Urogynecology 101

In the past few weeks, I’ve given you an overview of some of the great things the Patty Brisben Foundation for Women’s Sexual Health is passionate about. This week, I’d like to hone in on a type of doctor that can be a woman’s best friend and voice of comfort during trying times.

As minimal as training for general practitioners may be, there are certain healthcare providers that do specialize in women’s sexual health dysfunction, which are called urogynecologists. They typically specialize in Pelvic Floor Disorders, but also help in all realms of a woman’s sexual health throughout her lifespan. I decided to talk two experts in the area: Victoria Schwartz, DPT, WCS, and Mary South, M.D. and Board Member of the Patty Brisben Foundation for Women’s Sexual Health. Like a good patient, I turned to them with a list of questions to see if they could help me better understand what there is to know about pelvic floor disorders and other ailments that fall under the specialty of urogynecologists.

What does urogynecology entail?

The field of urogynecology (a subspecialty within Obstetrics and Gynecology) is dedicated to the treatment of women with pelvic floor disorders (PFDs) such as urinary or fecal incontinence and prolapse (bulging or falling) of the vagina, bladder, and/or the uterus, and pelvic discomfort.

How many women do pelvic floor disorders affect?

Victoria Schwartz: PFD affect a substantial portion of women and [likelihood to have a PFD] increases with age. Statistics vary depending on the study. Some statistics from recent studies are:

-Up to 50% of women have urinary incontinence.
-25-40% of women report urinary leakage during gynecological exams.
-There is a 16% lifetime risk of developing chronic pelvic pain.
-The prevalence of having at least one pelvic floor disorder is 23.7%.
-The lifetime risk of undergoing surgery for pelvic organ prolapse is 11.1%
-There are more than 500,000 surgical procedures performed annually for urinary incontinence and prolapse.

What age range does this normally affect?

VS: PFD can affect women throughout their entire adult lifespan.

What causes PFDs? Are there any preventative measures women can take?

VS: Risk factors for developing PFD include: increasing age, pregnancy and delivery, trauma, decreases in estrogen levels, a history of hysterectomy, obesity, chronic coughing, constipation and straining, and connective tissue laxity. Pelvic floor muscles are the hammock-like muscles that support the pelvic organs, have sexual function, and help to maintain continence. Weakness and dysfunction of these muscles can lead to PFD.

Women can help to prevent conditions like bladder and bowel incontinence and pelvic organ prolapse with pelvic floor muscle exercise (commonly known as Kegels). Pelvic floor muscle training is a conservative approach to treatment and extends far beyond Kegels. It is estimated that 30% of women incorrectly perform a pelvic floor muscle contraction even after instruction. Women’s health clinical specialists in physical therapy can be helpful in training women to correctly perform pelvic floor contractions and establishing a progressive exercise program for muscle strengthening. Women’s health physical therapists take a holistic approach to solving PFD by looking at the whole body and incorporating core and postural muscle exercises into pelvic floor muscle exercise. Respiration, body mechanics, and lifestyle modifications are all included in preventing and treating PFD.

Are PFDs something women have dealt with for centuries, or is this recently becoming more and more prevalent?

VS: Cundiff et.al. (2000) states that the use of pessaries to treat pelvic organ prolapse can be traced back to antiquity. [Pessaries are typically plastic or silicone medical devices used to support the uterus, vagina, bladder, or rectum.] Women have dealt with PFD for centuries however it is under-reported because of shame and embarrassment involving the conditions. The intimate nature of the topic prevents women from discussing their symptoms openly or even confiding in their medical doctor. Many women believe that their condition is a “normal” part of aging and that they should just “live with it.”

Recently it seems more and more people are speaking out about PFD, which makes it seem like these conditions are more prevalent. Commercials are aired where women such as Whoopi Goldberg freely speak about “losing water” every time she laughs (this commercial makes me cringe because it is a commercial for pads, which means she is one of the many women who “lives with it”). Other commercials for medications, which treat conditions like overactive bladder, have increased awareness about these conditions. Recently Oprah Winfrey did a segment on “Physical Therapy for Your Lady Parts” which detailed common PFD and conservative management for these conditions, and Dr. Oz has recently discussed topics like pelvic floor anatomy and pelvic floor dysfunction. Education and scientific research are key to spreading the word about PFD. It is time for women to realize that there are treatment options available for these conditions and there are people out there who can help.

Mary South: This problem (pelvic organ prolapse and pelvic floor disorders) has been around as long as women have had pelvises (i.e. forever). Even in Egyptian times, there are reports of gold pessaries. People used to use potatoes too! What is happening now is this:

1.  More doctors are becoming subspecialty trained in urogynecology, formally known as Female Pelvic Medicine and Reconstructive Surgery. The first fellowship in the United States was started in the 1980s and there are now over 30 nationwide.
2.  More women are willing to talk about these issues.
3.  The baby boomers are aging, and the fastest growing population in the US is in the over-80 age group. Since these disorders are more prevalent in aging women, the overall incidence is increasing.

What are some early signs a woman has a PFD? When should she see a doctor if symptoms continue?

VS: Signs of PFD include: urinary urgency, frequency, and leakage, bowel incontinence or constipation, pelvic organ bulging or a “feeling of falling out,” pelvic pain or pain with intercourse. These symptoms are not normal and a woman should report these symptoms to a doctor as soon as possible.

Is there anything else you would like to add to the conversation or discuss?

VS: A women’s health physical therapist is a physical therapist who specializes in the treatment of women throughout their lifespan. Women’s health PTs have specialized training to treat women who have urinary and fecal incontinence, retention, constipation, pelvic and low back pain, painful intercourse, women who have recently undergone gynecological surgery, women post cancer treatment, and women who are pregnant or in the post-partum period. Individualized treatments are performed following a throughout evaluation. Treatments can include pelvic floor muscle exercise, massage, myofascial release, trigger point release, biofeedback, flexibility, strengthening, core exercise, and lifestyle modifications. Urogynecologists refer patients to physical therapy as do gynecologists, colon and rectal surgeons, nurse practitioners, midwives, and primary care physicians. Most states have Direct Access, which means a patient may see a physical therapist without a referral from their doctor. Additionally, insurance covers pelvic floor therapy. To locate a women’s health physical therapist, one can visit the “PT locator” on the Section on Women’s Health website: www.womenshealthapta.org.

 

Victoria Schwartz, DPT, WCS has her doctorate in physical therapy from the University of Miami, Florida. She is board-certified from the American Board of Physical Therapy Specialties as a Women’s Health Clinical Specialist. The Center for Pelvic Floor and Core Rehabilitation is the leader in treating PFD in the Cincinnati area. The physical therapists see patients in offices located in Clifton and West Chester, OH. Please call 513-463-2518 or visit its website at www.pelvicfloorandcore.com. Victoria is a member of the American Physical Therapy Association and a member of the Section on Women’s Health. She is also proud to be a Pure Romance consultant who specializes in sexual health education and empowerment.

Dr. Mary South serves as adjunct assistant professor at the University of Cincinnati in the Department of Obstetrics and Gynecology. She practices with UC Health and specializes in the areas of Urogynecology and Pelvic Reconstructive Surgery. Dr. South earned her B.A. in Chemistry from the College of Wooster, her M.D. from Case Western Reserve University, and went on to the University of North Carolina as a Resident in Obstetrics and Gynecology. Dr.South also completed a Fellowship in Urogynecology at Duke University Medical Center. She also serves as a Board Member of The Patty Brisben Foundation for Women’s Sexual Health.

 

*Disclaimer: I am not a doctor. With the assistance from doctors on our Board combined with research, the blog posts this month have been created.

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