Pelvic floor disorders bring together a set of pathologies, which are due to a relaxation of the support system of the different pelvic organs (bladder, uterus and rectum). These perineal problems can cause discomfort for the patient and are managed in consultation with a specialist urologist or gynecologist.
What are the causes of pelvic floor disorder?
Perineum problems can occur in different contexts. The pelvic floor of pregnant women in particular undergoes significant pressure due to the weight of the uterus And of the baby. Pregnancy, difficult childbirths or even the absence of perineal rehabilitation can therefore promote pelvic floor disorders.
In addition to pregnancy and postpartum, various factors can weaken the perineum. We can in particular cite overweight, chronic constipation as well as activities that encourage abdominal thrusting (sports practice such as Crossfit or jobs involving carrying heavy loads). Likewise, hormonal changes linked to menopause can promote muscle relaxation and therefore perineal disorders with prolapse.
How to recognize a perineum problem?
Pelvic floor disorders can go from a simple embarrassment, a feeling of pelvic heaviness or intravaginal foreign body, especially at the end of the day or after a significant effort. This is due to genital prolapse, in other words the descent of one or more pelvic organs into the vagina.
Urinary symptoms can also occur if there are problems with the perineum. Patients may suffer from recurrent urinary tract infections, urinary frequency (a frequent urge to urinate), or urinary retention (difficulty completely emptying the bladder). “At the digestive level, they may present with constipation or anal incontinence, which can decompensate by gas leaks And of stools. The anal sphincter sometimes has difficulty functioning in static disorders.explains Doctor Inès Dominique, surgeon-urologist.
When should you consult a specialist for perineum problems? How is the diagnosis made?
It is recommended to consult your doctor, gynecologist or urologist as soon as you feel discomfort in the pelvic floor. “No treatment will be implemented if a prolapse is diagnosed, but the person is not bothered by this symptom and there are no associated complications”indicates the specialist.
The diagnosis of a pelvic floor disorder is based on a gynecological examination. Using a speculum, the healthcare professional determines which organ(s) descends through the vagina (bladder, uterus, vagina rectum, small intestine) and at what level. Examinations can complete the diagnosis such as a pelvic MRI. A urodynamic assessment can be carried out in the event of urinary disorders associated with prolapse.
Pelvic floor disorders: what are the treatments?
Treatment varies depending on the type of prolapse and the age of the patient. Initially, perineal rehabilitation is indicated, in order to tone the perineum. It is also recommended to stop intense physical or professional activities which can promote organ descent. A pessary can also be prescribed to patients. This medical device is placed intravaginally to limit the discomfort linked to prolapse.“It is possible to insert it yourself into your vagina to tone the perineum. This avoids surgical interventions”notes Doctor Inès Dominique.
In a second field of action, surgical treatments can be recommended. Promontofixation is the reference intervention for the management of prolapse in women before the age of 75. It consists to place strips in the stomach of the patient to reassemble the organs. In the majority of cases, it is performed by laparoscopy.
For older women or in the event of a significant surgical history, vaginal prolapse cures can be carried out, without the use of synthetic material. However, the risks of recurrence are greater. Surgical indications must be discussed in a multidisciplinary consultation meeting and preferably in a pelvic statics reference center.
Thanks to Doctor Inès Dominique, surgeon-urologist