Prof, I’ve lost control of my bladder since I had two sets of twins, please help!

Prof Useh answers:

• You are not alone, many women with multiple pregnancies, multiple vaginal deliveries during childbirth etc. suffer from vagina prolapse.

• You will be ok when you see a gynaecologist and physiotherapist 

Dear Prof,

I am a 55-year-old woman from Uyo who had two sets of twins in 2000 and 2005. I now find it difficult to control my urine when my bladder is full and sometimes leak urine. Also, I feel pain during intercourse with my husband. This has been on for over 10 years and I’ve consulted different doctors and specialists with no significant remedy. Two months ago, I was advised to see a physiotherapist. Thank God I can talk to you first. Please help.

Ekaete

Uyo

Dear Ekaete,

I want to thank you for sharing this with us. This condition is very common in women who have had multiple pregnancies and especially those who have had multiple vaginal deliveries during childbirth, have gone through menopause, are smokers, or are overweight.

The chances of developing a prolapse also increase as you age. You most likely now have what is called vaginal prolapse. There are different degrees of prolapse. You will benefit from physiotherapy if your diagnosis is first-degree vaginal prolapse.

Vaginal prolapse happens when the muscles that support the organs in your pelvis are weak and over-stretched.  This weakening allows the uterus, urethra, bladder, or sometimes the rectum to droop down into the vagina. If the pelvic floor muscles weaken enough, these organs can even protrude out of the vagina.

There are different types of prolapse: anterior (front) vaginal prolapse (cystocele or urethrocele) which happens when the bladder falls into the vagina. There is Posterior (back)  vaginal prolapse (rectocele), when the wall separating the rectum from the vagina weakens. This allows the rectum to bulge into the vagina. Uterine prolapse occurs when the uterus droops down into the vagina. Also, Apical (superior or top-most) prolapse (vaginal vault prolapse) is when the cervix or upper part of the vagina falls into the vagina.

Ekaete, please see a gynaecologist and also a physiotherapist who is in Obstetrics and Gynaecology to confirm the nature and type of your prolapse. There are instances where women may not easily notice any symptoms of vaginal prolapse. Symptoms usually depend on the organ that is prolapsed. Symptoms may include: feeling of heaviness in the vagina, a bulge at the opening of the vagina, a sensation of heaviness or pressure in the pelvis,   abnormal bleeding from the vagina, pain during sex, leaking of urine when you cough, sneeze, laugh, have sex, or exercise.     

Please consult urgently if, in addition to the symptoms you described in your email, you are feeling or seeing a bulge or lump in or coming out of your vagina. Yes, you will benefit from physiotherapy. As part of your assessment, the physiotherapist will insert a lubricated gloved finger into your vagina or back passage to assess the strength of your muscles. You will be asked to perform series of pelvic floor exercises to assess your muscle function. You will also be given vaginal faradism. This will assist the pelvic floor which has become weak or damaged resulting in a pelvic floor disorder, such as pelvic organ prolapse, urinary or fecal incontinence and other storage and evacuation problems. When this occurs, pelvic floor therapy can help the in controlling the coordination of pelvic muscles. With consistent work and treatment, you should begin to see changes in your symptoms in two weeks.

Best Wishes