Different Treatment Options for Pelvic Floor Disorders
There are many different treatment options for PFDs, some of which can be used to prevent PFDs and/or to slow progression. All treatment options should be discussed in detail with your doctor to make sure it is the best option for you. When discussing these treatments with your doctor, be sure to discuss the side effects and possible complications of each as well as the care involved for each, especially if you will need to rely on others for this care.
It is always a good idea to know your options beforehand so you are prepared and can advocate for your needs. We have listed the most common treatments as well as how they may be affected by your disability.
Lifestyle and Behavioral Changes
If you are overweight, losing even a few pounds can reduce episodes of incontinence by half. Obesity affects the normal function of nerves and muscles in the pelvis by putting excess strain on them, which can cause PFD to worsen.
-Weight Management with a Disability: Here at CROWD, we recognize that weight management is a challenge for women with disabilities, especially those with mobility impairments. For starters, it is difficult for many women with disabilities to even get an accurate weight measurement as many scales do not work for these women. There are many exercise barriers faced by women with disabilities and few guidelines exist for nutrition professionals to counsel overweight individuals with mobility impairments. CROWD has several resources on weight management, available here.
Be sure to intake an appropriate amount of fluid every day. Many women believe 64 ounces is the magic number for fluids, but it is really dependent on multiple factors and can be different for every individual. Again, this is something to bring up to your doctor. You should also limit fluids and foods high in caffeine, such as coffee, tea, some sodas and energy drinks, artificial sweeteners found in diet foods, and chocolate. Caffeine can cause you to have to urinate more than usual.
In addition to helping you maintain a healthy weight, eating a healthy diet with a variety of fruits and vegetables can help in the management of PFDs. Many fruits and vegetables contain large amounts of fiber, which helps keep your stool moving to avoid constipation.
Regular physical activity can keep bowel movements normal and help in weight management. Again, we know this is difficult for women with disabilities, so see the resources under the weight management section for more details.
Risk for PFDs is double for women who smoke.
Pelvic Floor Muscle Exercises (Kegels)
Kegel exercises are a great way to reduce symptoms of PFDs. They involve exercising the muscles that stop your urine stream and those that hold in gas. Unfortunately, many women with disabilities are unable to do Kegels properly. Be sure to ask a doctor, nurse, or physical therapist if this is a possibility for you and/or to make sure you are doing them correctly to maximize the benefit.
Urinating on a schedule can help your bladder get into a routine, which will reduce the frequency of incontinence episodes. The good news is, many women with disabilities already do urinate on schedule! The goal for many women is to go every 2 ½ to 3 hours, so talk to your doctor about a plan to reach this goal if you are not already there.
A pessary is a device that fits in the vagina and is used to lift the bladder and apply compression to the urethra to help prolapse and bladder and bowel control problems. Pessaries come in many sizes in order to meet the needs of each individual woman. Your provider may fit you with several pessaries before you find one that works. They are a good option to avoid surgery; however, they require removal for cleaning and can cause side effects such as infection and bleeding. For women with limited arm movement and dexterity, pessaries may be hard to care for properly without assistance. For women who use intermittent or indwelling catheterization and are already at risk for urinary tract infections, they may not be a good option. In addition, women with reduced vaginal sensation may be unaware when the pessary has shifted out of position or unable to detect side effects.
Medications are another area where treatment for PFD and those for bowel and bladder problems due to disability can overlap. A group of medications called anticholinergics are commonly used to control all forms of urinary incontinence, including that caused by PFDs and neurogenic bladder. Anticholinergics suppress involuntary contractions of the bladder, which decreases the “gotta go now” sensation. Antispasmodics are also a group of medications used both in disability-related and PFD incontinence as they stop overactive muscle activity.
For bowel incontinence, the medications are almost identical for a neurogenic bowel and incontinence caused by PFD. Bulking agents, such as fiber, soften the stool and increase its bulk. As mentioned above, fiber is found in most fruits and vegetables, but if you need additional fiber, Metamucil® is a common over the counter supplement used by many. Laxatives are a general term for multiple medications, available both over the counter and by prescription, that increase bowel movements. They can work in a variety of ways in your body. Some common laxatives include MiraLax® and milk of magnesia. Stool softeners, such as Dulcolax® are also used to treat bowel incontinence.
Nerve stimulation is commonly used to “wake up” the pelvic floor. This treatment is done by sending small amounts of electrical current to the nerves that control your pelvic floor.
Botox injections can also be used in both disability-related medicine and treatment for PFD. Injections to your bladder may help decrease incontinence. Bulking agents can be injected to narrow your urethra (the tube that carries urine to the outside of your body) and the anal canal to decrease both urine and stool leakage.
Surgical treatment for PFD is usually a last resort, used when none of the above methods are effective. The surgeries for prolapse, urinary incontinence, and bowel control are different and vary in terms of incision, recovery, and organs affected. Before you get too worked up, speak with your doctor to see exactly what is the best option for you!