Pelvic floor Muscle training (PFMT). Also known as Kegel exercises. PFMT if performed correctly, consistently and under the direct supervision of a qualified professional, can greatly improve the symptoms of the prolapse, even without correcting the degree of prolapse.
Biofeedback is sometimes used to help teach women what muscle groups to contract.
The vaginal pessary is a soft silicone device that is vaginally inserted and offers support to the prolapsed structures. It is used to treat some types of prolapse and occasionally can improve bladder control.
In some cases, surgery is the best management option, especially when other treatments have not been effective or have not resolved the problem. Most surgical treatments for pelvic floor problems can be performed as ambulatory procedures or with a minimum hospital stay (1 or 2 days maximum).
Prolapse. Surgery involves correction of the prolapse and recovery of the pelvic floor support. There are many available techniques and depending on the type of prolapse, previous surgery and patient´s medical conditions, we will offer the option that we believe is most indicated.
Women with uterine prolapse, depending on their preferences, may opt for reconstructive surgery preserving or sparing the uterus. The approach may also vary depending on the case and this may be vaginal or laparoscopic (abdominal). In cases where it is decided to proceed with the hysterectomy, it will be accompanied by the suspension of the vaginal vault or cuff.
For problems with bladder control. Surgery is mainly offered in two situations, stress urinary incontinence, where urine leaks occur in situations such as coughing, sneezing, laughing or exercising; and urge urinary incontinence where there is clear hyperstimulation or overactivity of the bladder's muscles, the detrusor.
Stress urinary incontinence is usually treated with a polypropylene mesh (sling) that supports the urethra, the pipe through which urine runs from the urinary bladder. This is a minimally invasive technique, with a high success rate and very low risk of complications when performed by a properly trained physician. Hospital admission is not usually required.
Other options such as bulking agent injections, vaginal laser or adjustable slings can be also offered but are recommended in very specific cases.
The great benefit of vaginal surgery is the reduced time of post-operative convalescence. The absence of abdominal incisions facilitates rapid recovery, minimal pain during the postoperative and the return to an active life in a few days.
The overactive bladder is a complex entity that is not yet fully understood. Sometimes the cause can be an alteration of the "communication" between the brain and the bladder. And in other cases it can be caused by a hyperactive detrusor muscle, that is, it gets too much and too often.
The first treatment is usually an oral medication that seeks to "relax" the muscle. If this is not effective, an option may be to inject Botox (Botulinica Toxin A) directly into the muscle to relax it. This can be performed as an outpatient procedure without requiring admission.
"Combined" or "multidisciplinary" are words that want to represent the complexity of pelvic floor related problems.
Often the problems are not limited to a single symptom or structure and we aim to evaluate the issues globally and assess each and every one of the different treatment options.
We also believe that in the 21st century a person must be able to make an informed decision on what treatment option they prefer. This is why we good communication and providing quality scientific information to all our patients is paramount to us.
Post-operative Recovery Powered or "Fast Track". Scientific studies have shown that optimal recovery can be achieved in a short time, integrating certain changes pre-operatively, during surgery and post-surgey.
This new approach will help patients undergoing vaginal surgery recover quickly and in optimal conditions. This will allow them to be discharged from hospital earlier and go home sooner.