2/18/19

4 questions women should ask their gynecologist

Embarrassment and fear top the list of reasons women shy away from addressing pelvis issues. Studies show 11-20 percent of women will undergo surgery to repair or treat conditions of the pelvic floor, but urogynecologist Leon Plowright, MD, says data likely underestimates women who face symptoms but never seek care.

Many options are available to treat pelvic floor dysfunction with early recognition, education and intervention.

“Women want to know right away, ‘Can this cause cancer?,’ ‘Is my bowel going to fall out?’ and ‘Can having sex make it worse?’ The answer all of these questions is ‘no,’” Dr. Plowright said.

Every woman’s situation is unique, and she can experience multiple symptoms such as urinary incontinence and weakening of the pelvic muscles and tissues, known as pelvic organ prolapse. Dr. Plowright answers some of the hardest questions to ask but most important to answer.

First of all, what is pelvic floor dysfunction?

Pelvic floor dysfunction can be in the form of pelvic organ prolapse or urinary incontinence. Unfortunately, the two often happen together.

Pelvic organ prolapse is a dislocation of pelvic parts at or beyond the vagina.

What causes pelvic organ prolapse?

  • vaginal childbirth (particularly if delivering a baby over 8.5 pounds)
  • aging
  • hormonal changes or menopause
  • family history
  • strain on the abdomen from chronic coughing, sneezing or obesity

What are the warning signs or symptoms?

  • sensation of a bulge or a pulling sensation in the vaginal canal
  • feeling of pressure
  • difficulty having a bowel movement or emptying the bladder
  • lower back pain
  • pelvic discomfort
  • pain with sexual intimacy

How is pelvic floor prolapse diagnosed?

Consult with an urogynecologist or a pelvic floor physical therapist. They’ll discuss your symptoms and conduct a physical examination.

How are these conditions (urinary incontinence and pelvic organ prolapse) treated?

Treatment depends on your diagnosis, symptoms, age, health history and whether you’re sexually active. Options can include management up to surgery.

Non-surgical treatments help address or manage two types of leakages. Timed restroom breaks can address overactive bladder, a constant urge, frequency and inability to control.

Other options include doing pelvic floor exercises and removing carbonated and caffeinated beverages from the diet. More advanced treatment options include medication, injections into the bladder, nerve stimulation, inserting a bladder pacemaker or surgical intervention.

“The second type of leakage, urinary incontinence, happens when you laugh, cough or exert pressure onto the bladder,” Dr. Plowright said.

Treatment with pelvic floor exercises can strengthen the area or doctors may place a pessary, a device inserted in the vagina to support its internal structure.

“Fitted properly, patients find it comfortable. It’s similar to using a retainer from the dentist to hold things in place,” said Dr. Plowright. The patient removes it weekly or a doctor does every three to four months for maintenance.

Pelvic organ prolapse treatments widely vary based on where the prolapse occurs – the front wall (bladder), back wall (rectum) or the top of the vagina (near the uterus and cervix). Pelvic floor exercises or a pessary provide strength and support.

What exactly are pelvic floor exercises? Isn’t it just Kegel exercises?

Pelvic floor exercises are most effective with a therapist by your side to identify weakened areas and provide a targeted approach and attention.

What’s the best defense to prevent this?

  • discuss your specific risk factors with your healthcare provider
  • maintain healthy weight or focus on weight loss
  • treat chronic constipation
  • avoid jobs that require heavy lifting