September 26, 2022
Millions of women embrace the risks of pregnancy to bring new life into the world and experience the joys of motherhood. For many women, however, childbirth can be traumatic to their body and leave a long-lasting impact on their quality of life.
Some women are too busy or may feel too embarrassed to seek help for their pelvic floor-related issues that surface in the months and years after delivering children. Penn Medicine's Female Urology Program strives to provide compassionate care and effective treatments to women who often suffer in silence from pelvic organ prolapse and stress incontinence that occur when the pelvic region of the body is weakened from pregnancy and childbirth.
"At the time of childbirth, the body goes through many changes to facilitate the baby coming out easily and properly. But what can be left behind is excessive stretching or even damage to the pelvic muscles and ligaments," said Dr. Ariana Smith, Director of Pelvic Medicine and Reconstructive Surgery at Penn Medicine. "For many women in the recovery period after having a baby, those muscles and ligaments will heal and return to their normal position. For some people, that is not the case, or maybe it does with the first baby, but after a second or a third delivery, the returning to normal doesn't necessarily happen."
Smith and her team at Penn Urology treat women of all ages who encounter problems related to childbirth. Addressing these conditions as early as possible can help prevent additional problems from developing in the future. There are a range of surgical and non-surgical options available to help women who are suffering with these conditions.
The most common problem associated with childbirth-related weakening of the pelvic region is stress incontinence. Women with this condition experience urinary leakage typically when they cough, laugh, sneeze or exercise.
"It comes from a weakening of the muscles and ligaments that support the bladder and urethra," Dr. Smith said. "This can be very distressing to people and it can be a reason why they stop exercising. They don't want to wet themselves. It's a vicious cycle, because if there's weight gain, the problem tends to get worse. There's more pressure on the pelvic floor and greater volumes of urine loss."
Many women who have natural births suffer from a feeling of pressure in the vagina. This condition, known as pelvic organ prolapse, can occur when pelvic support muscles and ligaments no longer hold organs like the bladder and uterus in position behind the pubic bone and in the pelvic cavity. These organs can begin to sink into the vagina.
Many women describe prolapse as feeling like a tampon is falling out, or something feels out of position when they are standing. The most common words used to describe the sensation are pressure, a fullness in the vagina or a heaviness and pulling down sensation in that area of the body.
Rectocele is another type of prolapse where the wall between the rectum and the vagina is weakened during the delivery of the baby.
These problems may not be experienced until a long period of time has passed since giving birth. Mild discomforts that some women have managed on their own may start to get worse, prompting them to seek medical care.
At Penn Medicine, urologists perform the most advanced procedures for pelvic organ prolapse and incontinence, including minimally invasive options.
The primary surgery for stress incontinence involves implanting a mesh urethral sling. This minimally invasive procedure is often done using a mesh material, but some women may opt for an autologous sling, which utilizes fascial tissue from the woman’s body.
Penn Medicine’s treatments for pelvic organ prolapse include robotic prolapse surgery and vaginal prolapse surgery.
Many younger women opt for robotic prolapse surgery, a minimally invasive laparoscopic procedure that only involves smaller incisions. This allows women to get back to normal life more quickly than an open surgery performed through the abdomen or vagina. There's also no lasting scar across the abdomen.
Vaginal prolapse surgery is another option in which surgery is done using the natural opening in your vagina and offers a mesh free approach to support the bladder and correct the prolapse.
“The impact of these procedures on patients is life changing,” said Dr. Smith. “They’re able to return to their daily lives without the fear and discomfort they’ve been experiencing, many times in silence.”
It can be possible to have more children after surgery, but many women are advised to wait until they are done having children. This increases the likelihood that the patient will only need one surgical intervention that lasts for as long as possible.
Women with mild symptoms may not need surgery for their pelvic organ prolapse.
"Many more women suffer with these conditions than actually undergo surgery for them," Dr. Smith said. "Part of that is because there are some non-surgical treatments that can help women. Some women also experience these things later in life and choose not to undergo surgery."
For prolapse specifically, women have the option of getting a pessary — a diaphragm-like object made of medical-grade silicone that’s placed in the vagina to help hold organs in place. These tend to be a temporary solution before surgery or a preferred option for older women who may not be candidates for surgery.
Pelvic floor physical therapy can also be helpful for women with milder symptoms, or those who have had traumatic childbirth experiences and are trying to prevent a problem from worsening.
Penn Medicine has a full range of urology services, along with fellowship-trained providers and nurse specialists. Patients are treated at three hospitals and several multispecialty centers throughout southeastern Pennsylvania and New Jersey. If you’re suffering with symptoms from prolapse or incontinence, the team at Penn Medicine stands ready to help. They’ll provide you with compassionate care that puts equal focus on your emotional and physical well-being. Make an appointment today.