With the new treatment techniques in pelvic floor surgery, which we also call "Pelvic Reconstructive Surgery", uterus, bladder prolapse, large intestine prolapse and urinary incontinence problems can be operated on.
Pelvis is the lower part of the abdomen where the reproductive organs in women are located. is the field. We can define the pelvic floor as the layer that forms this area and consists of muscles, connective tissue and ligaments. One in every four women suffers from problems with their bladder and pelvic floor. ”I can't hold my urine...!” , ”I go to urinate every hour, I know almost every toilet...!” , ”I can't go out to the street because of fear, I can't go to the neighbor...! >” , ”I feel like I am constantly urinating…!” , ”I go to the toilet frequently at night…!” , ”I have back and groin pain…! strong>”, ”I can't control my stool like I used to…!” or “There's something I can reach downstairs…!”.
As one might think, it's just It is not a problem for older women. According to recent research, “one in every three postpartum women has problems with their bladder” and only a minority of them return to normal. The underlying cause of all these problems is the loosening of the muscles and connective tissue in the pelvic floor due to birth, operations and age. As a result, significant and negative changes occur in the quality of life of these people. Patients change their lifestyles and limit their social lives. By drinking less water, kidney stones, urinary tract infections, and processes leading to depression by restricting the body's water needs are experienced. We had to put our patients with severe kidney failure due to mass effect on dialysis. The sexual lives of these people are also seriously restricted for reasons such as embarrassment, loss of self-confidence and fear of their partners noticing their problems. Surveys have shown that sexual life is hindered in rates of up to 60%.
Although the problems are increasing, voicing their problems is seen as a "taboo" as in the past, and these patients rarely seek help. Some patients are embarrassed to tell their complaints to the doctor or their relatives, while others He thinks these problems are normal at his age. The most important reason was that until recent years, there were no permanent and effective treatment methods and the doctor consulted did not have many options. Supporting the bladder opening with a synthetic band is a highly effective new operation technique, such as TVT and TOT, which have recently started to be applied (even though laser cutting is used, there are also those who present these operations as laser surgery). However, it is the right operation for only 15% of patients with urinary complaints.
In 1990, Prof. Dr. from Australia. Peter Petros and Prof.Dr. from Sweden. Thanks to the "Integral Theory"-based approach and initiatives put forward by Ulmsten, great advances have been made in Pelvic Floor Surgery. With the contributions and studies of Prof. Dr. Klaus Goeschen from Europe, surgeries, which were initially performed only for urinary incontinence, began to be performed on the entire Pelvic Floor with the principle of "Integral Theory". All damages in the pelvic floor were evaluated with careful and comprehensive examinations, and not only the damaged area, but the entire region began to be addressed.
After a careful examination and necessary research, vaginal (reservoir) surgery was performed, almost without bleeding and with small incisions. is being carried out. Weak and loosened ligaments are strengthened using synthetic materials if necessary, and the sagging layers are placed on top of each other appropriately without being removed, thus preventing scars after the surgery and preserving the elasticity and functionality of the chamber. At the end of these surgeries, patients can return to normal lives in a short time. Apart from having intercourse, they can return to their normal lives in a few weeks.
How does the pelvic floor work?
In the light of new information, Pelvic floor training can be done on a trampoline. It is likened to a trampoline.
It resembles a trampoline, consisting of the pelvic floor muscles (the blue jumping net section in the middle) and the jumping spring section (holding on to the sides) that forms the ligaments. Ligaments attach to the pelvis in the front, middle and back. The bladder sits on top of the trampoline like a rubber balloon. When the urinary bladder is full, the trampoline net and spring stretch and hang downwards. As the bladder fills, the nerves at the base of the bladder send signals to the brain, causing urinary retention. It tells you that your mouth is full. After a certain stage, the brain sends a warning to the bladder to empty it. If the person is not in a position to urinate at that time, the muscles in the Pelvic Floor contract and ensure that the trampoline net lifts up, thus preventing pressure on the bladder floor. Thus, the feeling of tightness decreases and the person relaxes. But of course, this perfect system is only possible if the trampoline is solid.
Especially if the muscles are weak and not tense due to birth, the bladder floor will not be lifted enough and kept in balance. Ligaments and muscles will sag, and the person will go to the toilet with urge to urinate, even if the bladder is slightly full. Depending on the area of damage in the pelvic floor, the disorder in the trampoline system will manifest itself with different complaints.
In case of weakness in the frontal areas, the mouth of the urinary bladder will not be able to close adequately during activities such as coughing, sneezing, straining, walking, sports, and uncontrolled urinary incontinence may occur. It will happen. At the same time, since the ligaments in the anterior region also play a role in defecation control, these patients may experience involuntary fecal incontinence.
Damages in the middle region of the pelvis usually present as frequent urination, feeling of urgency, and urinary incontinence before reaching the toilet. p>
In connective tissue damage in the posterior region, we see urination difficulties, night urination, back and groin pain, uterine or chamber prolapse.
Within this complex and holistic structure, each patient is carefully evaluated and evaluated. Sometimes many corrections (Total Pelvic Reconstruction) are required for one complaint. This shows why, in the past, "surgeries performed solely for complaints were not fully successful."
Organically caused sexual problems?
Sexuality, as long as there is no problem It's not a problem for most people. However, if it is blocked one day, troubles begin. Problems may increase, especially after birth, lower genital area surgeries, receptacle or uterine prolapse, and with aging. People choose to share these problems with their doctors rather than their spouses. Sometimes they may encounter reactions even up to humiliation and rebuff. In a problem-free sexual life, the Pelvic Floor has a healthy Your identity is essential. Here, the functions of the organs in that area during intercourse are as important as the prolapse of the chamber or uterus and damage due to previous surgeries. As can be predicted, urinary, gas and fecal incontinence during intercourse puts these people in even greater trouble.
These problems are actually more common than thought. It is possible to help patients of all age groups with a detailed examination and interview. A healthy sexual life can be achieved by detecting the prolapsed and enlarged areas in the chamber and making corrections.
Births
A uterine or chamber prolapse that may occur in the later years of life is mostly caused by births are responsible (births are only the common cause. Prolapse may also occur in those who have never given birth). Many women state that their chambers are enlarged and that they feel like they cannot satisfy their partner. There are also spouses who come to us and say this personally. Damages due to birth can occur in any part of the chamber and Pelvic Floor. It manifests itself as sagging in the chamber walls and weakness in the pelvic floor muscles, nerves and ligaments. It is also necessary to pay attention to birth-related tears around the chamber entrance. These problems can lead to inability to enjoy intercourse, urinary incontinence, and pain during intercourse.
Surgeries that have been performed
Surgeries that have been performed in the lower genital area, to a considerable extent, can cause problems in life. It may cause sexual problems in its advanced stages. Uterine surgeries and prolapse surgeries performed on the chamber may cause new problems, continuation of complaints, pain during intercourse, and inability to enjoy pleasure.
Although there are so many sexual problems with organic (non-psychological) reasons, today this Going to the doctor for these reasons is still considered a taboo.
Pelvic floor exercises
Based on the trampoline example, exercises have been developed to strengthen the important Pelvic Floor muscles. People can perform these exercises in their daily lives without spending extra time. In this sense, two very important different muscle groups that control the functioning of the urinary bladder and bowel are targeted.
The first is the striated muscle group; urinary bladder and the last part of the intestine It enables the opening and closing of the area where the sun is located. The smooth muscle group provides elasticity, which is very important for the organs in this region. It keeps the genital organs in a normal position and prevents unnecessary movements. Electrical stimulation is effective to strengthen these muscles. Studies have shown that blood flow to damaged tissues increases as a result of electrical stimulation. Therefore, muscle strengthening was achieved by increasing oxygen and energy in the region. This increases the endurance strength of the muscles. A recent study by a group we work with showed up to a 70% improvement in problems. However, if the ligaments that provide communication between the organs (urinary bladder, urinary tract, chamber, intestines) and the muscles are damaged, these exercises will not work. For example, when the Achilles tendon ruptures, you cannot move your foot backwards even though the muscles are normal.
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