Conditions and Management

If you are experiencing some form of pelvic floor dysfunction, your doctor may have recommended that you undergo pelvic floor therapy. This treatment can help women who have pelvic floor muscle weakness or tightness and related problems that impact their sexual function, bowel movements, and urination.

Whether the problem is due to childbirth, aging, stress, or other factors, pelvic floor physical therapy is a minimally invasive treatment that can help women with urinary or fecal incontinence, pelvic organ prolapse, or painful intercourse.

Pelvic floor therapy is similar to the type of physical therapy people undergo to recover from a sports injury; the main difference is the area being targeted. However, it may be helpful to have a clear idea of what to expect when you go to your pelvic floor therapy sessions. Here is a look at the typical procedure for pelvic floor therapy treatment.

Your First Visit

At your first visit, you will be evaluated to assess your condition and develop a treatment plan. You will normally have to fill out some paperwork related to your insurance and medical history. When your appointment begins, a therapist will take you into a private room for your therapy.

In the Examination Room

At the beginning of your first visit, you will have a short conversation with your therapist about your reasons for needing therapy. Depending on the problems you are experiencing, you may need to discuss the amount of pain you feel during activities such as sexual intercourse or using tampons, how many times you go to the bathroom eachr day, your eating and drinking habits, and other details.

You may then undergo an evaluation that involves moving your body around to see if your hips, back, or core may be playing a role in your pelvic floor condition.

There may also be an internal exam. Many clinics give you the option of having another person present during the internal examination, whether it is someone you have brought with you for support or another clinic worker. You may also decline to have another person present or decline the internal exam altogether. Although the internal exam can provide the therapist with a clearer picture of your condition, you will still receive treatment if you decide against it.

For the internal exam, you will undress from the waist down and cover yourself with provided sheets. The therapist may ask you to perform functions such as bearing down, coughing, or Kegels, which involve squeezing your vaginal muscles like you would to stop the flow of urine. The therapist may also feel around externally to identify any tight spots such as muscle knots.

If you agree, they might also insert a gloved and lubricated finger to internally assess your muscles. You may be asked to perform another Kegel so they can assess your strength and endurance.

The internal exam is important because women have three layers to their pelvic floor. Different exercises can be used to target and strengthen the specific layers of concern for more effective treatment. However, you can also describe your symptoms to your therapist in detail if you do not wish to undergo the pelvic internal examination.

Then, you will be asked to get dressed and prepare for the rest of the appointment. Your therapist will then assess the muscles and joints in your back and hips. This may involve seeing how you move with flexibility and range-of-motion testing and determining your strength using manual muscle testing.

The results of this assessment will be used to draft your plan of care and determine how often you need to visit for treatment. You may also be provided with some exercises to perform at home that will bring you closer to your goals.

During Follow-Up Sessions

During your subsequent pelvic floor therapy sessions, the focus will be on treating your symptoms. This will usually entail treatments such as exercises, manual therapy, and relaxation techniques. In some cases, electronic therapies may be used. For example, biofeedback, which entails applying small and painless electrodes to the areas being treated, can improve bladder function. Lifestyle modifications and advice may also be provided.

There may be some discomfort during some parts of treatment, but it should not be painful. However, you may be asked during your assessment to reproduce your pain symptoms. For example, if you feel pain in your lower back when you bend over, the physiotherapist may need to ask you to bend over so they can assess how your back is moving and what could be causing your pain. This should not aggravate your symptoms or create additional pain after your session.

You might also experience some mild discomfort while performing prescribed exercises at home, but they should not be painful.

Reach Out to the Women’s Healthcare Team

Initiating pelvic floor therapy early can help stop symptoms from getting worse and allow you to return to your normal lifestyle more quickly. If you are noticing symptoms that interfere with your daily functioning, including pain during intercourse, pelvic organ prolapse, or incontinence, reach out to the women’s healthcare team at Raleigh Gynecology & Wellness today.

When one or more of the organs in the pelvis area slips down from its regular position and bulges into the vagina, it is known as pelvic organ prolapse. This typically affects the uterus, but it may also occur with the bladder or bowels. Although it is not a life-threatening condition, it can lead to pain and discomfort.

Pregnancy and childbirth, menopause, aging, being overweight, chronic coughing or constipation, and heavy lifting can all weaken the pelvic floor and raise your chances of developing pelvic organ prolapse.

If your doctor has diagnosed you with pelvic organ prolapse or you suspect you may have it, you may be wondering how it can be addressed. Here is a look at the treatment options that are available for pelvic organ prolapse.

Treatments For Pelvic Organ Prolapse

There are many treatment options available for pelvic organ prolapse. The right choice will depend on the type of prolapse you are experiencing, the severity of your symptoms, and your age and health. Your doctor will also take into account whether you intend to have children in the future when determining the right course of treatment. In some cases, you may not need any treatment if you are not experiencing pain or discomfort and your prolapse is only mild.

Lifestyle Changes

Women who are experiencing mild prolapse may be able to get relief and prevent their prolapse from worsening by making some simple lifestyle changes. These approaches are also useful as preventive measures if you are concerned about developing prolapse in the future.

Improving Your Diet

Consuming a diet that is high in fiber and drinking plenty of fluids can help to avoid constipation, which is one common cause or contributing factor to pelvic organ prolapse. Women who experience regular constipation or strain frequently during bowel movements should increase their intake of vegetables, fruits, whole grains, and beans to ensure adequate fiber intake.

Avoid Lifting Heavy Objects

Another important way to prevent pelvic organ prolapse is by avoiding lifting heavy objects. If you use weight training as part of your exercise routine, make sure you are using appropriate weights for your body and that you are following proper lifting form. If you must lift something heavy, such as for work or while moving, do so with your legs and not your waist or back.

Lose Weight

Being overweight or obese raises your chances of experiencing uterine prolapse. Therefore, if you are not currently at a healthy weight, take steps to shed some pounds. Improving your diet and exercising regularly are great ways to work toward your ideal weight.

Pelvic Floor Exercises

Pelvic floor exercises such as Kegels can be used to strengthen your pelvic floor muscles and provide relief. Your doctor may suggest that you undergo a program of supervised pelvic floor muscle training, or you may be able to carry out these exercises on your own.

Hormone Treatment

Women who have already gone through menopause and are experiencing mild prolapse may be able to ease some of their symptoms with estrogen. It is particularly useful for addressing discomfort during sex or vaginal dryness related to prolapse. It can be used as a cream, suppository, or estrogen-releasing vaginal ring.

Pessaries

A pessary is a device made out of silicone or latex that can be inserted into the vagina in order to support the vaginal walls and pelvic organs. A pessary can ease the symptoms of a moderate or severe prolapse and are often used by women who do not wish to undergo surgery. They are also the right choice for those who intend to get pregnant in the future.

A gynecologist will fit your pessary. They come in different sizes and types, and it may take some trial and error to find the right one for you. Pessaries need to be removed, cleaned, and replaced on a regular basis.

Surgery

For severe prolapse or cases where nonsurgical options are not providing relief, surgery may be necessary to correct pelvic organ prolapse. There are surgical repair procedures that can lift and support the pelvic organs, such as stitching them into place or strengthening existing tissues. Some women may have an operation that closes part or all of the vagina, although this treatment is only appropriate for those with advanced and severe prolapse that has not been helped by other treatments and who are certain they do not wish to have sex again in the future.

Talk To The Women’s Health Care Team

If you would like to find out more about treatment options for pelvic organ prolapse, get in touch with the women’s health care team at Raleigh Gynecology & Wellness. We can guide you toward the most effective lifestyle changes for you and explore additional treatments depending on the severity of your prolapse.

Your body will change in many ways throughout your lifetime, but some of these changes can be uncomfortable and disruptive. One problem that can affect women is pelvic organ prolapse, particularly in the uterus.

Pelvic Organ Prolapse

When the muscles and ligaments in the pelvic floor stretch and weaken to the point where they can no longer provide sufficient support for the uterus, the uterus may slip down into the vagina or protrude out of it. Although this can occur to women of all ages, it most often impacts post-menopausal women who have given birth vaginally in the past.

Uterine prolapse is typically associated with the prolapse of other pelvic organs. It can present in one of two ways: anterior prolapse or posterior vaginal prolapse.

Anterior Prolapse

Anterior prolapse, also known as prolapsed bladder or cystocele, occurs when the weakness of the connective tissue that separates the bladder from the vagina causes the bladder to bulge out into the vagina.

Posterior Vaginal Prolapse

Also known as rectocele, posterior vaginal prolapse occurs when the connective tissue that separates the rectum from the vagina becomes so weak that it allows the rectum to bulge out into the vagina. This may cause difficulty with bowel movements.

In some cases, severe uterine prolapse displaces part of the vaginal lining in a way that makes it protrude outside of the body. When vaginal tissue rubs against clothing, it can result in vaginal sores or ulcers that may become infected.

Symptoms

Uterine prolapse is often mild and does not typically have signs or symptoms. However, when the prolapse is moderate to severe, you may notice:

• A sensation of looseness in vaginal tissue tone
• Tissue protruding from the vagina
• Trouble with bowel movements
• Urinary leakage, urine retention or other urinary problems
• A sensation of pulling or heaviness in the pelvis
• The feeling of sitting on a small ball
• A sensation that something is falling out of the vagina

These symptoms are often less noticeable in the morning and get worse as the day goes on.

What Are the Causes Of Pelvic Organ Prolapse?

Pelvic organ prolapse occurs when pelvic muscles and supportive tissues become weakened. This can be caused by:

• Lower estrogen levels following menopause
• Chronic bronchitis or cough
• Delivering a large baby
• A difficult labor and delivery
• Trauma during childbirth
• Pregnancy
• Chronic constipation
• Repeated straining during bowel movements
• Repeated heavy lifting

Although this condition can affect any woman, you are more susceptible to experiencing pelvic organ prolapse if you have ever been pregnant. A history of vaginal births or giving birth to a large baby can also raise your risk. Women with a family history of weakness in their connective tissue or who have had pelvic surgery in the past are also more vulnerable to prolapse.

Your risk of experiencing prolapse increases with age and weight, and Hispanic and white women also have a higher risk. Frequent straining during bowel movements and constipation can also increase your risk of pelvic organ prolapse.

How Can You Prevent Uterine Prolapse?

If you have a higher risk of uterine prolapse, there are some steps you can take to reduce the chances of developing this condition. Here are some of the best ways to reduce your risk.

Perform Kegel Exercises

Kegel exercises can help to strengthen the muscles in your pelvic floor, which is particularly important after you have given birth. These exercises are easy to perform, and you can find instructions online.

Avoid Heavy Lifting

You should avoid lifting heavy objects if you are concerned about prolapse. When you do need to lift something, it is imperative to focus on using your legs rather than your back or waist. If you lift weights, make sure that you are doing so correctly.

Avoid Excess Weight

Maintaining a healthy weight is a great way to reduce your risk of uterine prolapse and maintain optimum overall health. Your doctor can help you determine your ideal weight and provide you with any strategies that are needed to reach that number.

Address Coughing

If you experience chronic coughing or bronchitis, it is important to get treatment. You should also avoid smoking.

Avoid Constipation

Because constipation is strongly connected to prolapse, it is important to take steps to treat and prevent constipation. Ensure you drink plenty of fluids and consume a variety of high-fiber foods, including vegetables, beans, whole grains, and fruits.

How Is Pelvic Organ Prolapse Diagnosed And Treated?

A gynecologist can diagnose uterine prolapse with a pelvic exam. During the exam, you may be asked to bear down as though you are having a bowel movement so the doctor can assess just how far the uterus is slipping into the vagina. You may also be asked to tighten your pelvic muscles as though you are trying to stop a stream of urine so the doctor can determine the strength of your pelvic muscles.

Mild pelvic organ prolapse does not usually require treatment. Many times, performing Kegel exercises, treating constipation, and losing weight can provide relief. A pessary, a plastic or rubber ring that is inserted into the vagina to support bulging tissues, may also be an option.

When the symptoms of prolapse disrupt normal activities, surgery may be recommended. Vaginal surgery or minimally invasive laparoscopic surgery can be used to repair weakened pelvic floor tissues.

Get In Touch With Raleigh Gynecology & Wellness

If you are experiencing symptoms of pelvic organ prolapse, reach out to the women’s healthcare team at Raleigh Gynecology & Wellness. Their team can diagnose the condition and help you find the right treatment.

The human papillomavirus (HPV) is a very concerning virus. Although it often goes away on its own, it can sometimes lead to medical issues such as genital warts and cervical cancer. Thanks to modern medicine, vaccines are available that can help protect people from HPV-related diseases. Although it has a demonstrated safety and efficacy profile, it is important to weigh the pros and cons of hpv vaccine before deciding whether or not the vaccine is right for you.

Here is a look at the advantages and drawbacks of the Gardasil vaccine.

The Pros of The Gardasil Vaccine

Here are some of the top reasons people choose to get this vaccine.

It Offers Prevention Against Some Types of Cancer

Gardasil is one of the few vaccines on the market that offers some protection against cancer. Gardasil and Gardasil 9 have both been approved by the U.S. Food and Drug Administration (FDA) to protect against HPV.

HPV is extremely common, with nearly everyone expected to get HPV at some point in their lives. It is spread through intimate skin-to-skin contact, such as vaginal, oral, or anal sex, and it can be transmitted even if the infected person is not currently experiencing any signs or symptoms of the virus.

More than 42 million Americans currently have an HPV infection with a type that can cause disease, the CDC reports. Approximately 13 million Americans are infected each year.

While it is important to note that most HPV infections will go away by themselves fairly quickly, it can sometimes last longer and lead to certain types of cancer. Gardasil vaccine can protect against HPV types 16 and 18, which can eventually lead to vulvar, anal, and cervical cancer.

It Offers Protection Against Genital Warts

The Gardasil vaccines also offer protection against two strains known for causing genital warts, strains 6 and 11. Genital warts are not dangerous, but they can be unsightly and annoying. They have a cauliflower-like appearance, and some people might get several of them at once. They can occur in various sizes and may be itchy at times but are generally not painful.

They are fairly common and spread easily during oral, vaginal, and anal sex or even skin-to-skin contact in those areas. They can be spread even when there are no visible signs. Therefore, the protection offered by the vaccine can help stop the spread of this frustrating problem.

It Has A Good Track Record

Since HPV vaccines like Gardasil were introduced in the U.S., HPV infections, cervical precancers, and genital warts have all dropped. Infections with the types of HPV that lead to most HPV cancers as well as genital warts have decreased by 88 percent among teens and 81 percent among young adult women.

Cons Of The Gardasil Vaccine

Here are some potential drawbacks to consider when deciding whether to get the vaccine.

It May Cause Side Effects

Like all vaccines, there is the possibility of experiencing side effects following the Gardasil vaccination. Although many people will not have any problems, some may experience mild to moderate side effects such as swelling and pain at the injection site, headache, fever, muscle or joint pain, nausea, diarrhea, vomiting, abdominal pain, or fatigue.

Some people may faint after getting the shot, particularly adolescents, so you will be asked to sit or lie down for 15 minutes following injection to avoid injuring yourself if you faint and fall down.

It Does not Prevent All HPV-Related Cancers Or STDs

Another drawback of the Gardasil vaccines is that they do not prevent every type of HPV-related cancer. Although their protection is very valuable, it will still be necessary to get routine Pap tests to look for any signs of cervical cancer.

It is also important to keep in mind that the vaccines provide no protection against other types of sexually transmitted diseases (STDs). This means that those who are not educated on what the vaccine does and does not do may engage in risky behavior, thinking that they are protected from all STDs. It is important to be aware that it will remain necessary to use barrier methods such as condoms during sex to prevent the transmission of other type of STDs.

The Schedule For The Gardasil Vaccine Can Be Complicated

This is not a serious drawback, but the vaccine’s schedule can be a bit complex. Therefore, it is best to talk to your doctor about whether you need the vaccine and when is the right time to get it. The CDC recommends it be given around age 11 or 12, at which time most children will not have been exposed to the HPV strains it protects against, allowing them to get the optimum benefits.

Those who get it at age 11 or 12 will need two doses 6 to 12 months apart; anyone who received their second shot less than 5 months after the first will need three doses. Adults and teens who are older than 14 need three doses across 6 months,

Reach Out To Raleigh Gynecology & Wellness

To learn more about whether Gardasil is right for you, get in touch with the women’s healthcare professionals at Raleigh Gynecology &Wellness. Serving the Triangle Area for more than three decades, Raleigh Gynecology & Wellness offers a comprehensive range of services with an emphasis on patients’ comfort.

If you are considering getting the Gardasil vaccine, you may have some questions about the shot itself and the vaccination process. Here’s a look at what you need to know before getting the Gardasil vaccine.

Who Needs The Gardasil Vaccine?

vaccine that is recommended around the ages of 11 to 12, although it may be given to children as young as 9. The aim of giving this vaccine to preteens is to provide them with protection from the types of HPV infections that could cause cancer later in life.

Gardasil is an HPVIn general, the CDC recommends that 11- and 12-year-olds be given two doses of the vaccine 6 to 12 months apart. Anyone who gets the vaccine before turning 15 will only need two doses.
The vaccination schedule is slightly different for those who are older. Teens and adults who start the series of vaccinations after the age of 15 will need three doses.

For those older than 26, the decision about whether to get the Gardasil vaccine should be made on a case-by-case basis. Those between the ages of 27 and 45 should discuss their risk of a new HPV infection with their doctor, along with the potential benefits of getting the vaccine. Generally speaking, the vaccine offers less of a benefit to people in this age range because many will have already been exposed to the virus.

Who Should Avoid Gardasil?

Besides those outside of the appropriate age group, people with allergies should proceed with caution. Be sure to discuss any severe allergies that you have with your physician before getting the vaccine. In particular, anyone who has experienced a life-threatening allergic reaction in the past to any of the ingredients in the HPV vaccine or a previous dose of it should not get the vaccine, nor should those who have an allergy to yeast or are currently pregnant.

However, it is safe to get the vaccine when you are mildly ill, such as if you currently have a cough, runny nose, cold, or low-grade fever. If you are experiencing a moderate or severe illness, however, it is best to wait until you are feeling better to get the vaccine.

What Are The Side Effects?

Many people will not experience any side effects from the HPV vaccine, while others report mild side effects, such as a sore arm at the injection site. This may also be accompanied by redness or swelling.

Some of the other common side effects include dizziness, headache, tiredness, muscle or joint pain, nausea, or fever. Some people may faint after getting the vaccine, particularly those who are younger. Adolescents will generally be asked to remain seated or to lie down for 15 minutes after getting the vaccine to prevent fainting and injuries associated with fainting.

In rare cases, a person may experience a severe anaphylactic allergic reaction after vaccination if they are allergic to any component of the vaccine.

However, it is important to keep in mind that both Gardasil and Gardasil 9 have undergone strict safety testing before getting approved, with more than 15 years of research and monitoring demonstrating the vaccine’s overall safety.

Can Gardasil Impact Fertility?

Gardasil has not been linked to fertility problems, and the Centers for Disease Control & Prevention notes that not getting an HPV vaccine can leave people at risk for the types of cancer that could compromise fertility. For example, people who develop cancer that is caused by HPV may need treatment such as chemotherapy, radiation, or a hysterectomy, all of which could limit their ability to have children.

How Long Does Protection Last?

It is believed that the protection afforded by Gardasil and similar vaccines is long-lasting. In research studies, people given HPV vaccines were monitored for about 12 years and their protection remained high with no signs that protection may be waning.

Where Can I Get the Vaccine?

Your gynecologist can administer the HPV vaccine to you. Other doctors’ offices may also offer the vaccination, along with school health centers, local health departments, and community health clinics. Many health insurance plans cover routine vaccinations such as Gardasil, while the Vaccines For Children program provides vaccines to those aged 18 and younger who are underinsured, uninsured, Medicaid-eligible, Alaskan native, or American Indian.

Get In Touch With The North Carolina Women’s Healthcare Specialists

If you would like to learn more about the protection offered by the Gardasil vaccine or find out more about how it could benefit you, make an appointment with the North Carolina women’s healthcare specialists at Raleigh Gynecology and Wellness today.