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Advocacy and Research

The da Vinci Mode

By Riva Preil

Pelvic Organ Prolapse (POP), organ descent of the bladder, uterus, or rectum, is an all too common problem which affects many adult women. There are several treatment approaches proposed by medical care providers, including physical therapy to strengthen the pelvic floor muscles that rest beneath and support the organs. Should physical therapy alone not sufficiently reduce POP symptoms and discomfort, surgical intervention may be indicated. However, there is a large debate within the medical community regarding what is the best surgery to perform. Not all surgeries are created equally, and different surgeries use different materials to stabilize the pelvic floor (ex. sling vs. propylene mesh). Women’s bodies respond differently to these variations, and some require a revision several years later if the prolapse returns. In addition, open surgery itself puts the individual at risk of sustaining a vaginal or bladder injury during the procedure itself, and some women experience post-surgical complications such as bowel obstruction.

The traditional sacrocolpopexy procedure involves removal of the uterus followed by attaching the vaginal vault to the periosteum of the sacrum with polypropylene mesh. This open procedure involves a vertical or horizontal abdominal incision above the pubic bone. The incision is closed with dissolvable or removable stitches. Fortunately, a recent study in Belgium discussed in European Urology (June 11, 2013) revealed promising results regarding a NEW technique. The study compared the previously aforementioned technique with a minimally invasive robot-assisted sacrocolpopexy (RASC) procedure. The RASC procedure was performed with the da Vinci Surgical System (created by Intuitive Surgical Company) on 95 women between April 2006 and December 2011. On average, the procedure took 101 minutes to perform, and at the 34 month follow up, only 4 women (4.2%) were still experiencing POP symptoms. Only 10.5% of participants experienced urinary urgency symptoms after the surgery, all of which resolved naturally within several weeks post-surgery. No new bowel or sexual dysfunction symptoms were reported. Therefore, if a surgical route is indicated, speak with your doctor about whether this safe and effective approach is appropriate for you!

—FAQ

Frequently Asked Questions

Pelvic Floor Disorders and Treatment

What is pelvic floor dysfunction and why does it happen?

Pelvic floor dysfunction is extremely common and occurs when the muscles, tissues, or nerves of the pelvic floor are weakened, tightened, or injured by trauma, chronic strain, or overuse. Pelvic floor disorders can result from traumatic injury such as a fall, from sporting activity, surgery, or childbirth. They can also happen from more chronic issues, such as infection or chronic inflammation such as endometriosis. Pelvic floor disorders can be a consequence of poor alignment or posture, overuse, or improper movement. The pelvic floor muscles surround the urethra, rectum, vagina and prostate; therefore, if there is a dysfunction in these muscles it can result in urinary, bowel, or sexual dysfunction in people of all ages.

Who should I see to get a proper diagnosis?

Many healthcare providers don’t assess – or don’t know how to assess – the pelvic floor muscles and nerves, so it’s important to get a proper diagnosis from a practitioner who specializes in pelvic floor dysfunction and pelvic pain. Too often patients tell us that they’ve been to 10 different doctors and healthcare providers and their symptoms have not improved, or have worsened. Find a specialist right away and get on the path to healing as quickly as possible.

Why do healthcare providers miss (or misdiagnose) pelvic floor dysfunction?

Long story short, the medical practice is divided into areas of the body: Urology. Orthopedics. Gynecology. But the body itself doesn’t have walls; every system interacts with everything else. Sometimes providers are so laser-focused on what they treat that they miss the whole picture. 

As more and more research emphasizes the importance of physical therapy as part of a complete treatment regimen, more and more physicians are learning how to recognize and treat pelvic floor disorder. In the meantime, if you’re not getting relief from your current treatment, make an appointment with a pelvic floor specialist to learn more.

How does pelvic floor dysfunction affect sex?

Pelvic floor muscles have a huge impact on sex. Muscles that are shortened or tight and are unable to elongate will not allow for good blood flow into the genitals. This can result in pain, weaker erections, diminished sensation, inability to orgasm, and even decreased lubrication. Pelvic floor PT can help with these issues by enhancing blood flow and improving muscle function. 

How can pelvic floor dysfunction cause bloating?

Pelvic floor dysfunction, a condition characterized by the inability to correctly relax and coordinate pelvic floor muscles, can significantly contribute to bloating due to its impact on gastrointestinal functions. When these muscles are not functioning properly, it can impact the ease of emptying and make it difficult for your body to pass stool and gas through the intestines. This obstruction leads to an accumulation of waste and gas in the gastrointestinal tract, causing bloating and abdominal discomfort.

Is it true there’s internal massage?

There can be. We do perform internal soft tissue mobilization of the pelvic muscles that are inside your pelvis and are accessible only through the vagina or rectum. We never do internal treatment without your consent and understanding.

What makes someone a pelvic floor PT vs a regular PT?

All pelvic PTs get additional training in pelvic floor internal treatment through continuing education and at our clinic. 

We pride ourselves on the level of training we provide, not just at the beginning but throughout the time our therapists spend at Beyond Basics. We know that learning is a life-long process.  We also provide additional training in physiology of the GI system and urinary system as well as sexual health and function and nutritional training. Most PT programs and schools do not provide the depth and breadth of knowledge that we provide all our PTs at Beyond Basics.

Get help now from a pelvic floor therapist.

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