Pelvic floor disorder occurs when the muscles and tissues supporting the pelvic organs are weakened or damaged. This could lead to problems like urinary incontinence (involuntary leakage of urine), faecal incontinence (involuntary passage of stool), or pelvic organ prolapse (bladder, bowel, or uterus drops into the vagina and cause a bulge). Women are more prone to this problem as their pelvic floor undergoes stress during childbirth.
Symptoms include a lump in the vaginal orifice, pressure in the bladder region, leakage of urine or stool, difficulty in emptying the bladder, a dragging sensation in the pelvis especially at the end of the day, backache, difficulty in walking and intercourse, constipation.
A physical examination and pelvic ultrasound will help confirm the diagnosis. Sometimes prolapse may be diagnosed during a routine gynaecological examination. Such patients may not have any symptoms. They are advised buttock squeezing exercises or Kegel exercises. In post-menopausal women, use of oestrogen cream may also help to strengthen the support. Surgical options help create a support for the affected area. Pelvic surgery helps repair the damaged tissues and muscles. The nature of surgery depends on the degree and type of prolapse and the need to preserve menstrual, reproductive or coital function. The operation can be done vaginally, abdominally or laparoscopically.
Non-surgical treatment options include pelvic floor muscles like Kegel’s exercises or losing weight. Lifestyle and dietary changes including avoiding alcohol and caffeine also help. Pessaries that lift the bladder, physical therapy, and electrical nerve stimulation are also very effective. Kegel’s exercises have a 75 per cent success rate, if done in the right manner. In men too, these exercises are very helpful, more importantly after prostate surgery.
What to do
For beginners, lie down on an even floor after emptying your bladder and locate your pelvic muscles.
Try to squeeze the vagina as if holding a finger and contract the muscles without any abdominal or buttocks movements.
Don’t hold your breath, breathe normally. Locating the muscles can be a problem initially but gets easier with practice.
Try to squeeze your rectum towards the vagina, as if trying to stop passing gas and stopping the urine flow midstream. Tighten and count till three and count back (3-2-1). Do five sets of 10 rounds daily.
Just holding back urine is also an exercise. This also strengthens the pelvic floor and prevents urinary incontinence. But do not overdo this. In case of urinary incontinence, try to do Kegels exercise while you cough, sneeze or lift something.
These exercises are very beneficial and help tone the muscles. As you progress, increase the time and hold the muscles in contracted position and decrease the relaxation time. These can be done while sitting or standing also.
Kegel’s exercises improve circulation to the vaginal and rectal areas and also help prevent haemorrhoids. They also speed up the healing of the tear during childbirth.
Kegel’s are not helpful in cases where the cause is excess pressure on the bladder due to constipation, obesity, or where frequent urges are because of caffeine excess. Also, Kegel’s must not be overdone during pregnancy. In such cases, the exercises can cause infections.
The writer is a Senior Consultant Gynaecologist and Infertility Specialist based in New Delhi.
