Postpartum and postmenopausal pelvic floor dysfunction

This is an automatically translated article.

The article was written by Senior Doctor Nguyen Thi Tan Sinh - Deputy Director of Women's Health Center - Women's Health Center - Vinmec Times City International General Hospital.

Although pelvic floor dysfunction is not life-threatening, it greatly affects the quality of life of women, especially for those after childbirth and after menopause causing many organ system disorders such as: : Urinary incontinence, bowel incontinence, lower urinary tract obstruction, constipation, pain during intercourse.

1. What is pelvic floor dysfunction?

Pelvic floor dysfunction (including genitourinary, urinary and digestive system dysfunction) is a common disease globally, accounting for 25% of women in general.
However, according to a study by Dr. Nguyen Thi Tan Sinh, Vietnamese women in 1996 showed that the prevalence of pelvic floor dysfunction accounted for 25.4% in people of childbearing age and 35% in women. perimenopausal women. Diseases of the pelvic floor cause many inconveniences and seriously affect the quality of life of women.

2. Manifestations of pelvic floor dysfunction

Genitourinary disorders manifest as:
Decreased libido, painful intercourse, decreased secretions Unsatisfied in sexual relations. Urinary disorders include 2 types of urinary incontinence:
Urinary incontinence due to urgent need to urinate: the feeling of needing to urinate is sudden and strong, the sufferer can't hold back for up to 2 minutes to get to the toilet. Stress urinary incontinence: leaking urine during strenuous activities such as coughing, sneezing, laughing, holding a baby, carrying heavy objects, climbing stairs, exercising, having sex. Digestive disorders:
Incontinence of bowel movements, not being able to keep at will when sniffing.

3. Effects of pelvic floor dysfunction

Although not life-threatening, these disorders affect health, psychophysiology, work, quality of life and family happiness.
3.1 Health effects Due to limited physical activity, do not dare to do sports, the risk of being overweight, diabetes, high blood pressure is higher, especially in menopause. Insomnia due to waking up at night to urinate. Not daring to drink water leads to urinary tract infections, constipation.
3.2 Psychological effects Sadness, low self-esteem, consider yourself unhealthy, unlucky.
3.3 Impact on work Loss of ability to concentrate on work due to frequent stopping of work to go to the toilet, change laundry. Limit jobs that require standing for a long time and changing positions a lot.
3.4 Impact on quality of life Discomfort when participating in recreational activities because of often feeling pain in the pelvic region, lumbar region or lower abdomen, affecting quality of life.
3.5 Affecting family happiness Avoiding sex due to decreased arousal, decreased pleasure, pain or urine during sex. The husband also feels less satisfied because his wife's body decreases in "tightness" or "dryness". Prolonged lack of harmony in unresolved sexual relationships is a threat to family happiness.

4. Treatment of pelvic floor dysfunction

4.1 Treatment with pelvic floor rehabilitation exercises Rehabilitation exercises are recommended by the International Organization for Autonomy (ICS) as the first choice because of its high effectiveness (78-85%), safety, and no pain. pain, few side effects. Early exercise after birth has the effect of preventing urinary incontinence and genital prolapse. Practicing rehabilitation helps relieve pain, increase vaginal tightness, and create satisfaction in sexual intercourse. High improvement rate 88%-90%.
Rehabilitation exercises with manual exercises with instructors (doctors, nurses). The main content is to help recognize the pelvic floor muscles and contract properly to restore the strength and flexibility of these muscle groups. Exercises on the machine with electrical impulse stimulation or biofeedback help strengthen blood vessels, restore nerve reflexes. Results are evident after 10 to 12 training sessions.

4.2 Drug therapy Reduces abnormal spasms of the bladder muscle (which holds urine produced by the kidneys). Medications are used in case of urinary incontinence due to urgent need to urinate
Reduces abnormal contractions of the bladder muscle (which holds urine produced by the kidneys). Medications Used in Urgent Urinary Incontinence
4.3 Surgical Treatment There are a variety of techniques to correct anatomical changes of the perineal support system. Today the techniques have been improved, much simpler and safer than before. However, the cost is still quite high (about 1300 USD) and there are unwanted complications.

The basic principle of surgery is to use supplementary materials (rings) to raise the bladder neck with low prolapse, or "graft" muscles when the bladder neck muscles are too weak to perform the tight contraction function. allow urine to drain out when there is exertion (coughing, sneezing ..) or against strong bladder muscle contractions when urinating without reaching the toilet.
In developed countries, postpartum women are allowed to participate in 10 rehabilitation training sessions, to strengthen the perineal and perineal support systems, to prevent genitourinary disorders. All Obstetrics and Gynecology departments have Urology units for examination and treatment. In Vietnam, especially in the North, there is no hospital with a Department of Gynecology and Urology and a facility for rehabilitative genitourinary function. Therefore, according to a study by Dr. Nguyen Thi Tan Sinh, up to 91% of women with the disease have a need for treatment but do not dare to go to the doctor because of shame and do not know where to seek medical attention.
Vinmec International General Hospital is one of the hospitals that not only ensures professional quality with a team of leading medical doctors, modern equipment and technology, but also stands out for its examination and consultation services. comprehensive and professional medical consultation and treatment; civilized, polite, safe and sterile medical examination and treatment space. Customers when choosing to perform tests and treat diseases here can be completely assured of the accuracy and high efficiency in the treatment process.

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