Pelvic Floor Health: Addressing Top Concerns with Viable Solutions

According to the National Institutes of Health (NIH), nearly one-quarter of women in the United States experience pelvic floor disorders, including urinary incontinence, pelvic organ prolapse and bowel-control issues. While these conditions can be uncomfortable, frustrating and even debilitating, they are far more common than many realize—and, more importantly, they are treatable. Yet, due to stigma or a lack of awareness, many women suffer in silence, unsure of where to turn for help.

The good news is that a variety of effective treatments, lifestyle modifications and supportive resources are available to help women regain confidence and improve their quality of life. Dr. Costas Apostolis, a double board-certified physician in obstetrics and gynecology and a subspecialist in urogynecology and pelvic reconstructive surgery at Southwest General, discusses pelvic floor issues; the impact they can have; and solutions that empower women to take control of their health and well-being.

Two Types of Incontinence: Stress and Urgency

When discussing urinary incontinence, Dr. Apostolis notes that patients are introduced to a simple care pathway that outlines its two main types. The first, stress incontinence, occurs when physical activities like coughing, sneezing, laughing or running put pressure on the bladder, causing leakage. Despite the name, it’s not related to emotional stress but rather increased abdominal pressure.

The second type, overactive bladder, is marked by urgency—the sudden, frequent need to urinate. Many patients are surprised to learn what’s considered a normal frequency for bathroom visits, highlighting the importance of education in managing these conditions.

“There’s often a stigma that you have to live with either of these conditions, because it's a natural part of aging. The attitude of, ‘My grandmother did it, so therefore I'm going to live with it as well’ is absolutely not true,” assures Dr. Apostolis. “There are things that can be done to help women who suffer with urinary incontinence, even if it's just a bit. Today, we have a number of treatment options that can help women live a more comfortable way of life.”

Clarifying the Rumors Surrounding Mesh as a Therapy

Many patients express concern about mesh as a treatment for urinary incontinence and prolapse due to negative media coverage. However, mesh has historically been an effective and safe option. The controversy arose in 2008, and then again in 2011, when large mesh implants for vaginal prolapse were scrutinized and ultimately discontinued.

Today, slings—a thin strip of mesh placed under the urethra—are widely used to treat stress urinary incontinence. This minimally invasive procedure, performed since 1996, is supported by major medical organizations and has a high success rate with minimal downtime.

For advanced prolapse, a Y-mesh is used via robotic or laparoscopic surgery to suspend the vaginal canal to the tailbone, offering near 100 percent long-term success. Other alternatives, like skin grafts, also can be used in prolapse repairs.

“My oldest patient is 104, and she is very active. She continues to walk one mile a day, and when she came in with severe stress incontinence, and we spoke about treatment options, she opted for a midurethral sling procedure. Guess what? She was back on the treadmill the next day,” shares Dr. Apostolis. “I'll never forget when I saw her at her two-week postoperative visit. She gave me a big hug and said, ‘You know what? I used to leak and have to wear pads on my treadmill, and now those pads are gone.’ It doesn't matter how young you are or how old you are, it's all about quality of life.”

Understanding Pelvic Organ Prolapse

Pelvic organ prolapse and urinary incontinence are closely linked, with both conditions affecting about one in three women. Among women with prolapse, 30-40 percent also experience incontinence, and the reverse is also true—those with incontinence may have some degree of prolapse. However, not all prolapse requires treatment. The key is diagnosis; ensuring that women are aware of their condition; understand potential symptoms; and explore available treatment options.

“I can't tell you the number of patients I see who come in and are terrified to talk about their symptoms because they think it's going to mean going ‘under the knife.’ Absolutely not true,” assures Dr. Apostolis. “It all starts with a conversation to learn about treatment options. The majority of them are not surgical. There are a lot of behavioral techniques. Physical therapy absolutely has revolutionized the way we treat women who suffer with prolapse and urinary incontinence.”

Several minimally invasive treatment options for pelvic organ prolapse exist, depending on which organs are affected. Bladder prolapse can be corrected through a vaginal procedure, while cases involving the top of the vagina may require an abdominal approach.

Minimally invasive laparoscopic surgery is commonly used, involving small incisions—typically four, including one in the belly button—to reposition and secure the prolapsed organs. Advances in techniques, such as straight-stick laparoscopy, help ensure faster recovery, less pain and minimal blood loss, allowing women to return to their daily lives more quickly. At Southwest General, ongoing innovations focus on enhancing patient outcomes with less invasive approaches.

Do Not Hesitate to Seek Out Professional Input

If you experience vaginal pressure or notice a bulge from the vagina or anus, it's important to consult a gynecologist, primary care provider or urogynecologist for an evaluation. Additionally, any urinary leakage is not normal and should be addressed. While frequent urination may depend on fluid intake, leakage should never be ignored, as effective treatments are available.

“Don't be afraid of your own body. It is your body and your duty to make sure to keep it as healthy as possible so you can live a comfortable way of life moving forward,” urges Dr. Apostolis.

To request an appointment with Dr. Apostolis, review his provider directory page information on swgeneral.com