Your pelvic floor, whether you realize it or not, is constantly under stress. Pregnancy, obesity and physically demanding jobs can strain the pelvic floor muscles, the network of tissues that support the intestines, bladder, urethra, rectum, cervix, uterus and vagina. Those muscles are responsible for a number of functions, including controlling urination and bowel movements, as well as supporting the organs within the pelvis. A weak or dysfunctional pelvic floor can lead to a host of symptoms, ranging from the occasional urinary incontinence to pelvic organ prolapse.
The Urogynecology and Reconstructive Pelvic Surgery program is a new subspecialty at UK HealthCare for the treatment of pelvic floor disorders. Physicians Gerardo Heredia Melero, MD, and Johnnie Wright Jr, MD, with advance practice provider Briana Bell, are experts in pelvic medicine and reconstructive surgery and work with patients to develop a treatment plan; those treatments can be as simple as exercises or medications or as complex as robotic surgery.
“At UK HealthCare, we are among the few providers in Kentucky equipped to diagnose and treat common conditions that frequently go undiagnosed,” said Wright. “We offer advanced subspecialty care, providing comprehensive and tailored treatments to women, ensuring they receive the specialized attention they need for their unique health concerns."
Wright and Heredia identified a need for comprehensive care for patients who experienced complications during or after childbirth, both acutely after delivery and years after the fact. Many women experience urinary incontinence and other symptoms after having children but dismiss them as a normal aftereffect of pregnancy. Other risk factors, such as obesity and occupational hazards such as heavy lifting, can contribute pelvic floor stress. Over time, the weakened pelvic floors could lead to pelvic organ prolapse, the herniation of one or more of the pelvic organs into or out of the vagina. Wright says time is a factor; these disorders need to be addressed early before they are beyond the help of surgical intervention.
“The majority of patients come to see us for the management of pelvic floor prolapse,” said Wright. “Probably 40% of them experience some degree of urinary dysfunction – either urgency, frequency or urge incontinence.”
Other common symptoms of pelvic floor dysfunction include:
- A heavy dragging feeling in the vagina or lower back
- Feeling of a lump in the vagina or outside the vagina
- Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency, urgency and urinary stress incontinence
- Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly
- Pain or discomfort during sexual intercourse
Those symptoms can lead to issues that go beyond the pelvic floor. Depression and anxiety are linked to urinary dysfunction; someone who feels they no longer can control their bladder may withdraw and become more socially isolated.
According to Wright, the first and arguably most important step in diagnosing and treating pelvic floor disorders is helping patients understand urinary incontinence is not normal, and that a better quality of life is possible.
“The greatest impact we can have is with education,” said Wright. “There’s a small subset, both in patients and referring providers, who believe that if there’s no pain and it’s not cancer, then there’s no reason to worry.”
Urogynecology has been a board-certified subspecialty for 11 years; many current practicing providers have not had the opportunity to participate in a subspeciality fellowship or training. Additionally, Wright and Heredia say a number of patients they see have already had pelvic reconstruction surgery performed with materials and techniques that are no longer standard practice.
“This is a fairly young subspecialty,” said Wright. “In the past, pelvic floor surgeons were obstetricians and gynecologists who just had a special interest. And unless you lived in a major metropolitan area, you didn’t have access to a provider with that specialized skill set.”
Wright and Heredia are working with referring providers throughout the Commonwealth, spreading awareness of not just the specialized program at UK HealthCare, but about pelvic floor health in general. Surgery should be the last resort, Wright said; physical therapy, relaxation techniques, medication and targeted therapies can offer lasting relief.
“I call it ‘pelvic floor empowerment,’” said Wright. “We welcome anyone who is experiencing incontinence, discomfort or pain. The tide is changing, and patients are more informed and are being more proactive with their health. And we’re here to help.”