The bladder, uterus and bowel can descend with age. The consequences have a significant impact on the quality of life of the women affected.
Sabine has always enjoyed playing tennis. Since her retirement, she can be found on the court more often. However, she finds the leaking of urine during an abrupt stop-and-go in the game increasingly troublesome. That chips away at her self-esteem. Anna also finds her quality of life increasingly restricted. The former teacher and mother of two grown-up children no longer goes on long hikes. She finds it very annoying to constantly have the feeling of having to urinate when descending.
Change after menopause
For many older women, incontinence is a major problem in everyday life. “The frequency of incontinence increases with age. Almost a quarter of women over the age of 60 are incontinent,” confirms Cornelia Betschart. The gynecologist is a senior physician at the Clinic for Gynecology and head of the Pelvic Floor and Continence Center. On the one hand, there are problems with the various types of incontinence that can occur, but also with prolapse of the pelvic floor. The muscles and ligaments can no longer hold the organs in the abdomen, and the bladder, uterus or bowel descend. Women who have given birth are often affected. Late effects can also occur 30 years after a birth.
Studies show that certain muscles are probably able to hold the organs in a compensatory manner. As hormones change with age, the bladder, uterus and bowel can descend. The muscles that had previously remained intact and were able to hold the bladder in place suddenly weaken.
Helpful pelvic floor training
Unfortunately, women who were older than 35 when their children were born are more likely to suffer from these late effects. Even a caesarean section does not completely protect against this, because pregnancy puts a lot of weight on the pelvic floor. The baby, the amniotic fluid and the uterus – together weighing up to nine kilos – put pressure on the ligaments. The more difficult a vaginal birth has been, after hours of pushing, a vacuum or a forceps delivery, the greater the strain on the pelvic floor.
Regular pelvic floor training can help. However, many women don’t manage to stick with it and keep doing the exercises consistently. With good physiotherapy, women can achieve a great deal, especially with incontinence, even with prolapse if it is not too severe. At the USZ, physiotherapists, gynecologists, proctologists and urologists work together in an interdisciplinary pelvic floor board, where they discuss the appropriate therapy for their patients.
Train the pelvic floor with targeted exercises
Knowing the pelvic floor and exercising it in a targeted manner is the best preventive measure. With the targeted strengthening of the pelvic floor, incontinence in particular can be well prevented in many cases.
Prolapse often after the menopause
Not all women feel as restricted in old age as Sabine and Anna. Sometimes she sees women with prolapsed organs who have no complaints at all, says Cornelia Betschart. 50 percent of women have a prolapse after the menopause. Around 18 percent undergo surgery. Studies from Australia show that the number is increasing. This is probably due to the fact that women today are more physically active than in the past, even at an advanced age. Almost one in five women up to the age of 80 requires surgical treatment to alleviate their symptoms.
But not all complaints have to end with surgery. Pessaries can also help as a first step. These are cubes, rings or small plates that are inserted via the vagina. They can support the bladder or the uterus. For women like Sabine, it is probably enough if she uses an appropriate pessary when playing tennis. Other women, on the other hand, do not want to be dependent on such medication for the rest of their lives; for them, surgery can help.
Gentle and individualized interventions
The insertion of a band or special material is a minor procedure that takes around 20 minutes and can be performed without anesthesia. “The procedures are becoming increasingly gentle and minimally invasive. We can respond very individually to the needs of patients,” says Cornelia Betschart. Sometimes the procedure is performed without an incision via the vagina, sometimes via laparoscopy. Abdominal incisions are no longer needed. “Our ambition,” explains the doctor, “is to use the latest techniques and materials at the USZ.”
Numerous research projects
The USZ also conducts research in the field of urogynecology. One project examines women who have just given birth. The researchers want to better understand whether ligaments or muscles are more affected by the stresses of childbirth. Well-treated external birth injuries, such as a perineal tear, are not a problem. However, late effects such as incontinence or organ prolapse occur further up in the pelvis. The study examines how long the ligaments are before and after birth. Other research projects are looking at prediction models to calculate how likely a woman is to develop organ prolapse. Cornelia Betschart is convinced that the findings from such studies could be used to better advise pregnant women in the future.
Urogynecological consultation hour
In our urogynaecology consultation, all problems relating to female urination disorders are clarified and treated.