Weighing your options, Knowing your risks...

Tasha Mulligan MPT Health Pro
  • When you begin to experience incontinence symptoms, you have several options or directions to go to find a solution. These options range from non-invasive exercise programs aimed at strengthening your pelvic floor muscles to surgical procedures inserting a mesh into your body to assist in appropriately supporting your abdominal organs. I am not here to tell you what is the right decision for you, but I do want to clearly present all your options so you can make an informed decision. In the paragraphs below, my goal is to provide a comprehensive list of options available to women wanting to resolve their incontinence. The options will be presented in order from least invasive to most invasive.

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    The 1st option is the purchase of a physical therapist guided dvd or book to thoroughly guide you through a pelvic floor exercise program. A book or dvd provides you with a program that you can perform in the privacy of your own home. This approach is aimed at strengthening your pelvic floor muscles and your entire abdominal basket with the purpose of resolving your incontinence within 4 to 6 weeks. Your commitment is to performing the given exercise program 3x/week for 6 weeks and then a maintenance program from there on. There are no risks associated with this option. Two resources available to you can be found at www.hab-it.com and at www.pfilates.com
     The 2nd option is slightly more invasive involving insertion of weighted cones or other tampon-like weights into your vagina with associated instruction in pelvic floor contraction. It is also aimed at strengthening the muscles that have become weak within your pelvic floor.  Again, effects should be seen in approximately 4-6 weeks with regular exercise and a maintenance program should be continued thereafter. This also can be performed in the privacy of your own home and there are no risks associated with this approach.


    The 3rd option available to you is to find a womens health physical therapist in your area and schedule appointments. In this option you will receive an internal evaluation and the therapist will be able to give you both verbal and manual feedback as you work to strengthen your pelvic floor muscles. The advantage of this approach is that you have a one-on-one coach to guide you through your exercise program and to ensure all your muscles are firing as they should. In this approach, you do have to take the time to make and attend regular appointments with your physical therapist, but again there are no risks associated with this approach. A comprehensive list of Women's Health physical therapists can be found at the American Physical Therapy Association website and go to "find a PT".


    The 4th option is to schedule an appointment with your OB/GYN or family practice physician for insertion of a pessary device within your vaginal canal. The pessary device is designed to help hold up or give support to your bladder or uterus, which may improve or resolve incontinence symptoms by taking some of the downward pressure off your pelvic floor muscles, allowing them to fire more efficiently. This approach should also be followed by an exercise program to address the underlying muscular weakness. The disadvantages and risks associated with inserting a pessary device is changes to your vaginal canal, infection, and bleeding. Click for more information on pessary devices


  • The 5th option is surgery to insert a mesh into your body giving support to your bladder or uterus. The details of this surgery should be discussed with your surgeon. Many urologists share a strong opinion that an exercise based program should always be a patients first option because of the risks associated with any surgery. They have cited the risk of infection, the lack of long term studies to show exactly how long the mesh will last, and the unknown of how many surgeries a women should expect throughout their lifetime.

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    I will refer you to 2 sites addressing surgical treatments for incontinence for more detailed information:

     

    1. Urology Channel 
    2. Also a recent article in the New York Times, "Women Sue Over ObTape, a Devise to Stop Urine Leaks," which highlights the risks associated with the "quick fix."

     

    It is highly recommended that you discuss all the possible outcomes of surgery and the different techniques and products available. 

     

    In general there have been many positive stories with surgery for incontinence and many negative stories. I want you to encourage you to explore all your options and weigh the risks before you decide on ANY of the above options.

Published On: December 28, 2009