Pelvic floor, but ensure they’re the right ones
her body as an elite athlete, McMahon recalls learning in a physio session earlier in her career that, while she thought she had been doing pelvic floor exercises, she was not doing them properly.
Pelvic floor issues can present themselves at any age, from childhood right up to the elderly, although they are more common in pregnant women, women who have given birth, and seniors.
‘‘About 80 per cent of women will be affected by incontinence, either bladder or bowel, and over half of them are younger than 50,’’ Citroen says.
While incontinence is normal, Citroen says women should not be complacent about it or they will risk more serious problems later. ‘‘If women start to see those ‘once offs’ – like a leak when they laugh, or needing to rush to the toilet – as a sign of there being some poor pelvic health issues, it may be that they don’t need to go down the path of more invasive measures.’’
Those more invasive measures have been in the headlines recently, after the Senate released its report into pelvic mesh implants, which can be used during pelvic floor surgery for severe incontinence or prolapse to reinforce the tissue. The report, released in July, recommended the mesh implants ‘‘only be used as a last resort’’.
The Therapeutic Goods Administration (TGA) banned the sale of mesh for use in patients with pelvic organ prolapse in November, and a class action involving more than 700 women who say they have suffered debilitating pain after undergoing pelvic floor surgery for prolapse using the mesh implants is currently before the courts.
However, Dr Jenny King, chair of the Urogynaecological Society of Australasia (UGSA), is concerned women suffering from severe incontinence are now shying away from surgery, even when it could be ‘‘life-changing’’, stressing that mesh implants are not ‘‘intrinsically evil’’.
The implant used in surgery for incontinence is known as the ‘‘mid-urethral sling’’.
In use for 20 years, it is recommended by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, among other international medical organisations, as having an 80 to 90 per cent rate of complete cure or significant improvement when used in women suffering from incontinence.
King, who is based at Sydney’s Westmead Hospital, explains that mesh implants are sometimes necessary in pelvic floor surgery, particularly in older women, or in women who have already had the surgery.
‘‘We are holding up tissues against gravity; these are tissues that were never strong, and they are past their use-by date.’’
Anecdotally, King says she has patients who are ‘‘frightened’’ by what they have heard about vaginal mesh and, as a result, they are receiving sub-standard operations.
‘‘People are coming back [with failed surgery] because I’ve been too anxious to push them into mesh,’’ she says, adding that surgery should only ever be recommended for women who genuinely require it, in circumstances where the muscles are beyond repair through physiotherapy.
– Sydney Morning Herald