Pelvic Floor Health ~ Dr.Rabab Mustafa

Pelvic Floor Health – Evidence-Based Guidance

The pelvic floor is a group of muscles and connective tissue that support the bladder, uterus, vagina, and rectum. When weakened, women may suffer from incontinence, prolapse, sexual dysfunction, and chronic pelvic pain.

🔎 Why do pelvic floor problems happen?

Pregnancy and vaginal delivery
Menopause (low estrogen)
Obesity and chronic straining (constipation, heavy lifting, chronic cough)
Aging
Pelvic surgery

⚠️ Symptoms to watch for

Urinary leakage, especially when coughing or sneezing
Vaginal bulge or heaviness
Back or pelvic pain
Difficulty emptying bladder or bowels
Decreased sexual sensation

📋 Guideline-Based Approach

🔹 1. Prevention & Lifestyle (First-line for all women)

Daily pelvic floor muscle training (PFMT/Kegels) – recommended by NICE & ACOG.
Avoid constipation: high-fiber diet, hydration.
Weight management.
Postpartum: early screening & start PFMT within 6–12 weeks.
Stop smoking (chronic cough worsens prolapse).

🔹 2. Non-Surgical Interventions

Pessary: silicone device inserted to support the vagina, especially for women not fit for surgery.
HIFU (High-Intensity Focused Ultrasound): emerging, minimally invasive option for mild prolapse/vaginal laxity.
Topical estrogen (post-menopause): improves tissue quality and reduces symptoms.

🔹 3. Surgical Management (for advanced cases, Stage III–IV POP-Q)

Anterior or posterior colporrhaphy (vaginal wall repair).
Hysterectomy or uterine-sparing surgeries.
Sacrocolpopexy (mesh repair, abdominal approach).
Chosen based on patient’s age, fertility wishes, severity, and comorbidities.

🔹 4. Follow-up

Reassess every 6–12 months for symptom progression.
Monitor for recurrence or complications.

🌷 Key Takeaway

Pelvic floor health is not only about avoiding prolapse — it’s about protecting women’s comfort, dignity, and quality of life. With early prevention, proper assessment, and individualized care, most women can avoid long-term complications.

📚 References

RCOG Green-top Guideline No. 46: Pelvic Organ Prolapse (2015)

ACOG Practice Bulletin No. 214: Pelvic Organ Prolapse (2019)

NICE Guidance NG123: Urinary Incontinence and Pelvic Organ Prolapse in Women (2019)

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