Diagnostic testing is performed to determine the best approach to treating pelvic floor dysfunction. Testing ranges from a pelvic exam to state-of-the-art urodynamic testing in our Pelvic Floor Lab. Tests which may be recommended to better assess your pelvic floor are:
- Pelvic examination - specifically focused on assessing prolapse or other anatomic findings at rest and with straining.
- Urinalysis – a urine sample is tested for signs of bladder infection, blood in the urine and other health conditions.
- Office cystoscopy - a small scope, gently inserted through the urethra, is used by the doctor to magnify and examine the inside lining of the bladder and urethra. No special preparation is required. Plan for between 30-60 minutes for this visit.
- Urodynamic Evaluation (UDE) - computerized testing done in our Pelvic Floor Lab. The storage capacity and function of the bladder and urethra are tested using a very small catheter (hollow tube) during bladder filling, emptying and activities such as coughing. Sterile water is used to fill the recently emptied bladder. During testing the bladder, urethral and pelvic muscular activities are monitored and recorded. Testing should not be painful – to maximize comfort, a bit of topical anesthetic (numbing) gel is placed into the urethra. Leakage very well may occur during testing – this is nothing to be embarrassed about as it is only the water we have just instilled and will help us better understand the problem causing the leakage.
- Preparation – if you are able, please arrive with a comfortably full bladder.
- How long is the UDE testing appointment? Plan for anywhere from 30-90 minutes for this visit.
- Mild burning with urination or irritation after the testing may occur in some individuals. Normal activities may be resumed following testing.
- Post-void Residual (PVR) Measurement - when evaluating the function of the pelvic floor it is important to know if the bladder is emptying adequately. Immediately following a void (urinating) we will measure the amount of urine remaining in your bladder either with a hand held device (bladder scanner) placed below your belly-button or by passing a very small catheter (hollow tube) into the bladder through your urethra.
Treatment for PDFs
Controlling factors suspected of contributing to or worsening pelvic floor disorders by increasing healthy pelvic habits is the best first step. This includes:
- stopping smoking
- losing weight
- keeping bowel movements soft and easy to pass
- avoiding lifting very heavy objects
- reducing high impact activities
- strengthening the pelvic floor muscles
If there are no bothersome symptoms, pelvic organ prolapse can simply be monitored over time at routine yearly examinations. If symptoms of PFDs are bothersome, treatment options offered to patients for consideration will be done with attention to:
- general health
- symptom severity
- desire for future pregnancy
- whether or not there is prolapse
- whether or not there is stress incontinence, overactive bladder and/or other bladder dysfunction
- whether or not there is bowel dysfunction
Treatment options for pelvic floor disorders:
- Pelvic floor muscle exercises (PFME, “Kegels”) and core-strengthening exercises – helpful for urinary incontinence symptoms. In patients with prolapse, PFME will not change the bulge size but may help with symptoms/progression of mild to moderate POP by strengthening these muscles
- Dietary Modifications
- Bladder Irritants – there are many known and suspected bladder irritants. Simple changes in one’s diet can alleviate urinary urgency, frequency and urge incontinence. If you are troubled by any of these symptoms, elimination or marked decrease in consumption of caffeine, acidic foods, artificial sweeteners and alcohol is advised.
- Fluid consumption – drinking either too much or too little should be avoided. Too much increases urinary frequency and too little results in concentrated urine which can be irritating to the bladder. A total of 6-8 glasses per day is advised.
- Fiber intake – avoiding constipation (hard, dry, infrequent and/or difficult to pass bowel movements) is advised. Respond to an initial urge, eat a fiber-rich diet (whole grains, fruits, veggies), drink enough fluid, exercise and talk to your healthcare provider about medications or supplements potentially contributing to constipation.
- Timed Voiding / Bladder Retraining – voiding by a schedule which incrementally increases in duration between voids as well as learning techniques to delay voiding until urgency passes can be effective in retraining the overactive bladder.
- Pessaries – these flexible devices made of silicone which are placed temporarily in the vagina to hold-up or support the bulging areas if there is prolapse and/or treat stress incontinence. Incontinence pessaries have a thickened area placed below the urethra to control stress-related incontinence. Pessaries must be removed and cleaned regularly either by a healthcare provider or the patient herself.
- Medications – there are several medications available to decrease symptoms of overactive bladder.
- Estrogen – this hormone is available either in cream applied to the vagina or in other forms and is helpful for treatment of vaginal dryness and thinning (atrophy) in appropriate patients.
- Sacral Neuromodulation
- Percutaneous tibial nerve stimulation (PTNS)
- Urethral Implants – bulking material is injected by your doctor into the urethra through a cystoscope to help with incontinence when one has a very weak urethra. The thick material which is injected puffs up the walls of the urethra to make the seal stronger.
- Surgery– stress-related urinary incontinence and POP may be surgically treated. Minimally invasive midurethral slings are available for stress incontinence. There are several surgical options for the correction of pelvic organ prolapse. Before you elect to have an operation, your surgeon will discuss which procedure(s) he or she recommends for you as well as the risks and benefits. Options for repair are:
- Vaginal surgery
- Robotic surgery
- Abdominal surgery
- Combined abdominal /vaginal
- Laparoscopic surgery