Menopause & The Struggle Of Pelvic Floor Disorders: Expert Reveals A Solution

When menopause arrives, for most women, it brings challenges like hot flushes, night sweats, as well as an erratic sleep cycle, along with mood swings. In some cases, there is also development of osteoporosis, where bones become weak and are prone to fractures due to decreased bone mass and density, and an increased risk of cardiovascular disease. However, it also causes other issues that are rarely discussed and require equal attention.

Leaking urine while coughing or laughing, feeling a heaviness in the pelvis, noticing a bulge in the vagina, or struggling with discomfort that affects intimacy – women tend to dismiss all this as a natural part of ageing rather than something to be given immediate attention.

They do not realise that they could be symptoms of pelvic floor dysfunction, a condition that affects around 30% to 40% of menopausal women. Most women believe that they have to suffer silently and that no solution is available, which is far from the truth.

Today, robotic-assisted surgery using advanced technologies like da Vinci is changing the way pelvic floor dysfunction is treated, bringing both respite from symptoms and enhancing quality of life. 

What is pelvic floor dysfunction?

The pelvic floor is made up of muscles, ligaments, and connective tissue that support the uterus, bladder, and bowel. Around menopause, oestrogen levels drop, leading to weaker muscles, less elasticity, reduced blood supply, and thinning of the tissues that hold these organs in place.

Over time, this loss of support can cause urinary and faecal incontinence, cystocele (when the bladder sags and pushes against the vaginal wall), rectocele (when the rectum bulges forward into the vagina) and pelvic organ prolapse (descent of pelvic organs from their normal positions into the vagina).

Menopause, along with factors like multiple vaginal deliveries, chronic coughing, obesity that increases abdominal pressure, poor nutrition, smoking or alcohol use, can all worsen pelvic floor disorders.

Simple pelvic floor exercises like kegels and pelvic tilts can give relief in the early stages, but if symptoms persist, surgery is recommended.

In robotic reconstructive surgery, surgeons no longer rely on the body’s weakened tissues to support the pelvic organs. Instead, they use a special surgical mesh that provides stronger, long-lasting support.

This mesh is attached to the base of the spine (the sacrum) or to pelvic sidewall ligaments like the pectineal ligament to lift and hold the organs in their correct position, helping restore normal function and prevent recurrence.

What makes this modality stand out is that it allows surgeons to work with extraordinary precision. They can operate using magnified three-dimensional vision and instruments that move like the human wrist, giving them the ability to access the narrow spaces and challenging angles of the pelvis better, and work around vital organs like the bladder and rectum.

The surgical robot filters out tremors, ensuring optimal placement of stitches. This level of accuracy is difficult to achieve with conventional techniques.

Who can benefit from this procedure?

While most women present with pelvic dysfunction after fifty, even younger women can develop prolapse. In such cases, robotic-assisted surgery can preserve the uterus and restore normal function, especially for women who want more children.

At the other end of the spectrum, elderly women in their seventies can also undergo the procedure safely if they are medically fit.

And the result? Patients recover faster, with many able to go home within a day or two and resume normal activities within weeks. They endure less pain and undergo minimal blood loss.

In addition to getting physical relief, women report getting their confidence back and are able to feel feminine again, while also being able to be more intimate with partners. Thus, advanced surgical robotics gives women a new lease of life – physically, mentally and emotionally. 

Authored by Dr Archana Trivedi, Gynaecologist and Robotic & Laparoscopic surgeon | Views expressed are the author's own.