Pelvic Floor Weakness Specialists Germany & Switzerland

What is a Pelvic Floor Weakness?

Pelvic floor weakness or dysfunction happens when the interaction of the pelvic floor muscles is no longer present or disturbed. The pelvic floor is a functional system of various muscles and organs in the pelvic area. These include the abdominal cavity, the intestine, the urethra, and in the woman's cervix, as well as the vagina. This system is instrumental in helping the human body consciously hold in stool and urine while actively using the muscles of the pelvic floor. The pelvic floor closes the trunk downwards with a layer of muscle and connective tissue about three to four centimeters thick.

When the pelvic muscles do not function properly any more, the organs held in place by the pelvic floor lack stability. This may lead to a prolapse or drop of the uterus, the so-called Descensus uteri, and to incontinence.

How Does a Pelvic Floor Dysfunction Develop?

Normally, the muscles of the pelvic floor are consistently tightened and relax only during bowel movements, urination or sexual arousal. The special feature of these muscles is that they can contract reflexively, thus ensuring no stool or urine escapes when sneezing, coughing or jumping.

There are many factors that can lead to pelvic floor insufficiency. Women with a hereditary connective tissue disease are particularly at high risk. Although the pelvic floor muscles actually lose stability in old age, the connective tissue usually holds these muscles together well. If connective tissue weakness is detected, the risk of developing pelvic floor insufficiency is increased.

Risk Factors for Pelvic Floor Weakness

• Many Births
• Perineal Tear
• Hard Physical Work
• Nicotine and Alcohol Abuse
• Overweight

The pelvic floor weakness occurs in a typical pattern: Troubled patients experience muscle weakness in the pelvic floor, which is associated with urinary and/or fecal incontinence. Abdominal pain can also occur. Women can suffer from a descensus of uteros and vagina.

Pelvic Floor Therapy and Pelvic Floor Surgery

Before specialists in urology, neurourology and urogynaecology apply surgical treatment options, all conservative curing methods are exhausted first. Initially, they attempt to strengthen and harmonize the pelvic floor muscles physiotherapeutically through targeted training. Electrical stimulation devices, which can be provided to the patient, can help stabilizing the functioning of the neuromuscular system (so-called biofeedback).

Methods of Pelvic Floor Surgery

In women, two types of pelvic floor incontinence exist: Urge incontinence (the bladder is not working properly or is even hyperactive) and stress incontinence (there is a sealing defect in the pelvic floor area).

In urge incontinence, doctors resort primarily to physiotherapeutic measures (so-called toilet training). In stress incontinence, the suburethral ligament plastic has been proven effective in many clinics today (so-called TVT - tension free vaginal tape). It is a minimally invasive treatment that can be successfully performed up to 90 percent.

In a pronounced or total descent of the pelvic floor, conservative therapeutic measures are not considered. In this case, physicians usually cannot avoid surgery. Common to all surgical procedures is that they strengthen the resilience of the weakened organs and stabilize them sufficiently in the pelvic area.

Pelvic Floor Reconstruction Using Mesh Surgery (Colposacropexy)

Today's standard procedure for the treatment of pelvic floor weaknesses focuses on the so-called robot-assisted colposacropexy (or synthetic mesh surgery). Here, the upper vaginal walls are reinforced by a coarse mesh strip made of polypropylene via an abdominal access. At the same time, these mesh strips are fixed on the periosteum of the sacrum, resulting in a nearly completely tension-free vaginal suspension. The advantage of this surgical treatment is that the uterus can be preserved if the patient asks for it.

Increasingly older women, who often suffer from a prolapsed or fallen uterus, are treated with vaginal vault suspension. Surgeons pin nets with application spikes on certain parts of the vaginal wall and thus allow the physiological attachment of the vagina in the pelvic floor. It is interesting that this therapy also helps with increased pressure conditions in the abdomen, as they can occur in smokers and overweight people.

Tension-free vaginal tape has a high success rate. Only up to 4% of patients suffer from erosion after therapy due to the fact that doctors use partly bioresorbable materials, which are constantly optimized and improved.

Colporrhaphy

Another surgical procedure is the posterior or anterior colporrhaphy (anterior/posterior vaginal surgery). In this operation, the medical practitioner either sutures the front or rear part of the vaginal wall and folds it into itself, thus stabilizing the positions of the forward fallen organs. Indications for this therapeutic option are mainly patients with descending pelvic floor, whereby it should be considered that a new, postoperative disposition cannot be ruled out.

Hysterectomy

In case of a total uterine prolapse, hysterectomy can be performed. In this case, the uterus is partially or completely removed in combination with synthetic mesh surgeries.

Which Doctors and Clinics are Pelvic Floor Specialists?

Surgical treatment options in pelvic floor therapy are constantly optimized. Since there are many choices, patients sometimes find it difficult to decide. Patients question themselves where to find an experienced pelvic floor specialist or treatment center in Germany or Switzerland specializing in urology, neurourology or urogynaecology. We at PRIMO MEDICO help patients to find experts for pelvic floor dysfunction. All listed doctors and hospitals in Germany and Switzerland have been reviewed by us for their outstanding specialization in the field of pelvic floor therapy and pelvic floor surgery. These practitioners await patients’ treatment request.

What Does Pelvic Floor Therapy and Pelvic Floor Surgery Cost?

For patients from abroad, the costs for pelvic floor treatment are strictly regulated by the German government (GOÄ Department). German physicians are not entitled to determine their own self-calculated fees for medical services. They are legally obliged to adhere to the official fixed tariff rates for doctors.

In order to calculate the costs for a specific pelvic floor therapy in Germany or Switzerland, treatment centers first require detailed information on the specific pelvic floor disease. This data can be transferred to the hospital in form of medical reports, findings, and images taken prior to treatment. The pelvic floor center then prepares a cost estimate. In most cases, the amount due must be paid ahead of treatment.