«The main objective of the different treatments for pelvic organ prolapse (POP) is focused on recomposing the woman’s anatomy to redirect the situation and, in turn, return normality to her altered bodily functions, such as urination, deposition or sexuality”, informs the urologist and surgeon, Carmen González Enguita.
The multidisciplinary treatment of POP women
“But we should not always go to treatment once the diagnosis has been established,” says the head of the Urology Service at the Fundación Jiménez Díaz University Hospital in Madrid. If women have no or mild symptoms, the emphasis should be on avoiding risk factors.”
“Even so, the specialists will carry out regular follow-up consultations to control the woman’s POP progression in detail,” he adds.
An organ prolapse is any descent into the pelvic floor or perineum of part of the bladder, uterus, rectum, including bowel loops, through the vagina. It is a frequent condition that up to 40% of multiparous mothers can suffer, that is, who have had several births.
“For the doctors who treat POP it is quite a challenge”
In these surprising cases, the most important thing is that the multidisciplinary team virtuously demonstrate their knowledge of the anatomy and physiology of the pelvic floor.
“We must be sure of what is happening in the pelvic area for this vaginal descent of organs to occur and at the same time understand the pathophysiology of prolapse. Both aspects are fundamental when we have to plan the treatment».
“Furthermore, I would say that all women who consult for this POP problem, once diagnosed, need a preventive guidance so that they understand it well and can take care of themselves properlyavoiding factors that facilitate the progression of the pathology».
We CANNOT avoid age, or past pregnancies, or complex deliveries, or perhaps that musculoskeletal weakness characteristic of each person, or the stages that women go through throughout their lives… but we CAN avoid all those situations that increase, inappropriately, abdominal pressure.
Obesity, constipation, lung pathology that leads to chronic cough, so you have to stop smoking, important efforts performed incorrectly, such as carrying or pushing weights, and impact sports.
However, it is usually advisable to maintain healthy physical exercise, as well as rehabilitate and strengthen the pelvic floor.
Dr. Carmen González Enguita
Rehabilitation and physiotherapy with Kegel and pessaries
«They make up a specialty within Physical Medicine, which is in charge of helping to know where the muscles of the perineum are, those that participate in these pelvic problems, to learn how to exercise them, train them and strengthen them to prevent prolapse, stop its advance or even push it back,” he says.
With the kegel exercises it is possible to firmly tighten the musculature that surrounds the vagina, the urethra and the rectum.
“We must contract the muscles for one or two seconds, approximately, and then relax them for ten seconds. Little by little, the contractions lengthen until they reach periods of ten seconds, thus equaling the relaxation time », he explains.
This exercise, which women can do sitting, standing or lying down, will be repeated about ten times in a row, recommending doing each series several times a day.
Women can also use vaginal cones: inserted into the vagina, they help to contract the correct muscles to prevent the cone from falling to the ground under its own weight”, she describes.
In Rehabilitation, they also work with biofeedback devices, sensors that show the muscle contractions of the pelvic floor on a screen, and electrical stimulation, with a probe to transmit current and contract the target muscle.
The pessaries They are circular devices, although there are different shapes and models, which are inserted into the vagina to support the pelvic organs.
“They reduce prolapse and reduce symptoms, but they are not a cure. They are especially beneficial for women who are waiting for surgery and for those who do not want or cannot undergo surgery, “says the urologist.
Anatomical reconstruction of the pelvic floor and the use of mesh
When pelvic floor rehabilitation does not achieve its goals, surgical intervention is necessary to definitively treat pelvic organ prolapse (POP).
“Surgery is used in those POP cases that cause an alteration in the patient’s quality of life, whether due to discomfort, pain, loss of urine, urination difficulty, constipation or problems in sexual relations,” he relates.
There are several types of interventions, most based on anatomical reconstruction of the pelvic floor. Always try to use the patient’s own tissues.
“When these tissues are very weak and in poor condition, or when we believe that the repair cannot be carried out with these tissues, we will use tissues designed and manufactured for this purpose, such as the well-known tights«, exposes.
Dr. Carmen González Enguita
Surgeries can be performed vaginally and/or abdominally. The decision of one or the other approach will depend on the type of prolapse, the anatomical characteristics of the patient, her age, her sexual life and the skills of the surgeon.
“There are many different types of surgeries and ways to perform them. In this section, the specialist should be consulted, with whom the best agreement will surely be reached, depending on both the POP problem and the patient’s preferences and values”, concludes Dr. Carmen González Enguita.
Recovery time will depend on the type of surgery. Most women will be able to gradually resume their physical activity in a few weeks, normality conditioned by the surgical technique used.
During the six months after the intervention to correct a pelvic organ prolapse (POP), straining or lifting heavy weights should be avoided, as they can affect healing.
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