Rhenish Pelvic Floor Center

The purpose of pelvic floor training is to train the muscles of the pelvic floor, which perform the main work of bladder closure and urination.  An untrained or poorly trained pelvic floor can lead to a variety of problems. In women, pregnancy and childbirth, obesity and loosening of the connective tissue can lead to prolapse of the bladder and uterus in the course of life, which can result in urinary incontinence, among other things. In addition, many women have forgotten how to use these important muscles, as the pelvic floor is not sufficiently consciously perceived in everyday life. As a result, the pelvic floor muscles are often not used at all. However, a muscle that is not exercised will regress.

However, in order to be able to start training effectively at all, it is necessary that you are first taught under professional guidance what the pelvic floor actually is and which muscles belong to it. You should learn to perceive your pelvic floor clearly and become aware of the function of the muscles. By learning various exercises, you can then train and continuously strengthen your pelvic floor muscles. Through targeted pelvic floor training alone, incontinence symptoms can be significantly improved and sometimes even disappear completely.

We recommend pelvic floor muscle training for almost all types of incontinence and all patients, from pregnant women to women who have recently given birth (with or without incontinence symptoms) and all other women (whether pre- or post-menopausal).

In our intensive course, which takes place regularly, we teach you effective pelvic floor training under professional guidance, which you can continue at home after completing the course.

To make pelvic floor training even more effective, we use so-called biofeedback. During training, you receive precise instructions on the exercises and also direct feedback on whether you are performing the exercise correctly. This is done with the help of a small electronic device. You insert a probe into the vagina yourself, which measures the activity of the pelvic floor muscles during the exercise. You will receive instructions on a display, which you can also hear via headphones, on how and for how long the exercise should be performed. After starting the exercise, you receive feedback via the display and also acoustically as to whether you are performing the exercise correctly and with the right intensity. The therapy is completely painless and is initially carried out over three months.

Regular use, usually daily, strengthens the pelvic floor muscles, the urethral closure mechanism and promotes coordination between the bladder and pelvic floor muscles.

If required, you can obtain a loan device from our clinic as part of our biofeedback consultation hours. The rental costs are usually covered by your statutory health insurance. When you are given the device, you will receive instructions on the device itself and also on the exercises. The method is mainly suitable for treating stress urinary incontinence.

Electrostimulation has proven to be an effective form of therapy for the treatment of incontinence. It can be used for stress and (motor) urge incontinence and makes sense. In patients with urge and mixed incontinence, electrotherapy can bring about a cure in around a third of cases and an improvement in a further third. In patients with stress urinary incontinence, therapy is even successful in 50 percent of cases.

Electostimulation uses electrodes to transmit electrical impulses to the nerves of the pelvic floor, bladder and genitals. This is done via a small probe that is inserted through the vagina so that the impulses can be transmitted directly to the site of action. This electrical stimulation causes the pelvic floor muscles to contract. As a result, the muscles are trained virtually by electrode. The stimulation strengthens the pelvic floor muscles and the bladder sphincter and promotes coordination between the bladder muscles and the pelvic floor muscles. In the case of an overactive bladder muscle, the nerves of the bladder muscles are calmed or attenuated, thus normalizing bladder function. It should be used regularly, i.e. daily.

If required, you can obtain a loan device from our clinic as part of our biofeedback consultation hours. The rental costs are usually covered by your statutory health insurance. When you receive the device, you will be given instructions on how to use it. The method is suitable for treating stress urinary incontinence, urge incontinence or mixed forms.

The female reproductive organs, which include the vagina in the external area, the pelvic floor, the bladder and the lower urinary tract are structures that are hormone-dependent. A hormone deficiency, especially an oestrogen deficiency, can easily lead to inflammation of the urinary and genital tract. The deficiency can also lead to a loss of tension in the bladder and urethra. This in turn can often lead to incontinence (involuntary loss of urine). For this reason, we often recommend starting any treatment for incontinence with localized hormone treatment, i.e. through the vagina, of the structures involved in the development of incontinence.

The hormones can be inserted into the vagina in the form of a vaginal suppository, a vaginal cream or in the form of a tablet. The form of application and dosage are individually adapted and discussed with your registered gynaecologist.

Oestriol is used for purely topical treatment. Oestriol is one of the female sex hormones. In contrast to oestradiol, it has no effect on the uterus or the bone system. There is normally no vaginal bleeding. However, it also offers no protection against osteoporosis (bone loss) and has no positive influence on fat metabolism.

Oestriol improves blood circulation and the structure of the tissue in the lower genital area (urethra, bladder and vagina) and promotes a normal vaginal environment. It is therefore an indispensable component of conservative therapy for urinary incontinence, for the prevention of ulcers during pessary therapy and, very importantly, for pre-treatment prior to incontinence or prolapse surgery. It also reduces the frequency of urge symptoms, vulvovaginal complaints (itching, dry vagina), urinary tract infections and dyspareunia (pain during sexual intercourse).This form of therapy is suitable for treating stress urinary incontinence, urge incontinence or mixed forms.

There are a variety of medications that can be used for the different forms of incontinence. A rough distinction is made between bladder-relaxing and bladder-occlusion-strengthening medication.  Whether drug therapy should be started at all depends on a number of factors, such as the individual findings, age and life situation and also the individual's previous illnesses.

Bladder relaxant medication

Bladder relaxants, known as anticholinergics, are the drugs of choice for forms of urinary incontinence that are associated with increased bladder muscle activity. They are also known as spasmolytics or antispasmodics. The bladder muscle thickens and develops so much strength that the bladder sphincter cannot withstand this pressure for long. Even when the bladder is only slightly full, there is a strong urge to urinate, frequent urination and uncontrolled leakage of urine (urge incontinence). However, these bladder relaxants only have an effect if they are supported by accompanying measures such as bladder training, local estrogen application and pessary adjustment. There is also a certain delay before an effect is felt after starting to take the medication. Like all medications, anticholinergics can also cause certain side effects such as dry mouth, blurred vision, palpitations, stomach problems or constipation, which can vary greatly from person to person.

Bladder occlusion-strengthening medication

As an example of a possible drug therapy for stress urinary incontinence, we would like to mention the so-called serotonin and noradrenaline reuptake inhibitors. These drugs strengthen the muscles in the area of the urethra. They act via the central nervous system and are a very promising and often very effective option for the conservative treatment of stress urinary incontinence. Several studies have shown that this type of therapy can effectively reduce the frequency of incontinence episodes in around half of all cases. This form of therapy is also associated with undesirable but often controllable side effects, the most common of which are temporary nausea, dry mouth and constipation.

Pessaries are mechanical aids to improve the symptoms of both prolapse and urinary incontinence of the stress type. Depending on the findings and indication, there are many different shapes, which are available in different sizes to suit the anatomical conditions. Modern pessaries are made of well-tolerated silicone rubber, which does not cause allergies. Previously used pessaries made of glass, porcelain, clay, hard plastic or rubber are generally no longer available.

Pessaries are inserted into the vagina to support the urethra, bladder and pelvic floor in the case of diseases associated with a weakened uterus (prolapse or prolapse of the bladder, uterus or vagina; urinary incontinence).

The pessary is an effective "immediate measure" that offers direct improvement in urinary incontinence immediately after insertion. The prerequisite for this is that the right type and size of pessary is selected to suit the symptoms and findings. It should also be easy to insert and remove; it must not hurt or fall out. In our pessary consultation, we will advise you and select the right pessary. You will receive instructions on how to insert and care for the pessary, and application checks will also take place later during the consultation.

The pessary is then inserted into the vagina by the patient herself at home using a cream containing oestrogen. This can be done lying down, standing or sitting. You are also responsible for removing the pessary, usually daily in the evening, and caring for it (washing under warm water). Depending on the symptoms, the pessary can be worn throughout the day or only inserted if necessary before physical exertion, e.g. before sport or jogging. It can then be removed again after the end of the activity. The pessary can be removed for sexual intercourse. However, if it does not cause any discomfort during intercourse, it can also be left in the vagina. Some pessaries have a small strap for easier application, which allows the pessary to be pulled out easily, similar to using a tampon.

A pessary can be used permanently or only temporarily.

Patients who wear a pessary permanently for several years quickly become very experienced in the use and care of their pessary. Pessary care is integrated into daily hygiene and eventually becomes part of everyday life. The prerequisite for long-term therapy is of course your consent and your motivation as a patient to wear a pessary. Regular check-ups by your gynecologist and in our pessary consultation guarantee problem-free use. The advantage of permanent pessary therapy is that if the symptoms improve sufficiently, there is no need for surgery.

All vaginal reconstruction procedures

• For the anterior compartment
  • Transobturator mesh-supported procedures (e.g. anterior InGYNious-Mesh® or Seratom-Mesh as 6-point foxing)
  • Classic anterior colporraphy
• For the central compartment​​​​​​​
  • Vaginaefixatio sacrospinalis uni- and bilateralis
  • Trans-ischiorectal mesh-assisted procedures (e.g. posterior InGYNious-Mesh®)
• For the rear compartment​​​​​​​
  • Posterior vaginal repair with InGYNious-Mesh®
  • Classic posterior colporraphy
  • Rectoceloplasty
  • High levator seam

All abdominal reconstruction procedures

• Correction of lateral defects according to Richardson
• Colpo and cervicosacropexy (also with mesh interposition)

• Tension-free adjustable vaginal tapes (retropubic or transobturator), TVT tape
• Colposuspension according to Burch
• Implacement of Bulky agents - Urethral injection with Bulkamid®
• Injection treatment of the urinary bladder with botulinum toxin (Botox®)