Pelvic Floor Surgery

With the new treatment techniques in pelvic floor surgery, which we call “Pelvic Reconstructive Surgery”, uterine, urinary bladder prolapse, large bowel prolapse and urinary incontinence problems can be operated.

The pelvis is the area in the lower abdomen where the reproductive organs are located in women. We can define the pelvic floor as the layer that forms this area, consisting of muscle, connective tissue and ligaments. One out of every 4 women complains of problems with the bladder and pelvic floor. ” I can’t hold my urine…!” ” i urinate every hour, i know almost every toilet…!” ” I can’t go out to the street because of my fear, I can’t go to the neighbor…!” ” I always feel like I have urine…!” ” I often go to the toilet at night…!” ” I have back and groin pains…!” ” I can’t control my stool like I used to…!” or ” below is something that came to my hand…!”.

As it is thought, it is not only the problem of older women. According to recent studies, “one out of every three women after giving birth has problems with the bladder” and only a few of them return to normal. The root cause of all these problems is the loosening of the muscles and connective tissue in the pelvic floor due to births, operations and age. As a result, significant and negative changes occur in the quality of life of these people. Patients change their lifestyles and restrict their social lives. By drinking less water, kidney stones, urinary tract infections, and processes leading to depression by limiting the body’s water need are experienced. We had to receive dialysis patients with severe renal failure due to the mass effect. Their sexual lives are also severely restricted for reasons such as embarrassment, loss of self-confidence and fear of noticing the problems of their partners. In the surveys, it has been seen that sexual life is prevented up to 60%.

Although the problems are increasing, it is seen as a “taboo” to talk about their problems as it used to be, and these patients ask for little help. Some patients are ashamed to tell their complaints to the doctor or their relatives, while others think that these problems are normal at their own age. One of the main reasons was the lack of permanent and effective treatment methods until recent years, and the physician consulted did not have many options. Supporting the bladder opening with a synthetic band is a very effective new operation technique, such as TVT and TOT, which have been applied recently (although there are some who offer these operations as laser surgery, although laser cutting is useful). However, it is the right operation for only 15% of patients with urinary complaints.

In 1990, Prof.Dr. Peter Petros and Prof.Dr from Sweden. Thanks to Ulmsten’s “Integral Theory”-based approaches and interventions, great progress has been made in Pelvic Floor Surgery. With the contribution and work of Prof.Dr.Klaus Goeschen from Europe, surgeries that were initially performed only for urinary incontinence began to be applied on the entire Pelvic Floor with the principle of “Integral Theory”. All damage to the pelvic floor was evaluated with careful and comprehensive examinations, and not only the damaged area, but the entire area was started to be addressed.

After a careful examination and necessary research, the operation is performed vaginally (from the chamber), almost without bleeding and with small incisions. The loosened ligaments that have lost their strength are strengthened by using synthetic materials if necessary, the overhanging layers are placed on top of each other without removing them, thus preventing post-operative scars, and at the same time, the elasticity and functionality of the chamber are preserved. At the end of these surgeries, patients are allowed to return to their normal lives in a short time. Apart from having intercourse, they can return to their normal lives in a few weeks.

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How does the pelvic floor work?

In the light of new information, pelvic floor work has been likened to a trampoline.

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It is similar to a trampoline, consisting of the pelvic floor muscles (the blue colored jump net section in the middle) and the jump spring section that forms the ligaments (attached to the sides). Ligaments attach to the pelvis anteriorly, middle and posteriorly. The bladder rests on the trampoline like a rubber balloon. When the bladder is full, the trampoline net and spring stretch and hang down. With the filling, the nerves at the base of the bladder send a warning to the brain, informing that the bladder is full. After a certain stage, the brain sends a warning to the bladder to empty. If the person is not in a position to urinate at that time, the muscles in the Pelvis Floor will contract, allowing the trampoline net to rise, thus preventing the urinary bladder floor from pressing. Thus, the feeling of tightness decreases and the person relaxes. But of course, this perfect system only exists if the trampoline is solid.

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Especially if the muscles are not weak and tense due to childbirth, the base of the urinary bladder will not be sufficiently lifted and balanced. Ligaments and muscles will sag, and the person will go to the toilet with urination, even when the bladder is filled with a small amount. Depending on the area of ​​damage in the pelvic floor, the disorder in the trampoline system will manifest itself with different complaints.

In a weakness in the anterior regions, the mouth of the urinary bladder will not be able to close enough during activation such as coughing, sneezing, straining, walking, sports and there will be uncontrolled urinary incontinence. At the same time, since the ligaments in the anterior region play a role in defecation control, involuntary stool incontinence may occur in these patients.

Damages in the middle region of the pelvis usually appear as frequent urination, urgency, and urinary incontinence before reaching the toilet.

We see urination difficulties, night urination, back and groin pain, uterine or reservoir sagging in connective tissue damage in the posterior region.

In this complex and unified structure, each patient is carefully evaluated and sometimes many corrections (Total Pelvic Reconstruction) are required for a single complaint. This shows why, in the past, “surgeries performed only for complaints were not fully successful”.

Organic-caused sexual problems?

Sex isn’t a problem for most people unless it’s a problem. But if it is blocked one day, troubles begin. Problems may increase especially after births, lower genital area surgeries, sagging of the chamber or uterus, and with aging. The person chooses to share these problems with their physicians rather than their spouses. Sometimes, they may encounter reactions up to humiliation and resentment. A healthy integrity of the Pelvic Floor is essential for a problem-free sexual life. Here, the functions of the organs in that region during intercourse are as important as the sagging of the chamber or uterus, damage due to previous surgeries. As can be expected, urinary, gas and stool incontinence during intercourse puts these people in even greater trouble.

These problems are actually more common than you might think. It is possible to help patients of all age groups with a detailed examination and interview. A healthy sexual life can be achieved by detecting the sagging, enlarged areas in the chamber and providing corrections.

births

Births are mostly responsible for a uterine or chamber prolapse that may occur later in life (births are the only common cause. There may also be prolapses in those who have never given birth). Most women state that their chambers are enlarged and they feel that they cannot satisfy their spouse. There are spouses who come to us and tell us this in person. Damages due to childbirth can occur in any region of the chamber and Pelvis Floor. Sagging of the chamber walls manifests as weakness in the pelvic floor muscles, nerves, and ligaments. In addition, it is necessary to pay attention to birth-related tears around the chamber entrance. These problems can lead to inability to enjoy intercourse, urinary incontinence, and pain during intercourse.

Past Operations

To a considerable extent, operations on the lower genital area can cause sexual problems later in life. As a result of uterine surgeries, sagging surgeries from the chamber, new problems, persistence of complaints, pain during intercourse and a lack of pleasure may result.

Although there are so many organic (non-psychological) sexual problems, it is still considered taboo to go to the doctor for these reasons today.

Pelvic floor exercises

Based on the trampoline example, exercises have been developed to strengthen the important Pelvic Floor muscles. People can perform these exercises in their daily lives and without spending extra time. In this sense, two very important muscle groups that control the urinary bladder and bowel function are targeted.

The first is the striated muscle group; The urinary bladder and the last part of the intestine allow the opening and closing of the area where the anus is located. The smooth muscle group, on the other hand, provides elasticity, which is very important for the organs in this region. It keeps the genital organs in their normal position and prevents them from moving unnecessarily. Electrical stimulation is effective to strengthen these muscles. Studies have shown that as a result of electrical stimulation, blood supply increases in damaged tissues. Therefore, with the increase of oxygen and energy in the region, the muscles were strengthened. This increases the endurance of the muscles. A recent study by a group we work with showed up to 70% improvement in problems. However, if the ligaments that provide communication between the organs (urinary bladder, urinary tract, reservoir, intestines) and muscles are damaged, these exercises will not work. For example, when the Achilles tendon ruptures, you cannot move your foot backwards even though the muscles are normal.

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