[1] Disclaimer

[2] Title

Nurse: We have covered a lot of material in the last 3 videos.

You likely know more than most people about your pelvic floor and its issues. 

We hope that you have found out specific things about your own issues and things you can do to improve your symptoms. 

We also hope you have a clearer idea about your treatment options and what you would like to try. 

You can review these videos at any time.  

We also encourage you watch the other pelvic floor education videos on the website.

[3] The objectives for this final video are:

- to review treatment options for prolapse and bladder issues

- to review your role in improving your symptoms

- to allow you to think about and choose the type of care you might need, and what to expect at a pelvic floor clinic

Let's now think about the pelvic floor issues that bother you. 

For some, the issue is clear.

For others, there may be a few things going on. 

It helps to know which problem bothers you most so you can focus on it first and look for solutions.

Some solutions are up to you.

But some require clinical appointments, testing, and treatment. 

Let's review your options to help you choose your priority and your next step.

[4] Pelvic organ prolapse affects up to half of all people.

It can be mild to severe. 

Remember how the front wall of the vagina—with the bladder behind it—may prolapse down towards the vagina, which is the most common type of prolapse.

The uterus can come down from on top, or if you have had a hysterectomy, the top or vault of vagina itself can still come down. 

The back wall can also prolapse forwards.

It is normal to have some movement in the vagina after having children, but prolapse can happen and cause distressing symptoms.

[5] Here are the options that may help with your prolapse symptoms. 

[6] You can review video 2 about pelvic organ prolapse to refresh yourself, and watch our extra videos that go into more detail on these items.

[7] How do you decide what to do next? 

You may or may not have prolapse symptoms, but if you do, think about how much they bother you in your daily life.

[8] If you have prolapse, but it does not really bother you, you may choose to do nothing.

Remember that it is important to prevent your prolapse from getting worse. 

Now that you know what may make it worse, be very careful with things like ongoing coughing, straining with bowel movements, weight gain, heavy lifting, and high impact activities. 

Keep your pelvic floor muscles strong so they will help support around your vaginal openings and everything in your abdomen.

[9] If you have prolapse that bothers you and you are concerned that it might get worse, would you like to try a pessary to help support it?  

You may try the pessary and decide it's not for you, and that is OK. 

Or it may work well for you. You also may be thinking about surgery, which is a big decision.

Your surgeon will work with you to decide if surgery is right for you, which type of surgery they would recommend, and explain the risks and possible outcomes. 

Or you may just decide to wait and see if your prolapse doesn't get worse—especially if you keep working to make your pelvic floor stronger and you're careful not to do things that could make prolapse worse. 

[10] You may have prolapse symptoms that are difficult to deal with, such as pressure, discomfort, and bladder and bowel problems. 

Maybe you may have tried a pessary and it wasn't right for you.

Or maybe you had surgery that failed over time. 

You can always try or retry a pessary.

It may be a great long-term solution for you. 

Or you may want to meet with a surgeon to discuss surgery again or for the first time.

Whatever you decide, remember that it's up to you to keep your pelvic floor muscles trained and to do everything you can to have the best results from a pessary or surgery.

[11] Lastly, you may not have any signs or symptoms of pelvic organ prolapse. 

But remember that you could still develop prolapse at some point in your life.

You can stop prolapse from becoming an issue for you by doing what you can to keep your pelvic floor strong and healthy.

[12] Now let's think about bladder issues. 

Bladder leakage problems affect one third to one half of people at some point in their lives. 

The 2 most common types of urinary incontinence are stress and overactive bladder or urge incontinence. 

Many people will have a bit of both or mixed incontinence.

[13] Stress incontinence is leaking urine with pressure on your bladder from things like running, coughing, sneezing, and jumping. 

[14] Here are the 4 options to deal with stress incontinence as discussed in video 3.   

[15] You may want to review these options by watching video 3 about urinary incontinence again.

[16] Do you have stress incontinence? 

If you do, how much does it affect your life?

[17] If you don't leak at all, or you only leak a bit, it is important that you keep your pelvic muscles trained and working for you. 

Always squeeze and hold before you cough, sneeze, or lift to stop any leaking from getting worse.

[18] If you do leak, and it bothers you, again, consider your options. 

First of all, strengthen and train your pelvic floor muscles to hold your urethra closed when you do anything that puts pressure on your bladder. 

An incontinence pessary may be a good option for you. 

You don't know how well it may work until you get fitted and try it for a while.

Surgery may also be an option to think about. 

And as always—healthy bladder habits are important.

[19] If stress incontinence is a big problem for you, your options are the same.  You need to train your important pelvic floor muscles to work for you and use healthy habits. 

You may be thinking more about trying a pessary or having surgery.  Feel free to review what the doctor said in video 3 on urinary incontinence about the 2 types of surgery for stress incontinence.

[20] The other common bladder issue is overactive bladder, when the bladder is more sensitive to filling and contracts suddenly without warning.

This makes it hard or impossible to get to the toilet without leaking.

[21] Here are the treatment options for overactive bladder. Note that pessaries are not an option, and neither is surgery. 

But other options are lifestyle changes such as cutting out bladder irritants and fluid management, learning urge control techniques, retraining your bladder, and using some medicines to help control the urge to pee.

[22] Again, feel free to look back at video 3 on urinary incontinence for more information on overactive bladder.

[23] Do you feel a severe urgency to pee, pee often, or leak from overactive bladder? 

If yes, how big a deal is it for you?  Think about this.

[24] If this does not happen to you, or is very rare, remember to keep your pelvic floor muscles strong, be careful with what you eat and drink, and, in general, keep good control over your bladder habits so it never becomes a larger issue.

[25] If overactive bladder is a concern for you, you need to work hard on all these things. 

You may want to cut out bladder irritants completely and see if you feel better.

[26] If your bladder is controlling you, and you are always running to the bathroom and planning your daily errands around bathroom stops, you may want to try bladder retraining. 

Your doctor may prescribe medicines that relax your bladder so it is not always telling you it is time to go. 

There are no surgeries for overactive bladder, and pessaries are generally not used.

[27] Mixed incontinence treatment options include everything we have just talked about. 

It is helpful to think about which issue is worse—stress incontinence or urgency and frequency—and focus on those things first. 

The only treatments for the last 3 types of leaking problems are things that only you can do.

[28] There are 2 extra videos on bowel control issues.

You can watch them to understand how your bowels affect your bladder and prolapse and to learn about care options.

[29] If you go to a pelvic floor clinic for an appointment, giving your medical history is an important part of the visit. 

This information helps the pelvic floor clinic team understand your issues.

[30] If you fill out a medical history form, fill out the whole thing and answer the questions as fully as you can. 

Make sure to list any surgeries you've had as well. 

Bring an up-to-date list of all your medicines, including prescriptions and those you buy over the counter, and include how much you take and how often.

The medicines that you are taking also help the pelvic floor clinic team understand your other medical issues so they can tell if any of these medicines are affecting your symptoms. 

It's also helpful to bring a completed bladder and bowel diary with 3 days' of information to your first appointment.  

[31] On this form you keep track of when and how much you pee, how much you drink, and the type of bowel movement you have. 

This helps the clinic team understand your issues as shows them what is happening in your daily life with your bladder and bowels.

[32] After your information is reviewed, a nurse will check you.

They may ask you to pee on a uroflow chair—a special toilet that measures certain aspects of your urine flow. 

Then a hand-held ultrasound bladder scanner will rest on your tummy to check how much urine is still inside your bladder after you pee.  

Your bottom will be checked closely on the first visit to see the health of your vaginal tissues, to check for prolapse, and to see if you can properly contract your pelvic floor muscles. 

You may have other specialized testing at the pelvic floor clinic.

If you do, you'll need to come back for another appointment.

[33] Some people have urodynamic testing, which is done to see how your bladder is working. 

This is important if you are going on to surgery, or if your symptoms are unclear and your healthcare team needs to better understand how your bladder is working.

Trained nurses do this testing with special equipment. 

Cystoscopy is another test that pelvic floor clinic doctors do, where they look at the inside of your bladder with a telescope that fits in your urethra and bladder. 

You don't need any sedation or medicine to relax you for either test. 

The urodynamic test takes up to an hour and the cystoscopy takes about half an hour.

[34] Different pelvic floor clinic team members may see you, depending on your issues.  

It may be a nurse, a surgeon (or urogynecologist), or a nurse practitioner. All team members have special training in pelvic floor issues.

[35] A nurse may see you for your first exam and fit you with a pessary to help with prolapse or stress incontinence. 

Nurses also do and help with testing.

[36] A surgeon, or urogynecologist, will see you if you are interested in surgery to help your prolapse or incontinence issues, or if you need medicines as part of your treatment.

A surgeon will also see you if you have other more complicated issues or other concerns that we don't talk about in these videos.

[37] If you have overactive bladder symptoms, a doctor or nurse practitioner may see you and may prescribe medicines to help you.

[38] Pelvic floor physiotherapists, who are experts in dealing with pelvic floor issues, can also be of great help.

[39] If you can't come to your clinic appointment, please tell the clinic as soon as possible.

It's best to give lots of notice, but we understand that things happen.

The clinic will reschedule your appointment and, because so many people are waiting for care, they can give your spot to someone who needs it.

If you cancel more than once, you may need a new referral from your doctor before the clinic can book your appointment.

[40] Now you should be ready to decide on your next step for pelvic floor care.

Do you know what pelvic floor issues bother you the most and what you can do to help and improve your symptoms? 

Do you know what your options are?

And have you filled out any forms you've received to help the pelvic floor clinic understand how they can help you?

[41] Some treatment options are ones only you can do.

Treatment options that need an appointment at a pelvic floor clinic are in red.

[42] Remember, there are many things that only you can do for your pelvic floor symptoms.

Things such as what you eat and drink, your bladder and bowel habits, how strong your pelvic floor muscles are and how well you can use them, and activities you do may affect your issues.

Only you can changes these factors to help with your symptoms.

[43] Nurse: We hope you've learned a lot from these videos, and we hope they have challenged you to do what you can to improve your pelvic floor symptoms.

This last slide shows links to more useful information on other websites.

Thank you for watching.​