Surgery is not your only option

The following is written by Dr. Sinéad Dufour PhD. We are fortunate to have the opportunity to collaborate with Dr. Sinead Dufour, who is a Researcher (PhD) of all things Pelvic Health. She is also a Pelvic Health Physiotherapist in Burlington and Oakville, a Professor and lecturer at McMaster University, and on the teaching faculty of Bia Formation and Reframe Rehab and Pelvic Health Solutions. Dr. Sinead Dufour is also the sister of the founder of Compass Rose Wellness, and is a huge supporter in developing more resources and access for women’s healthcare. It was with her encouragement and assistance finding a top notch Pelvic Health Physiotherapy team, that Compass Rose Wellness Centre was opened in 2020.

Your pelvic floor fitness is part of your overall health and an important aspect to your general well-being. If you’ve discovered that you have a pelvic floor health issue, it can be tempting to look for a “quick fix”—and indeed, if you suffer from stress urinary incontinence or pelvic organ prolapse, some medical professionals might simply suggest surgery.

While surgery might be an option, it is also by definition “invasive” and may carry with it risks and complications. Even more frustrating, surgical solutions to pelvic health issues are not always effective and sometimes require repeat procedures.  This is why medically speaking, surgery is not supposed to be suggested as a first-line strategy.  The good news is that there are numerous non-surgical treatments for pelvic floor issues—we call these conservative care options.  These are the strategies that are supposed to be tried first…and typically nothing further is needed – that is how effective they are.
Just as with any other health matter, it’s important that you educate yourself on the available treatments for your pelvic health to make the best and most informed decisions.

Stress urinary incontinence

More colloquially known as “leaking when you laugh”, stress urinary incontinence is one of the most common pelvic floor health issues around. Unlike other types of incontinence, this condition is mechanical in nature and the cause is a problem with the secondary external sphincter of the urethra which is made of the pelvic floor.
Performed by a urogynecologist, the surgical treatment for stress urinary incontinence seeks to fix the pelvic floor by using transvaginal tape (TVT) to provide some reinforcement in the pelvic floor.  Wait times for the consultation can run a year or more, and many people end up not being good candidates for the procedure.  Really, does this sound like the best first option?

Recommended Alternatives

Remember that stress urinary incontinence is a mechanical problem and requires a solution that works to fix the mechanics. All of these options work to help restore your pelvic floor fitness.  To be effective, all of these treatments need to be undertaken with the guidance of a healthcare provider.

Incontinence pessary

A pessary is a silicone-based device inserted into your vagina to prevent incontinence, but providing some extra support around the place in your pelvic floor that needs a bit of a boost. Minimally invasive, a pessary can improve your quality of life without undergoing major surgery. It can also be selectively used for those specific times you might need more support, such as running or doing jumping jacks.

Vaginal cones or weights

Held inside the vagina, these are used to strengthen your pelvic floor muscles. They are a great addition to your personal training program for your pelvic floor IF, and that is only IF, the issue is related to weakness of the pelvic floor (Note weakness is not always an issue, so vaginal cone are not always useful or appropriate).

Electrical muscle stimulation

Low-grade electrical current can be used for any muscle of the body, including the pelvic floor, to stimulate and strengthen the muscles. Though this treatment has been around for a long time, more recently it’s been taken out of the doctor’s office and put in the palm of your hand through personal smart devices like “Elvie” which connects to your phone through Bluetooth.

Pelvic organ prolapse

Pelvic organ prolapse is a condition where one or more organs slowly descents downward.  Yep, this could mean that your bladder, uterus, or rectum moves and, in serious cases, can protrude through the vagina or rectum. (Yikes!)
The surgical treatment for prolapse is a complex and invasive procedure where a mesh sling is inserted to support the organs.  There has been lots of controversy and associated lawsuits related to these procedures.   As long as the right physician is performing this surgery, it can be a reasonable way to address the symptoms of prolapse.  However, there are many underlying issues related to prolapse (namely management of pressure in the pelvis) that is approach does not address.  So, often other organs start to shit downward after the first surgical procedures – leading to frustration and more surgery. provider.

Alternatives

When it comes to organ prolapse, you might try all of the non-surgical treatments recommended for stress urinary incontinence, plus a few more.  Again, it is actually not recommended to try surgery first – but no one knows this!

Prolapse pessary

Based on the same idea as an incontinence pessary, a prolapse pessary is a silicone-based device inserted to support your organs. Although this treatment is minimally invasive, it can be complicated to get the right pessary fit so it may require a nuanced approach. It’s sort of like getting that perfect fit of a shoe!

External supportive device

A person’s experience of prolapse—the physical sensation of bulging or heaviness—doesn’t relate to the seriousness of the condition. In other words, the prolapse may be severe with no sensation, or mild with a high degree of bothersomeness. An external support device, like the Hide-A-Way, which can be worn over or under underwear, can be very effective in reducing prolapse symptoms and increasing comfort.
When you face problems with your pelvic floor health, remember that before invasive and sometimes ineffective surgeries there are numerous safe treatments to explore. Work with your pelvic floor health experts to design an effective course of action.