Prevention of pelvic day problems
Prevention of pelvic day problems
Preventing pelvic floor problems
This group of problems, called pelvic floor dysfunctions, includes urine leakage, stool leakage, other urinary or bowel problems, pelvic organ descent, some sexological problems or pain. These problems are very common and affect at least ¼ of all women during their lifetime. According to recent data, 1/5 of all women will undergo surgery for urinary incontinence or descent in their lifetime. Treatment of leakage of stool or gas remains far from satisfactory results, especially in the long term. Incidentally, incontinence is the second most common cause of 'institutionalisation', i.e. placement in various types of nursing homes, in people of advanced age.
What is the cause
For all these reasons, prevention of these problems is therefore very important. One of the biggest risk factors is vaginal birth. However, a caesarean section carries risks of other health problems, and therefore performing a caesarean section on "all women" is certainly not ideal. However, the development of the "UR-CHOICE" scoring system could predict the risks of possible postpartum pelvic floor dysfunctions and here elective caesarean section could help.
In any case, vaginal birth is not the only contributing factor. Only 1/3 of cases of urinary incontinence can be attributed to vaginal birth. In the same way pregnancies (and their number) also contribute to the overall figures and so, again, caesarean section is of no help in such case.
The causes of pelvic floor problems are various, while each individual case can have its own specific causes. Here we present some potential reasons for pelvic floor disorders in a general context:
Pregnancy and childbirth
Massage of the perineum
Pelvic floor exercises during pregnancy can reduce the incidence of postpartum urinary incontinence.
Massage of the perineum during the last month before the birth can lower the risk of severe injury.
Caesarean section makes sense only in a high-risk group of women.
Injury to the anal sphincter is a significant risk of subsequent anal incontinence, perineal pain or dyspareunia (pain during intercourse). Obstetric procedures should take this risk into account.
Massage of the perineum during the last month before the birth can lower the risk of severe injury.
Episiotomy (a cut made on the perineum, i.e. in the area between the vagina and anus during childbirth) should only be performed in indicated cases and with the use of the correct technique.
Correct techniques for the protection of the perineum (Finnish or Viennese methods) lowers the maximum tension on the perineum and should therefore lower the risk of injury to the anal sphincter.
If a vaginal birth needs to be completed surgically, vacuum extraction should be preferred. At the same time an episiotomy should be performed and the perineum protected using the Finnish or Viennese methods.
Early postpartum pelvic floor exercise reduces the incidence of urinary incontinence andpelvic organ descent in particular.
Diabetes mellitus
here the effect on pelvic day problems is not clearly demonstrated
Obesity
Weight reduction has an effect especially for reducing the degree of urinary and anal incontinence.
Absolute weight increase (even if obesity is not reached) and increase in waist size, increases the risk of urinary incontinence.
Obesity increases the risk of anal incontinence.
Constipation
An increase in intravenous pressure during pushing increases the risk of urinary incontinence and urinary urgency.
Chronic obstructive lung disease
Coughing significantly increases intra-abdominal and subsequently intra-pelvic pressure, thus increasing the risk of incontinence and pelvic organ descent.
Lifestyle
• Liquid intake
Restricting fluid in the evening reduces bedwetting.
• Caffeine
Caffeine increases the frequency of urinary urges and toilet visits.
• Alcohol
Alcohol worsens already-existing urinary incontinence. Its role in overall prevention is not entirely clear.
• Sweet drinks
There is a link between sweet beverages and an increased likelihood of urinary urgency and stress incontinence. Nevertheless, there is a possible role played by artificial sweeteners.
• Physical activity
Physical activity (e.g. running) is not the cause of urinary incontinence but increases the degree of incontinence already present. Heavy physical work may contribute to pelvic organ descent.
However, adequate physical activity is necessary to support good condition of the pelvic floor muscles.
o Smoking
There is a clear link between smoking and both urinary and anal incontinence. The differences are already notable within one year.
o Insufficiency of vitamin D
A concentration of vitamin D lower than 30 ng/ml is linked to the occurrence of urinary incontinence.
Lower concentrations of vitamin D have been linked to weaker pelvic floor muscles after birth.
How the problem is treated
The main preventive step is to manage the exercising of the pelvic floor. Our physiotherapists can provide you with adequate exercise following further checks as to the intensity (or lesser intensity) of pelvic floor exercises you can handle.
Based upon current scientific information, we can recommend the following steps to you:
• exercise the pelvic floor at any age
• make use of those child-birthing techniques which lower the risk of the occurrence of postnatal pelvic floor disorders.
• appropriate weight loss
- prevention of constipation, as treatment of constipation already present does not guarantee improvement of incontinence
• an appropriate drinking regime during the day with regulated liquid intake during the evening hours.
• lowering caffeine intake (such as that in coffee).
• lowering the consumption of alcoholic drinks
• lowering the consumption of sweet drinks or drinks with artificial sweetener
• selecting physical activity (such as cycling or swimming ...) that does not significantly increase the internal pressure of the abdomen or the pelvis
• stopping or reducing smoking
• sufficient intake of vitamin D through your food or with vitamin supplements
• adequate treatment of diabetes