To answer all your questions, we bring to you a webinar, “Pelvic Floor Health – The Hidden Things That Matter!” with mumpreneur Dawn Sim and Dr. Ng Kai Lyn, consultant Obstetrician & Gynaecologist at the Advanced Centre of Reproductive Medicine, located in Gleneagles Hospital, Singapore.
Learn more about the various causes of pelvic floor dysfunction, how to diagnose it, and your treatment options. Tune in to our informative webinar wherein our speakers talk about:
What is Pelvic Floor Dysfunction?
Pelvic floor dysfunction is the inability of your pelvic floor to perform its normal functions. This can be caused, as Dr. Ng mentioned, “by a multitude of factors” such as weakened pelvic floor muscles, pregnancy, childbirth, ageing and menopause.
As this can lead to problems with bowel and urinary control, or sagging pelvic organs, many women shy away from acknowledging the problem and convince themselves that it doesn’t exist. Dr. Ng empathises that as Asian women, many of us are still not open to discussing these topics and it takes a very confident woman to admit to having this problem.
She began the webinar by reassuring, “I’m here as a woman, to tell fellow women, things that people don’t discuss on a daily basis.”
Our speakers also addressed the three main types of pelvic floor dysfunction.
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Pelvic Organ Prolapse (POP)
Our pelvic organs include the uterus, bladder and bowel. POP is the bulging of one or more pelvic organs into or out of the vagina. It affects 1 in 3 women who have had children and 1 in 10 women need surgery for prolapse in their lifetime.
Causes:
POP is caused by damage and weakening of nerves, ligaments and muscles, which support pelvic organs. Dr. Ng explains that this is sustained through pregnancy and childbirth, in which the weight of your baby has been straining your pelvic floor muscles for 9 months.
Age and menopause are also to blame, as well as excessive pressure on the pelvic floor. Dr. Ng cautions that if you are constantly lifting heavy things, you are more susceptible to this condition, especially as you age.
Symptoms:
- Feeling of a lump in or outside of the vagina
- Heavy dragging feeling in vagina / lower back
- Urinary / bowel symptoms (incontinence, more frequent usage of toilet, difficulty passing motion)
- Discomfort during sex
Dr. Ng warns that it can get bad. In severe cases, some women had to push the bulge back into their vagina in order to pass motion.
Likewise, Dawn shares, “One of my clients suffered with her prolapse for over a year before it got so bad that she had to go to the hospital. After which, she could no longer work.”
Dr. Ng aims to educate everyone so that they can seek help early!
Types of POP:
- Most Common, Cystocele – bladder bulges into or out of vagina
- 2nd most Common, Uterine Prolapse: uterus bulges into or out of vagina
- Rectocele: rectum bulges into back wall or out of vagina
How to diagnose POP:
- Urogynaecologist does detailed pelvic examination to determine type and severity of prolapse and establish pelvic floor muscle strength & tone
- Checks for complications
How to treat POP:
- Avoid heavy lifting / chronic straining / weight management
- Kegel exercises
- Vaginal / abdominal reconstructive surgery
- Vaginal pessaries: inserted in vagina by gynaecologist to provide support to prolapsed organs
Dr. Ng emphasises that the first step is to be open about POP and seek help. Don’t assume the worst. POP is not life threatening. Surgery might not be required especially if it is treated early. Most of the time it can be treated easily, even with just lifestyle changes. As Dawn said, “Don’t wait until the last minute hoping that it will go away with time.”
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Urinary Incontinence
This condition of leaking urine when you don’t want to is extremely common. In fact, it affects 1 in 2 healthy middle-aged Singaporean women.
Types of Urinary Incontinence:
- Urgency Incontinence: bladder muscles contract before you are ready to pee and you leak urine shortly after experiencing the urge to pee
- Stress Incontinence: urethra is too weak to stay closed when there is increased pressure on the abdomen & you leak during physical activity, such as coughing, sneezing, laughing etc.
- Mixed Incontinence: leaking under both of the above situations
Causes of Urinary Incontinence:
- Weakened pelvic floor muscles: just like POP, this is caused by pelvic muscle damage sustained through pregnancy, childbirth, ageing, menopause & obesity
- Weakened bladder muscles: usually from ageing and nerve damage
- Medications – blood pressure / heart medications
- Caffeine can be a contributing factor
- Medical conditions – such as asthma, chronic cough, poorly controlled diabetes
- Smoking
Just like POP, visit your urogynaecologist for a detailed history taking and pelvic examination to determine type and severity of your urinary incontinence, establish pelvic floor muscle strength and tone and look for co-existing prolapse.
How to Treat Urinary Incontinence:
- Lifestyle changes: maintain healthy BMI, Kegel exercises, adjust fluid intake, cut down on caffeine, quit smoking, bladder training & schedule toilet breaks
- Medication: relaxes bladder muscles & increases intervals between trips to the toilets but medication takes time to work and may have side effects such as dryness in the eyes, mouth and skin as well as constipation
- Surgery: Mid-urethral type, keyhole or open surgery
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Overactive Bladder
An overactive bladder is the urge to pass urine often and may or may not be associated with urinary incontinence. Needing to pee once every 2-3 hours in a day and once at night is considered normal. This is of course subjected to the amount of fluid you take in.
Dr. Ng mentions that an overactive bladder can be disruptive and affect your sleep quality. She added that as most people don’t keep track of their toilet visit frequency, keeping a bladder diary can go a long way in helping you to understand the situation better.
Normal urine output is between 250 and 400ml each time, so if you find yourself visiting the toilet frequently, and your output is barely 50ml each time, chances are that you may have an overactive bladder.
Causes
- Inappropriate peeing habits: holding bladder for too long, often due to the nature of your job
- Lifestyle habits: dietary factors like excessive salt, sugar and preservatives
- Inappropriate drinking habits: too much in too little a time, too much caffeine, drinking too close to bedtime, drinking when you wake up at night
How to Overcome that ‘Urgent’ Feeling
- Sit down on firm surface and cross your legs, stay still and distract yourself
- Tighten and release your pelvic floor muscles
Remember, the more flustered and hurried you are, the less likely you will be able to fight the urgent feeling. Dr. Ng compares your bladder to a child – if you keep ‘indulging’ your bladder whenever you feel a need to pee, the urge will continue, so train your bladder. There are good and bad days and it takes time to train your bladder and continue with the good habits upon successfully training your bladder.oh
Dr. Ng wrapped up the session by assuring everyone that pelvic floor dysfunction is more common than you think. It’s just not a commonly discussed topic. If you are suffering from it, you are not alone. But while it’s not life threatening, it does significantly affect quality of life and possibly your relationship with your partner. Avoid risk factors, and start Kegel exercises as early as possible as they are very important. If you are in doubt, see a urogynaecologist.
You are in charge of your pelvic floor health!
The session concluded with a question-and-answer session from participants on how to treat urogynaecological issues.
Watch the webinar recording here:
We hope that you will find answers to your pressing questions about pelvic floor dysfunction in this comprehensive webinar. Remember, never suffer in silence. When in doubt, consult a specialist and get the treatment you need!