginal Vault Prolapse?
The vaginal vault is the area at the top of the vagina, next to and
adjacent to the cervix. It can only fall or descend downwards toward the
introitus, or the entrance of the vagina, after a woman's womb has been removed
(hysterectomy).
Vaginal Vault Prolapse occurs in about 15% of women who have had a hysterectomy for uterine prolapse, and in about 1% of women who have had a hysterectomy for other reasons.
Vaginal Vault Suspension is a surgical procedure that may be selected to correct/repair Vaginal Vault Prolapse.
What is Vaginal
Vault Suspension?
Vaginal
Vault Suspension is the surgical procedure that repairs Vaginal Vault Prolapse
and also provides support for the
apex or "vaginal vault" of the vagina to pelvic structures.
What
is a Trachelectomy?
A trachelectomy, also referred to as
a cervicectomy, is the surgical removal of the cervix.
In this surgery, the uterus itself is saved or preserved, and therefore this type of surgery
preserves a woman's chance of becoming pregnant and having children. The trachelectomy
surgical alternative - as opposed to the more radical hysterectomy which removes
the uterus in addition to the cervix - is typically elected by younger women with early
stage cervical cancer.
What
Everyone Needs to Know About Reconstructive
Pelvic Surgery.
Reconstructive pelvic surgery is an area of surgery dealing with a woman's pelvis, and includes gynecology and uro-gynecology. Pelvic reconstructive surgery is many times very complex surgery that may require not just the removal of certain organs or tissues in a woman's pelvis, but may also include the resection of areas and putting her organs and tissues back together in a way that makes her more functional, with less/no pain and feels better.
What
is Pelvic Inflammatory
Disease?
Pelvic inflammatory disease, or "PID" is an infection of a woman's pelvic organs which include the uterus, fallopian tubes, and ovaries.
Bacteria
causes pelvic inflammatory
disease. Bacteria can move upward, from a woman's vagina or cervix - which
is the opening to the uterus, or womb - into her fallopian tubes, ovaries and
uterus, which then cause an infection. Many types of bacteria can cause pelvic
inflammatory disease.
But bacteria found in two common sexually transmitted diseases - chlamydia and
gonorrhea - are the most frequent causes of pelvic inflammatory
disease.
After a woman becomes infected, it can take from a few days to a few months to
develop pelvic inflammatory disease.
The major symptoms of pelvic inflammatory disease are lower abdominal pain and abnormal vaginal discharge.
Other symptoms of pelvic inflammatory disease may include one or more of the following; fever, pain in the right upper abdomen, pain during vaginal intercourse, and irregular menstrual bleeding.
Pelvic inflammatory disease, particularly when caused by chlamydia, may produce only minor symptoms or no symptoms at all, even though it can seriously damage the reproductive organs.
Untreated,
pelvic inflammatory
disease causes scarring and can lead to infertility, tubal
pregnancy, chronic pelvic pain, and other serious problems.
Pelvic inflammatory
disease is more common and more aggressive in HIV+ women
than in uninfected women. Pelvic inflammatory
disease may become a chronic and
relapsing condition as a woman's immune system deteriorates.
Women can play an active role in protecting themselves from pelvic inflammatory
disease disease by following these steps and precautions:
* Call your doctor if you have discharge with odor or bleeding between
cycles.
* Use either male or female condoms during sex.
What
are Pelvic Adhesions?
Pelvic
adhesions are the cause of many gynecological problems including significant
pain, infertility and conception. Pelvic
adhesions are irritations of a woman's pelvic organs as a result of a
"pelvic inflammatory event" or from trauma to the area such as in the
case of pelvic or gynecological surgery.
Examples of a pelvic inflammatory event include; fallopian tube infections that
might occur from endometriosis, removal of an ovarian cyst, sexually transmitted
diseases such as gonorrhea, post surgery infections, and even appendicitis and
appendectomies.
As a woman's body's pelvic area recovers from an inflammation, trauma or surgery, it begins the healing process and starts to repair itself. The woman's body and its' healing process may cause some tissues and structures in the pelvis to become unintentionally "stuck" to another tissue or structure. In a normal woman's healthy pelvis, this space is lined with a tissue called the peritoneum, which also covers the outside of organs located in the abdomen and pelvis. In the pelvis of a non-injured/non-irritated woman, the peritoneum can be very "slippery" with the the organs and structures lying immediately next to each other that "slip" off each other and do not become bonded together. With a woman who has had a pelvic inflammation, trauma or injury, her body's healing process starts a sequence of events that may result in some of the pelvic tissues becoming "stuck" to or "adhering" to tissues or organs next to the inflamed, or injured tissue, and when this occurs, the outcome may be pelvic adhesions.
What
is Menorrhagia?
Menorrhagia is the medical term for women (and young girls first starting their menstrual cycles) that excessive menstrual bleeding. Excessive menstrual bleeding is defined as having a period that lasts 7 or more days each menstrual cycle (period) or is so heavy that you saturate your menstrual pad and/or tampon and need to change your feminine hygiene product(s) every one to two hours. It is very important to inform your doctor if you have excessive menstrual bleeding!
Women
that are suffering from Menorrhagia
may experience; anemia, fatigue, embarrassing
menstrual accidents, and feel that you have to restrict your life and social
activities to such an extent that you "miss out on life." Many
women prefer to stay close to home so as to avoid embarrassment due to their
need to go to the restroom so often so that they can change their feminine hygiene
products before they become too saturated and cause even more embarrassment.
How many
women have Menorrhagia?
Approximately 1 in 5 women have Menorrhagia.
Are
there any treatments or therapies for Menorrhagia?
Yes, there's hope and help for women with Menorrhagia!
Here are a few of the options and therapies you will want to discuss with your doctor.
Hormone therapy - also known as "both control pills," and/or other medications may be prescribed to treat hormone imbalance. Hormone therapy is effective about 50% of the time, and may be required for a long period of time.
Uterine
Balloon Therapy - Also known as Thermal Balloon
Ablation) (see below for more
information)
Dilation and curettage - also
referred to as a "D & C" - is a surgical procedure whereby the
doctor scrape the inside of the woman's uterus to remove the lining. For most women with
Menorrhagia, a D&C is temporary and reduces excessive bleeding for only a
few periods.
Endometrial Ablation is another possible therapy but only if you and your
husband don't plan to have children in the future. Typical
Endometrial Ablation removes the lining of the uterus with an electrosurgical tool or laser.
Like any surgical procedure, there are risks, which include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.
Hysterectomy is the surgical removal of the
uterus. As a hysterectomy involves the removal of the woman's uterus, Menorrhagia
will no longer be a problem. Hysterectomy is also a surgical procedure and also
involves risks. The recovery period after hysterectomy is 3 to 6 weeks.
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