By Heather M. van Raalte, M.D.
Pelvic support problems are not often the first things that women talk about, even with their closest friends.
Yet nearly one quarter of American women are affected by pelvic floor disorders, which can cause physical discomfort and limit activity, according to the National Institutes of Health (NIH).
Fortunately, once diagnosed, pelvic floor disorders can be easily treated through a range of approaches, including minimally invasive surgery with the da Vinci Surgical System.
What are
pelvic floor disorders?
Pelvic floor disorders result when the muscles and connective tissue within the pelvic cavity weaken or are injured. These muscles and ligaments form a sling across the opening of a woman’s pelvis, holding the bladder, uterus, bowel, and rectum in place.
Problems with pelvic support are often associated with pelvic organ prolapse, a condition in which the muscles and ligaments can no longer support the pelvic organs. As a result, the organs drop, causing a variety of symptoms that can range from mild to severe.
The frequency of pelvic floor disorders increases with age affecting more than 40 percent of women from 60 to 79 years of age, and about 50 percent of women 80 and older, according to the NIH.
What causes
pelvic organ prolapse?
The main cause of pelvic organ prolapse is childbirth. Women who have delivered vaginally are at slightly increased risk than women who delivered by cesarean section. Other causes of pelvic floor disorders include:
• Prior pelvic surgery.
• Menopause.
• Intense physical activity, especially heavy lifting.
• Factors that increase pressure in the abdomen, such as being overweight or obese, constipation and straining to have a bowel movement, and chronic coughing.
• Genetics.
What are the symptoms
of pelvic floor disorders?
Common symptoms of pelvic floor disorders include:
• Urinary incontinence, also known as leakage.
• Frequent bladder infections.
• Pain with intercourse.
• Feeling of pelvic heaviness or fullness.
• Bulge in the vagina.
• Organs bulging out of the vagina.
• Lower back pain.
• Pelvic pressure that gets worse with standing, lifting or coughing or as the day goes on.
If you experience any of these symptoms, do not suffer in silence. Talk with your doctor and seek help from a urogynecologist — a specialist in treating urogynecological problems.
How are pelvic support
problems diagnosed
and treated?
Diagnosis is typically made through a physical evaluation, including a vaginal and rectal exam. You may be examined while you are lying down or standing up or both. Imaging tests such as MRI or ultrasound may also be used for further evaluation.
Once diagnosed, symptoms associated with mild cases of pelvic support problems can sometimes be corrected through lifestyle changes such as:
• Limiting fluid intake, especially caffeinated beverages, which can stimulate the bladder.
• Bladder training, a form of therapy that trains your bladder to empty at scheduled times.
• Kegel exercises, which strengthen the muscles surrounding the openings of the urethra, vagina and rectum.
• Losing weight. In addition to improving overall health, weight loss can help relieve symptoms of pelvic floor disorders.
• Pessaries. A pessary is a device that is inserted into the vagina to support the pelvic organs.
• Surgery. Surgery to correct pelvic organ prolapse is called sacrocolpopexy. Doctors at University Medical Center of Princeton at Plainsboro are performing sacrocolpopexy using a minimally invasive laparoscopic approach with the da Vinci Surgical System.
The da Vinci System is a state-of-the-art robotic surgical platform with 3D, high-definition vision and miniaturized instruments that enable the doctor to operate through small incisions (one to two centimeters) with enhanced vision, dexterity and control.
The potential benefits of sacrocolpopexy with da Vinci include less blood loss, a shorter hospital stay, shorter operation time, smaller incisions and less scarring. If your doctor recommends surgery to treat pelvic organ prolapse, be sure to ask whether da Vinci surgery is right for you.
Can pelvic floor disorders
be prevented?
Though pelvic floor disorders are common, there are a number of steps women can take to help reduce their risk and maintain pelvic health:
• Avoid heavy lifting. Be smart when lifting weights or anything heavy, including a child. Lift with your legs and not your back.
• Eat a healthy diet that is high in fiber. Fiber can help minimize constipation and straining with bowel movements.
• Maintain a healthy weight. Excess pounds can put pressure on your pelvic floor.
• Strengthen your core. Exercises like Pilates that focus on your abdominal muscles can help keep your pelvic floor strong.
• Do your Kegels. Kegel exercises are one of the best ways to prevent pelvic organ prolapse, and the good news is they can be done anywhere.
Too often, women will just accept pelvic support disorders and chalk them up to growing older. However, by discussing problems with a doctor and seeking treatment early on, women can take control of their pelvic health and prevent pelvic problems from interfering with their ability to enjoy a normal life.
To find a physician with Princeton HealthCare System, call (888) 742-7496 or visit www.princetonhcs.org.
Heather M. van Raalte, MD, is fellowship trained in urogynecology and a member of the medical staff of University Medical Center of Princeton at Plainsboro.

