Are you afraid to cough, sneeze, laugh, or exercise because you may leak urine? Sadly, you can’t simply dial your plumber. But if you educate yourself to become your own best health advocate, you may be able to turn off that unwanted drip! Time to break open the conversation about Pelvic Floor Dysfunction!

Many women are embarrassed to discuss this issue with their primary care physician, creating a significant barrier to care. The women who talk to their primary care physician about this issue are often told to grin and bear it. Nothing can be further from the truth. 

I reached out to UC San Diego Health for this interview. I was thrilled to speak with Christine B. Chung, MD, Professor of Radiology, Executive Vice-Chair, Vice-Chair Academic Personnel Department of Radiology, Director UCSD MSK Imaging Research Lab and Marianna Alperin, MD, MS Associate Professor of Obstetrics, Gynecology and Reproductive Services, Fellowship Research Director, Division of Female Pelvic Medicine and Reconstructive Surgery to help educate us on this topic.

Chung and Alperin told me that millions of women in the US experience incontinence and prolapse. These issues can cause embarrassment, affect our body image, and impact a women’s Quality of Life (QOL).

Here is your pelvic floor dysfunction 101:

What is the pelvic floor? It is the vagina and the group of muscles and connective tissues in your pelvic region that support your bladder, bowel, and uterus. The pelvic organs include your urinary (the bladder, the urethra, and the urethral sphincter, which helps keep your urine in the bladder) and reproductive organs (the uterus and the vagina). Pelvic floor disorders occur when the support and nervous system control of pelvic skeletal muscle, vagina, and bladder are disrupted.

According to Dr. Alperin, we are predisposed to pelvic floor disorders because:

“The female bony pelvis has a large (opening) filled by the structures comprising the pelvic floor which include connective tissue, skeletal and smooth muscles, and their innervation. As humans walk upright, the interplay between these components became especially important to counteract gravity and inertial forces and withstand intra-abdominal pressures to support pelvic and abdominal organs.”

We have a pelvic floor disorder when:

“Pelvic floor supportive structures work together with the vagina and pelvic sphincters to support sexual function and to assure urinary and fecal continence and aid with the proper evacuation of the bladder and bowel. When one or several of these integral supportive and functional structures fail, pelvic floor disorders ensue.”

Here are a few risk factors that can contribute to pelvic floor disorders:

• Pregnancy/childbirth (PFD occurs in 30% of vaginal deliveries, greater than those who had a C-section)
• Prior hysterectomy (especially if the top of the vagina is not supported)
• Obesity
• Family history
• Connective tissue disorders
• Chronic cough
• Chronic heavy lifting
• Chronic constipation/straining
• Smoking
• Aging
• Menopause
• Frequent and Vigorous Exercise

When our pelvic floor is not functioning normally, it can result in:

• Pelvic organs prolapse – Uterus, Bladder, Rectum, Vagina, Bowel
• Urinary incontinence -Stress incontinence, Urge incontinence, Mixed incontinence, Overflow incontinence, Nocturnal enuresis (bedwetting)
• Fecal incontinence
• Voiding dysfunction
• Sexual dysfunction
• Pelvic pain

I wanted to focus a bit on urinary incontinence because so many women email me about this issue. Dr. Alperin explained that for women 65 and older, urinary incontinence is a Medicare quality metric. Your primary care physician should ask you if you experience this problem, and if so, refer you to a specialist for treatment. Unfortunately, this does not apply to women under 65 years of age.

I am happy to confirm that the following are common myths:

• Incontinence is a normal part of aging.
• Nothing can be done about incontinence.
• There is nothing I can do to prevent incontinence.
• Prolapse causes incontinence.
• Surgery or medications are my only options to treat incontinence.
• Severe incontinence requires a catheter.

Please don’t get your pelvic floor in a tailspin. There are oodles of options for treating each type of issue ranging from: 

• Kegel’s exercises
• Physical therapy
• Biofeedback and electric stimulation
• Mechanical devices such as pessaries & barriers
• Medications
• Surgery (in-office procedures or outpatient surgeries)
• Behavioral modifications
• Vaginal estrogen
• Neuromodulation
• Botox bladder injections
• Intermittent self-catheterization
• …………..and more

I asked Dr. Alperin to tell us who we are to look to for help if we are experiencing symptoms of pelvic floor dysfunction?  Should we make an appointment with our gynecologist, find a Female Pelvic Medicine and Reconstructive Surgery/Urogynecologist, a Pelvic Physical Therapist, or just head to the nearest bar for a strong drink!?   She replied,

“The first most important thing to know is that you are not alone. Millions of women suffer from pelvic floor disorders. The second most important thing to know is that everyone can be helped, and many can be cured. Therefore, don’t hesitate to speak up and mention these conditions to your primary care or general OB/GYN provider, as often referral is needed to see a female pelvic medicine expert at such centers as UCSD Women’s Pelvic Medicine Center, where we provide specialty care for women with pelvic floor disorders. Also, your primary care or general OB/GYN doctor can refer you to a pelvic physical therapist even before you see a Urogynecologist. In addition, there are several online resources that are endorsed by our national professional society and that can be very helpful, such as American Urogynecologic Society Patient Website:https://www.voicesforpfd.org/.”

 I want to tip my pelvis to the incredible Dr. Arnold H. Kegel for inventing the famous Kegel perineometer (an instrument for measuring the strength of voluntary contractions of the pelvic floor muscles) and Kegel exercises (squeezing of the muscles of the pelvic floor). He first published his ideas in 1948. Brilliant! I religiously did my Kegels after delivering each of my children. Usually, I remembered when I was driving.  I highly recommend doing them to music. There is nothing like Kegel’s rhythm!

Thanks to Dr. Chung and Dr. Alperin, we have successfully mopped up the pelvic floor! 

Remember:  Suffering in silence is OUT!  Reaching out is IN.

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*EllenDolgen.com does not recommend, endorse, or make any representation about any tests, studies, practices, procedures, treatments, services, opinions, healthcare providers, physicians, or medical institutions that may be mentioned or referenced.