Pelvic Floor Disorders

This happens when the pelvic organs, like the bladder, uterus, or rectum, drop from their normal positions and push into the vaginal area because the pelvic floor muscles are weak. This can cause discomfort and a feeling of pressure.

This is when a person loses control over bowel movements, leading to accidental leakage of stool or gas. It can happen because the pelvic floor muscles are weak, nerves are damaged, or due to other health issues. There are two main types:

• Urge Incontinence: A sudden, uncontrollable need to go to the bathroom.
• Passive Incontinence: Leakage happens without any warning.

This occurs when the muscles that support the pelvic organs don’t work properly. It can cause symptoms like pain, difficulty controlling bowel or bladder movements, and pelvic organ prolapse. There are two types:

• Hypertonic Dysfunction: The muscles are too tight, causing pain and problems with bowel and bladder functions.
• Hypotonic Dysfunction: The muscles are too weak, leading to incontinence and prolapse.

Vaginal delivery can stretch and weaken the pelvic floor muscles, especially with multiple or complicated deliveries. The more pregnancies and deliveries a woman has, the higher the risk of developing pelvic floor disorders.

Muscle tone naturally decreases with age, increasing the likelihood that pelvic organs shift out of place. This makes it harder for the pelvic floor to support the bladder, bowel, and reproductive organs, leading to disorders such as incontinence and pelvic organ prolapse.

Constipation or heavy lifting puts repeated pressure on the pelvic floor. Over time, this repeated pressure can stretch and weaken the muscles, resulting in urinary and faecal incontinence or pelvic organ prolapse.

Obesity and chronic respiratory disorders that cause persistent coughing can lead to pelvic floor disorders. Obesity adds extra weight and pressure on the pelvic floor, while chronic coughing can directly weaken or damage the pelvic muscles and nerves.

As estrogen and progesterone levels decrease during menopause, the pelvic floor muscles may become weaker and less elastic.

Non-surgical treatments aim to strengthen the pelvic muscles, alleviate symptoms, and address specific issues without the need for surgery.

Medication

Medication for pelvic floor disorders can manage symptoms through various types of drugs. Muscle relaxants relieve pelvic muscle spasms and pain; topical oestrogen helps to strengthen pelvic tissues, particularly in postmenopausal women; and bladder control medications reduce urinary urgency and frequency associated with an overactive bladder.

When non-surgical treatments fail or complications arise, surgery may be required. The main surgical treatment options for pelvic floor disorders are:

Rectopexy

This procedure corrects rectal prolapse, where the rectum protrudes through the anus, by repositioning the rectum and attaching it to the sacrum to hold it in place. It addresses symptoms such as rectal bulging, discomfort, and incontinence, while restoring normal rectal anatomy and function. A colorectal surgeon ensures the rectum is properly repositioned and secured to prevent recurrence.

Perineal Repair

This procedure repairs defects or damage in the perineum (the area between the vagina and anus). It involves suturing torn muscles and tissues to restore normal function and support. It is often performed after childbirth or trauma that has caused damage to the perineal area. Perineal repair restores the integrity of the pelvic floor muscles and alleviates symptoms such as incontinence and pain. A colorectal surgeon ensures that the damaged tissues are properly sutured and the pelvic floor is adequately supported to restore function.