Pelvic floor disorders: The unpleasant aftermath of childbirth

Keeping your pelvic floor muscles toned can improve your bladder and bowel function, and even your experience of childbirth. Photo | www.dreamstime.com

What you need to know:

  • Although embarrassing or sometimes painful, pelvic floor disorders are a treatable. Talk with your doctor about your symptoms to get a proper and early diagnosis.

Pelvic floor disorders are any pain or dysfunction in the area of the uterus, cervix, vagina, bladder or rectum caused majorly by vaginal childbirth.  While natural delivery is the commonest mode of childbirth, it can be a physically damaging process that can cause prolapsed or sagging of the pelvic organs namely, the rectum, uterus, bladder, and weakening of pelvic muscles. The primary types of pelvic floor disorders are:

Urinary incontinence
This comes in two main forms; stress incontinence and urge incontinence. Stress incontinence is where the bladder leaks due to movement, coughing, sneezing or laughing. Urge incontinence on the other hand is the urgent need to go to the bathroom followed by an involuntary loss of urine. Fecal incontinence is the involuntary loss of stool, a condition that causes not just inconvenience but embarrassment as well.

Pelvic organ prolapse
This is when one or more of the organs in the pelvic area slip down from their normal positions and bulge into the vagina. It can be the womb (uterus), the rectum, the bladder or top of the vagina. While this condition is not life threatening, it can cause pain and discomfort, and as you can imagine, embarrassing sex. 

Fistula
Fistula is an opening between the wall of the vagina and the wall of the bladder or rectum, which can lead to urine and fecal leakage.

Causes 
Jane Tukamushaba, a midwife who has worked at Mulago National Referral Hospital for more than 40 years, says that while some women might develop pelvic complications during or soon after childbirth, many can develop them long after they have stopped having children. She explains exactly how and why these disorders occur: 

“The womb sits between the rectum and the bladder. During the contractions of labour, the baby keeps rubbing and pushing and squeezing both the rectum and the bladder. It is important that the bladder and the rectum be frequently emptied during labour and an experienced midwife will ensure that the patient does so. Otherwise if the bladder and rectum are full, then tears may occur,” she says.

She adds that the biggest cause of pelvic floor damage in Uganda is giving birth away from a hospital, in the absence of experienced midwives and other medical professionals. Also, other than unsupervised deliveries, the other main cause of pelvic floor disorders is teenage pregnancies. 

“Most young girls that get pregnant are at risk of these complications because their pelvic area is not yet fully grown to allow for safe childbirth. Usually pushing the baby for many of these young girls causes some of the organs around the pelvic area such as the rectum and bladder to experience intense pressure,” Tukamushaba says. 

Frequent childbirth
Women who give birth to many children or who give birth too frequently run the risk of suffering from pelvic floor damage later in their lives in the form of prolapsed organs, according to Tukamushaba. 

“Too many frequent deliveries cause the pelvic floor organs to sag into the vagina because they were over-stressed by frequent pregnancies and never had time to heal after each childbirth. This is why they loosen and sag,” she says.

Can pelvic floor disorders be prevented?
Tukamushaba says delaying pregnancy until after teenage years would go a long way in preventing many of the disorders. Other than ensuring to give birth with the help of trained professionals, a routine pelvic exam or Pap smear test is a good way to prevent the likelihood of these disorders.

Experts say that managing conditions such as obesity can help prevent pelvic floor problems from worsening. And performing certain exercises such as Kegels, especially during pregnancy, can be preventive and therapeutic. Kegels precondition the pelvic floor muscles prior to the birth by building strength and endurance and a better awareness of how to let go and relax when pushing.

Avoiding constipation or straining during pregnancy, fluid and fibre intake, and good bowel routines are good ways to keep away from pelvic floor disorders.

Treatment
Many women are embarrassed to talk about pelvic floor disorders, which keeps them from getting timely treatment. However, there are effective treatments, including surgical and nonsurgical treatments, a combination of the two and lifestyle changes. 

Some nonsurgical treatments include bladder training which involves using the bathroom on a set schedule to regain bladder control and applying techniques to overcome inappropriate urges to urinate. A mother starts by using the bathroom at a specific interval and slowly, over many months, increases that time, with a goal of using the bathroom only every three hours.
Pelvic floor muscle training or Kegel exercises involve squeezing and relaxing the pelvic floor muscles regularly until they improve the symptoms of urinary incontinence.

Prevalence 
In a 2022 study that was carried out at Mbarara Regional Referral Hospital, 27. 5 percent of women suffer from different stages of pelvic floor disorders. Of 338 participants enrolled, 93 had these conditions, with 12 percent at stage one, 63.4 percent at stage two, 16.1 percent at stage three and 8.9 percent at stage four.

The researchers found that majority of women with pelvic floor disorders were between 34 and 49 years of age. The study concluded that there should be routine screening for symptoms to enable early identification and management, especially in those who are grand multiparous (giving birth to many children), peasant farmers and mothers with a history of perineal tears.

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