This article originally appeared in the Winter 2018 edition of
Some women regard their struggle with pelvic floor disorders (PFDs), including
urinary incontinence and vaginal prolapse, with resignation and embarrassment.
Many in this “sisterhood of silence” are hesitant to talk
about their condition with their physician. “Women need to know
that there are viable treatment options,” says urogynecologist George
F. Craft II, MD. “Providers in women’s health work hard to
challenge the notion that ‘it’s just something I have to suffer
with,’ given how incontinence and prolapse impact quality of life
for an estimated one-third of women over 40.” Dr. Craft, an advocate
for “support, not silence,” answers questions about this frequently
Q: What causes pelvic floor disorders?
A: Urinary incontinence, the involuntary leakage of urine, and prolapse,
when the upper portion of the vagina and other pelvic organs drop into
the vaginal canal or outside the vagina, are primarily caused by pregnancy
and childbirth. Weakness in the pelvic muscles and connective tissue also
happens over time, so aging is a factor, as are lack of exercise, obesity,
chronic constipation, and smoking.
Q: How are PFDs treated?
A: The foundational, nonsurgical treatment is physical therapy, and frequently
it may be the only treatment required. A certified physical therapist
can offer training and exercise options, including Kegels, which can be
done at home to strengthen the pelvic muscles. Some patients use a pessary,
an insertable device that sits in the vagina and provides support to the
bladder and other organs. There are also surgical options where weakened
tissue is repaired and reinforced; sometimes the repair is augmented with
biologic material or mesh. Primarily an outpatient procedure, the surgery
is minimally invasive. Patients are encouraged to resume nonstrenuous
activity immediately after surgery, allowing them to return quickly to
normal daily functions.
Q: Are there ANY misconceptions about PFDs?
A: The main misconception is that PFDs are an inevitable fact of aging.
Having surgery can offer cost savings, due to the expense of years’
worth of incontinence supplies. Finally, given how these disorders can
impact activities in daily life, including intimacy, women experiencing
symptoms should not be afraid to speak up and have a candid conversation
with their gynecologist or primary care provider. Silence—and resignation—should
not be options.
Physical therapy can help women with PFDs. View a video featuring Kate
Divine, PT, one
of Valley Health’s therapists specializing in women’s health,