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This newsletter is about how to avoid or resolve organ prolapse and incontinence.
August 26, 2012
Prolapse and Incontinence
Hi ,
Most people would rather avoid this uncomfortable subject. It is not pleasant to think about your insides falling out. Yet 30% or more of women will have to deal with this problem. The early stages produce incontinence. Sneezing, laughing, jumping and many other common activities may cause urinary leakage or fecal incontinence due to weakness of the pelvic floor muscles. With advancing weakness the vagina, rectum, and bladder may fall and begin to protrude out interfering with normal function and exposing these areas to injury and infection.
To a lesser extent men may also experience pelvic floor weakness with the same problems of urinary leakage and fecal incontinence. However the process of childbirth creates over-stretching to the pelvic floor muscles making women more likely to experience pelvic floor weakness. However many other problems can cause the same type of weakness for men that childbirth does for women.
Factors contributing to pelvic floor muscle weakness
Childbirth
some types of prostate surgery
neurological problems
stroke
Parkinson's disease
urinary retention
diabetes
persistent straining to empty the bladder or bowel with or without constipation
constipation
persistent heavy lifting
a chronic cough (from smoking, chronic bronchitis or asthma)
being overweight
lack of regular exercise.
So this is a problem that will have to be faced by many of us at some point. My attention was brought to this subject one afternoon this last week by a couple patients talking about their problems and resolution approaches with prolapse of their bladder, vagina, and rectum. One was using a surgical approach while the other an exercise approach.
The first approach to correcting the weakness of the pelvic floor muscles (the muscles between the tailbone and the pubic bone in the front of the pelvis) was published in 1948 by Dr. Arnold Kegel. His exercises became known as Kegel exercises and the pelvic floor muscles as a group are often referred to as the Kegel muscles. You can best experience the function of these muscles if you try to stop your urine flow mid-stream or try to prevent yourself from passing gas. These are the Kegel muscles in action.
The now classic approach to solving pelvic floor weakness and the resulting incontinence and prolapse is to engage a program of Kegel exercises several times a week. It usually takes 8 to 12 weeks to see results. This exercise program is kept up then for the rest of your life. There are two difficulties with this approach. The exercises are difficult to do correctly and Kegel exercises are often not enough.
The pelvic floor muscles are a basket of muscles in the lower pelvis that closely interact with our core stabilizer muscles of the lower abdominal region. Proper pelvic muscle tension requires proper spinal posture. If the pelvis is tipped forward (sway back) or backward (tail tucked under - the typical posture when we sit and slouch), the pelvic muscles do not contract properly and get weak. Similarly, the proper function of the pelvic floor muscles requires proper functioning of the nerves of the low back. Put in simple terms, if you low back is out or you have poor posture, you will have weakening of your pelvic floor.
Hopefully you all know what to do if your low back is out - come see me for a correction.
The patient that was using an exercise approach was giving glowing reports about the Hab it program for exercising the spine properly to build good pelvic muscles. Here is a video preview..
The program can be found by going to this Amazon link
I would not recommend this as a replacement for Kegel exercises but as an additional program to ensure greater success. Plus it will have the benefit of improving your posture - always a good thing.
As for the Kegel exercises themselves, many resources can be found on the internet, but self administration is difficult as it is hard to tell if you are doing it right. As a consequence a number of devices have been developed to help you both perform the exercises and get feedback as to if you are doing them properly. Some of them work, particularly if supervised training is done with a physical therapist who has specialized in this type of work. Many of the devices do not work and end up exercising muscles other than the proper pelvic floor muscles.
An approach first developed by Chiropractors back in the early 50's is to use electric stimulation to exercise the pelvic muscles directly. As with most things developed by Chiropractors, mainstream recognition is missed completely until somebody inside the mainstream "borrows" the idea and markets it through standard medical channels. We now have electric stimulators used in medical clinics for Kegel muscle stimulation. While this improves strength, it does not give the coordination and daily living integration by itself. We still need the self-initiated exercises for that. But the electrical stimulation can really speed up the process of strengthening the muscles.
Going to a clinic several times a week for "training sessions" with the stimulator can be a burden, plus the excess cost of a medical office visit each time has generated the new idea of purchasing home units. This is actually a pretty good idea in the long run compared to frequent office visit charges... especially considering that this is not a short-term therapy. These muscles need regular exercising for the rest of your life. You may get relief from concerns like incontinence within a couple months, but if you don't keep up with the exercises it will come right back. The initial up-front cost quickly pays for itself. Here is a new unit on the market called In Tone.
It requires a prescription and the doctor has to program the unit in
the office to match your needs. Otherwise the application is done at
home by yourself. I talked to the company rep Friday and she told me a
doctor in Folsom is providing this service.
Other options are to ignore the source of the problem and simply wear a diaper. A huge adult diaper industry has sprung up over the last 20 years and is making loads of money for the manufacturers. Unfortunately, diapers are not environment friendly. We don't really need landfills full of dirty diapers.
A last option is surgery. In this surgery a mesh sling is implanted to hold the organs up in place and attaches to the sacrum in the back and the pubic bone in the front. I have had patients who were quite happy with the results of this surgery and others that have nothing but horror stories about problems with the sling after the surgery. Obviously any surgery should be a last choice. Too many things can go wrong and any time you cut open the body scar tissue is formed that restricts circulation and lymph flow. These can cause further problems down the road. The long healing journey my sweetie Ellen is going through is a perfect example of post surgical complications.
So - basic message - do the exercises first. They work for most people. The simpler you can make it the more likely it is that you will keep it up enough to be able to live without further problems.
Take care,
David
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New Exercise Program
Patients are reporting great results with the new back strengthening program I wrote about in the March 18th newsletter. I highly recommend this program for everyone as we all need stronger backs to counter the effects of too much sitting. If you missed this information here is a link to that newsletter.
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