Application of a simple cream might reduce recurrence of pelvic floor dysfunction symptoms
April 11, 2019
Many women experience overactive bladder or urinary incontinence after childbirth or around the onset of menopause. Additionally, many women are also diagnosed with pelvic organ prolapse, a condition under the umbrella term of pelvic floor dysfunction.
Pelvic organ prolapse occurs when weakness in the vaginal wall allows organs such as the bladder, uterus, or rectum to bulge into the vaginal canal, causing:
- Heaviness, bulging pressure, pain in the pelvic area
- Inability to control the bladder or bowels (incontinence)
- Reduced quality of life
Traditionally, pelvic organ prolapse has been treated with surgery. However, according to the National Center for Biotechnology, common surgical repairs are ineffective for nearly 20 percent of patients, resulting in the need for second surgeries to fully resolve their symptoms. Despite these alarming numbers, U.S. doctors continue to perform approximately 300,000 of these surgeries a year.
We hope to change this story.
An ongoing clinical trial is examining the effectiveness of vaginal estrogen – a supplemental, nonsurgical therapy – to reduce symptom recurrence and spare more women the risks and financial implications of revisional surgeries.
For an appointment, please call Dr. Rahn at 214-645-3848 to discuss treatments.
Stronger pelvic floor tissue, improved outcomes
During my fellowship at UT Southwestern, I worked on a pilot study with Dr. Ann Word, Professor of Obstetrics and Gynecology, which showed that vaginal estrogen, when used prior to surgery, improved the resilience of the connective tissue in the pelvic floor.
These promising data led to UT Southwestern securing a grant from the National Institute on Aging for a new clinical trial: Investigation to Minimize Prolapse Recurrence of the Vagina Using Estrogen (IMPROVE). The goal of the trial is to determine whether vaginal estrogen also could help prevent recurrence of pelvic organ prolapse, thereby reducing the need for additional procedures. We also are studying how vaginal estrogen may impact other pelvic floor disorders such as overactive bladder, urinary incontinence, sexual dysfunction/painful intercourse, and postoperative bladder infections.
IMPROVE researchers will enroll 222 postmenopausal women who are planning to have pelvic organ prolapse surgery at UT Southwestern, the University of Alabama at Birmingham, or Women and Infants Hospital of Rhode Island. Participants will be randomized to receive either vaginal estrogen cream or a placebo cream, which they will use prior to surgery and for a year after.
We anticipate that the cream will improve the quality of pelvic floor connective tissue, which likewise will improve wound healing and support natural tissue recovery processes after surgery for more effective, longer-lasting results.
Advanced treatments we offer today
As we continue to hone pelvic floor dysfunction treatment with studies such as IMPROVE, we stay abreast of advanced, personalized approaches to reduce our patients’ symptoms and improve their quality of life. As such, we tailor treatment plans for each patient’s particular symptoms and lifestyle. Depending on the type and severity of a patient’s condition, we might first recommend a nonsurgical treatment.
For prolapse, a common nonsurgical treatment is the pessary. This device is placed within the vagina – similar to the placement of a contraceptive diaphragm – to support the vaginal walls by using the strength of the pelvic muscles and bones.
During a simple office procedure, we can inject Botox® into the bladder muscle, and this has been shown to help manage overactive bladder. Percutaneous tibial nerve stimulation (PTNS) is another minimally invasive treatment for overactive bladder; the doctor places a tiny needle electrode near the patient’s ankle and sends electrical pulses to block bladder nerve signals that are malfunctioning. The treatment involves 12 weekly sessions that take about 30 minutes. Interestingly, PTNS is also being studied now at UT Southwestern as a treatment for accidental bowel leakage (anal incontinence).
Native tissue repair is the most common surgery we offer for pelvic organ prolapse. This surgery is done through the vagina without external incisions. We can use the patient’s own body tissues, such as ligaments, to raise the prolapsed organs to their proper positions and hold them in place with the tissue serving as a natural net.
For stress urinary incontinence (when patients lose urine when they laugh, cough, sneeze, or exercise), the mid-urethral sling is considered the gold-standard treatment. The doctor places a supportive sling between the vagina and the middle portion of the urethra to support the urethra like a hammock and control urine leakage.
Get effective treatment with a team approach
Women need to know that there are many options available to reduce – and sometimes eliminate – pelvic organ prolapse. I encourage women not to accept their symptoms as milestones of motherhood or aging. With active research into advanced techniques and new developments each year, women should feel empowered to ask their doctors for the latest treatments for incontinence and pelvic discomfort.