The structure that covers the abdominal cavity from below, supports the organs in the lower abdomen (pelvis), and consists of muscle and support (connective) tissue is called the pelvic floor. It attaches to the pelvic bone surrounding the lower part of this cavity like a frame and functions like a hammock. The pelvic floor not only closes the gap, but also provides support for the organs located here, which we call the pelvic organs.
These organs are the urinary bladder and urinary tract (urethra) in the front, the uterus and chamber (vagina) in the middle, and the intestine in the back. The last part is the rectum and the anus (anus) is located in the base.
Urogynecology examines the health problems that occur with pelvic floor insufficiency. Therefore, the failure of the base results in the organs it supports sagging downwards.
Complaints arising from the dysfunction of the prolapsed organs along with the palpability of a mass, pressure or a feeling that something is about to arise are within the scope of this specialty.
The pelvic floor contributes to the front urine storage and urination functions with its support function. If this function is disrupted, complaints that significantly negatively affect the quality of life such as frequent urination, frequent urination at night, urinary incontinence, inability to fully empty urine, and frequent urinary tract infections occur.
Reproduction in the middle part of the pelvic floor. There are organs. In case of prolapse of the uterus and chamber, a mass sensation, tissue coming out of the vagina, urinary incontinence or inability to urinate, pain in the lower part of the waist, and in advanced cases, ulcers may occur when the prolapsed part rubs against the underwear. These ulcers can cause discharge, odor and pain.
The posterior part is related to defecation. Gas may cause serious complaints such as incontinence, constipation, difficulty in defecation, and contamination after defecation.
Sexual life is often negatively affected by organ prolapse. Urinary incontinence, especially during sexual intercourse, puts a woman in a very difficult situation. Another complaint related to organ prolapse is pelvic pain, described as waist-groin pain. The pain that occurs for this reason is typical. The patient is not painful in the first half of the day. Because in the lying down position at night, the organs slide into place and the patients are able to cope with themselves due to adequate blood circulation. They feel good. Pain occurs especially in the second half of the day due to standing and fatigue, because the sagging situation increases with standing.
Pelvic floor insufficiency is frequently seen in middle-aged and older women, and we see that the frequency doubles with every 10-year period of age. Therefore, with the aging population, the desire for a quality life increases the importance of urogynecology.
What are the conditions that cause pelvic floor failure?
The most common cause is pregnancy and childbirth. Especially difficult vaginal births can cause stretching and damage to the pelvic floor structures adjacent to the birth path. Births with interventions such as vacuum and forceps, births of large babies, births with prolonged second term can be considered as risk factors.
Situations such as pregnancy that put a burden on the pelvic floor and increase intra-abdominal pressure (acid, tumor, mass), chronic coughs. (COPD, Asthma), obesity, chronic constipation, difficult defecation with straining, heavy lifting can lead to pelvic floor failure.
Very rarely, we can see pelvic floor failure and organ prolapse without the reasons listed above. Organ prolapse is more common in people with genetically weak connective tissue and in people of white or Latin race. Disorders such as umbilical and inguinal hernias, varicose veins, vascular aneurysms, and joint hypermobility are also common in these women. It may be familial. In practice, it is important that floor insufficiency is seen in the mother, sister and older sister.
Organ prolapse is included in gynecology practice to some extent. However, organ prolapse and disruption in functions may require detailed investigation. An appropriate treatment and result is based on an adequate evaluation.
When should we see a doctor?
Uterus and bladder prolapse does not require treatment unless it is severe. If the signs and symptoms are disturbing and prevent normal activities, a doctor may be consulted to discuss relevant options.
Health services for urogynecological problems can be evaluated in two scopes:
-Preventive Methods
-Treatment Methods
Preventive Methods
Kegel Exercises:
Strengthening the muscles of the pelvic floor, which has a muscular structure is for triangulation. Therefore, it is based on exercises. However, muscle exercises in this area are not ordinary exercises. They are specifically called kegel exercises. First you need to know these muscles. And for this reason, it is appropriate to get professional help.
Kegel exercises tighten your pelvic floor muscles, which support your uterus, bladder and intestines. A strong pelvic floor reduces symptoms related to uterine prolapse and provides better support for your organs in the pelvis.
Follow the steps below to do Kegel exercise:
-Strengthen your pelvic floor muscles (the muscles you use to stop urination). ) tighten (contract).
-Continue the tightening process for 5 seconds, then relax for 5 seconds. If this is too difficult, tighten for 2 seconds at the beginning and relax for 3 seconds.
-Continue working until you can hold the contraction for 10 seconds.
-Do this exercise 10 times each time, 3 sets a day. Do as follows.
Preventing and treating constipation:
Drink plenty of fluids; Eat high fiber foods such as fruits, vegetables, beans and whole grain cereals.
Avoiding heavy lifting and using the correct method when lifting heavy:
When lifting something, use your legs instead of your waist and back.
Controlling cough:
Do not smoke and get treatment for chronic cough or bronchitis.
Avoiding weight gain:
Keep your ideal weight and Determine your weight loss strategy if you need it.
Treatment Methods
Generally speaking, they can be divided into two groups: Surgical and Non-Surgical methods.
Surgical Methods:
There are different techniques in surgical methods. The patient's findings, general health status, complaints, expectations, and data obtained from the tests performed determine the shape and dimensions of the surgical method. In this treatment, in addition to anatomical correction, it is aimed to eliminate functional complaints. There are many surgical methods. The appropriate method is selected according to the patient, detailed information is given and it is performed with his/her approval.
Non-Surgical Methods:
In non-surgical treatments, strengthening the muscle structure that forms the pelvic floor. program is included. These consist of active methods (performed by the patient himself) and passive methods (applied with instruments). It is necessary to get medical help. In this context, electrical stimulation, tens, neuromodulation and biofeedback treatments are available.
The operation may not be suitable for those who have advanced organ prolapse but are not suitable for surgery due to their general condition and those who are planning a pregnancy in the future. It is more appropriate to use instruments called pessaries in these women.
Vaginal Pessary: This instrument is placed inside your vagina and keeps your uterus in place. Pessaries used for temporary or permanent treatment come in various shapes and sizes. Your doctor will choose the pessary that best suits you. You are taught how to remove, clean and reattach the pessary. Some pessaries can be removed in the evening and put on in the morning, but some pessaries can stay in place for a long time. However, vaginal pessaries have a small area of use in advanced uterine prolapse. Pessaries may injure the vaginal tissue and prevent sexual intercourse.
After adequate evaluation of the complaints arising from organ prolapse, the patient; Bladder training, behavioral treatments and (or) drug therapy (medical treatment) may be added.
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