All Our OwnSo common in women, pelvic floor problems have their own medical specialty.
There are some health issues women tend to hide from their doctors. Pelvic floor problems are one of them. It's not that these conditions aren't common-they are. It's mainly that women are embarrassed by them, or believe there's no effective treatment. Arising from a combination of issues, pelvic floor problems make many women leak urine or stool at inappropriate times, or experience pelvic organ prolapse, an unsettling condition in which internal structures drop down the vagina.
There's no better time than now for women to talk openly about these conditions. "The risk of pelvic floor disorders increases with age, but women need to know that these problems are not a normal part of aging," says Kathie Hullfish, M.D., a University of Virginia Health System urogynecologist who specializes in pelvic floor disorders. "They also should know there are a lot of effective treatments available."
Pelvic Floor Problems
According to Hullfish, the pelvic floor includes all the muscles, ligaments, tissues and nerves that help control and support the bladder, rectum, vagina and uterus. When muscles are weakened or tissues are stretched or damaged, problems can occur. For example:
Urinary incontinence. "Many new moms have this problem," says Hullfish. "They may start leaking urine sometime during their pregnancy, think the problem will go away, but discover three to six months after childbirth that they still can't pick up their child or exercise without leaking." All it may take is a cough or sneeze to trigger an accident. A related problem is an overactive bladder-a frequent urge to "go."
Fecal incontinence. Even more embarrassing, a woman may leak stool or have trouble controlling gas. Weakened sphincter muscles or nerve damage can be to blame.
Pelvic organ prolapse. "This is when one or more of the structures inside the vagina fall," Hullfish explains. All cases of prolapse are basically hernias, with either the bladder, intestines, and/or rectum prolapsing onto the vaginal walls. A woman may feel an uncomfortable sense of heaviness, as though her bladder or rectum is dropping out. Sometimes she can even see a bulge protruding from the vaginal opening.
Some women are born with weak tissues. A wide variety of other factors can add to the risk of pelvic floor problems, including pregnancy and childbirth, obesity, repeated heavy lifting, hysterectomy, nerve disorders, injuries and age.
What You Should Know
If you have a pelvic floor problem:
Go ahead, tell your doctor. As an example, fewer than half of women with stool incontinence will tell their family physician, Hullfish notes. At the same time, doctors may not think to ask their patients about incontinence or prolapse. They'll inquire about your smoking or eating habits or about any pain or shortness of breath, but how often has a doctor asked you if you've been leaking urine? The problem must be brought into the open before it can be treated.
Treatment may give you back your quality of life. Pelvic discomfort or bladder or bowel accidents can make it difficult or impossible to enjoy travel, entertainment, exercise, recreation or social occasions. What many women don't know is that nearly all bladder problems can be improved through treatment. There are a wide range of available options-from minor lifestyle changes, pelvic exercises or medications to physical therapy, biofeedback or surgery. "Incontinence rings" can be worn to help stem the flow of urine. "To relieve prolapse symptoms, a simple vaginal insert called a pessary works wonderfully for some women," Hullfish adds.
New surgical options are available, as well. "UVa Health System has robotic-assisted laparoscopic prolapse surgery, which uses sophisticated technology and tiny incisions to put things back where they belong," Hullfish explains. Compared with traditional prolapse surgery, this minimally invasive option allows patients to recover more quickly with less discomfort, and often return home the same day.
In order to ensure the most successful treatment options for pelvic floor disorders, Hullfish often teams up with William Steers, M.D., chair of UVa's Department of Urology and chair of the National Institutes of Health's Urinary Incontinence Treatment Network.
Treatment is up to you. "Some women tell me ‘It's not bothering me too much, I can live with it,'" Hullfish says. "By coming in for an evaluation, they can learn more about their condition and be reassured that it's not necessarily life threatening." She stresses that the final treatment decision is up to the patient and should be based on her personal goals.
"The time to think about treatment is when symptoms of incontinence or prolapse are just not tolerable for you," Hullfish adds. "Women should know that they don't have to live with it."
What Is a Urogynecologist?
Nearly every woman knows what a gynecologist is. Add "uro" to the title, and you have someone
who specializes in diagnosing, treating, and educating patients about pelvic floor problems.
"Primary care physicians can do a lot to diagnose and treat these problems, but sometimes you need a specialist," explains Kathie Hullfish, M.D., one of two urogynecologists at the University of Virginia Health System. Her colleague, Elisa Trowbridge, M.D., is scheduled to join UVa this summer. "Typically, the patients I see have already tried the initial frontline therapies and didn't get anywhere with them. Other patients come to see me just so they can learn more about their conditions and available treatments."
A urogynecologist not only can offer the best state-of-the art treatment but can also help women understand how to prevent a problem from getting worse.
Seeking Help
If pelvic floor problems are disrupting your life, talk to your primary care doctor about your symptoms. If you and your doctor think you might benefit from seeing a urogynecologist, call the University of Virginia Health System at 888-882-9892.
This article appeared in the Fall 2007 issue of Vim & Vigor, a family health magazine sponsored by the University of Virginia Health System. To receive Vim & Vigor at home four times a year, subscribe today. It's FREE.
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