Pelvic Floor Disorders: You DON’T have to live with them!

Dr. Lukacz presenting the most recent information on
pelvic health at the last Howell Luncheon 

Creating awareness on pelvic floor health starts with education.  The Howell Foundation hosted Dr. Emily Lukacz last week who gave a very informative summary on what comprises pelvic floor disorders, understanding the basic anatomy  of incontinence and its symptoms,  and the latest on treating these disorders. 

If we were to summarize her most important message it would be the fact that one does not have to live with pelvic floor disorders, especially when one out of three women suffer from it – a message worthwhile sharing since pelvic floor disorders  are under reported and therefore under served.  

“It’s not only women who suffer from these conditions.  Family suffers as well.  Reality is there are lots of fairly simple things you can do that don’t require surgery”, she stated.  “Being here and spreading the word on pelvic floor health is the first step”. 

The main conditions that characterize pelvic floor disorders are Incontinence (Urinary and Fecal) and Prolapse; both with lifestyle common risk denominators such as vaginal delivery, traumatic events such as stoke or dementia --where the incident prevents the brain from controlling the muscles and nerves, lifestyle conditions such as obesity or smoking, chronic straining and heavy lifting, and injury to pelvic nerves through pelvic surgery.  Surprisingly enough, symptoms of pelvic floor conditions can be managed more often than not with behavioral therapies such as exercising, dietary changes and learning about the different alternatives to managing incontinence and prolapse. 

The following staggering statistics help create awareness on the many effects that incontinence has in 1 out of 3 women helps create awareness on pelvic floor health.  Did you know that:   

• 18 million women in the US have an incontinence problem?
• There are more adult diapers than baby diapers in any given grocery aisle?
• 11 million diapers are dumped in landfills every day?
• More money is spent on diapers and cleaners than treating the problem, which is significantly more affordable?  

The description of common pelvic floor disorders, the risks and alternative therapies to treating the condition made this presentation one of its kind.  “The fact that Dr. Lukacz delivered highly informative information on such a delicate and personal matter and during lunch earned her my respect” comments a Fiend of Howell.   “Attending the Howell events is a huge resource to find out about the latest in women’s health”. 

Urinary Incontinence

Understanding the types of urinary incontinence starts with knowing about symptoms, summarized as:   

• Pressure or bulge in the vagina
• Difficulty emptying the bladder
• Difficulty emptying the bowel
• Having that “gotta-go” feeling (overactive bladder)
• Leakage

As for the causes of incontinence, some people are at a higher risk than others.  Typically considered as part of aging, incontinence may not be a consequence of aging alone.   Genetics are involved and lifestyle definitely plays a role.   

Urinary incontinence is related to the balance between the brain and the bladder, and to the strength of the muscles that hold the urine flow.  Typically the normal condition of the bladder is relaxed while the urethra is tight.  When it is time to go, the bladder tightens and the urethra relaxes.  These reflexes are coordinated by the brain. Incontinence happens when the muscles are too weak to work properly.  

Urinary incontinence – or overactive bladder syndrome-- takes place when the balance between muscles and nerves is altered--the nerves are hyperactive and over-responding to any given stimulus.   The symptoms include small or large volume of leakage, slow or intermittent urinary stream, leaking when one sneezes, lifts, coughs or laughs and a strong feeling of wanting to go or feeling you haven’t gone enough.  On the other hand, stress incontinence is characterized by the urethra being stressed, – or using Dr. Lukacz's analogy, like stepping on a hose.

Worthwhile mentioning is the fact that 40 to 50 percent of women have both types of incontinence, and that it is very important to understand the differences between both as one type can get worse if the other is treated.  Clear and concise communication with your physician is key, regardless of how awkward the conversation might be!

As for treatments, Dr. Lukacz commented that surgery should be a last resort and only after all other alternatives have been exhausted.    Her recommendations for treating incontinence are focused on behavioral changes:

• Leading a healthier lifestyle, losing weight and smoking cessation among the main recommendations.
• Knowing what is normal and what is not:  going 8 times per day and 1 per night is typically normal.  If one sees changes in frequency, she recommends seeking a physician.  
• Holding it for a long time will have an effect on your pelvic health.
• Limiting bladder irritants, such as alcohol, spicy foods and fluids like soda or coffee.
• Mind the delicate balance between drinking too much or too little water.  On the one hand, if you drink too much, you will want to go all the time; if you don’t, the toxins that are meant to be disposed of can irritate the bladder. 
• Become aware of your bladder.  Keeping a diary helps create awareness and consciousness. 
• Strengthen the pelvic floor muscles with Kegel exercises -- typically recommended 3 sets of 10 daily.
• Retraining the bladder and getting it under a routine:  program when to go;  for example, every hour and increasing bathroom breaks by 15-minute intervals.
• Holding and squeezing, and then going vs. rushing to go as soon as we feel the need.
• Using pessaries that help hold the internal organs.
• Talking to your physician on the use of medication.  Statistics show that 70% of patients will see symptom relief.

As for procedures for incontinence condition, Dr. Lukacz commented that standardization of 20-minute, minimally invasive procedures are successful 80 to 90 percent of the time and are available in office settings.  Other forms of incontinence procedures include bulking injection (Botox gel, 70% effective in decreasing incontinence symptoms), retro-pubic intervention and acupuncture for the bladder.  Ultimately, understanding what you can do is crucial to take care of bladder incontinence.  

Fecal Incontinence

It is important to realize that the withdrawal due to fecal incontinence has a bigger impact than urinary incontinence.  But there is hope for the 20% of women with bowel leakage problems:  it can be resolved and is supported by dietary changes.  

Fecal incontinence shows the same kind of restrictions as urinary incontinence so they often go hand in hand.  As with urinary incontinence, damage to the muscle at child birth or colorectal surgeries are going to have an effect how a woman can control their bowel movements. Chronic straining due to constipation can also result in pelvic floor disorders.  

It is important to keep track of our bowel movements to determine if it is caused by an underlying problem.  The typical symptoms of fecal incontinence can include difficulty holding loose stool, constipation, or going back and forth from constipation to diarrhea.

The first of Dr. Lukacz’s recommendations is the use of fiber supplementation.  Contrary to popular belief, fiber supplementation helps constipation as much as it helps diarrhea.  The body needs at least 35 mg. of fiber and organic fiber is typically more effective due to its absorption effect.

In addition to fiber supplementation, Dr. Lukacz additionally recommends following a healthy diet.  Avoiding spicy foods in case of a loose stool or starchy foods in case of constipation will help to manage fecal incontinence symptoms.  Kegel exercises will help with strengthening the pelvic muscles and should help ease the uncomfortable symptoms of the disorder.

As uncomfortable as it seems, accurate treatment for fecal incontinence is still at its early stages.  According to Dr. Lukacz, treatment for fecal incontinence is at a stage where urinary incontinence was 20 years ago!  As a matter of fact, clinical trials that explore treatment --exercise vs. surgery -- are currently in process today.    The new trends in 2015 that are currently being investigated as effective, additional treatments for fecal incontinence include special designs of insert devices, radio frequency, nerve stimulation, reconstruction surgery and bulking injections. 

Prolapse

According to Dr. Lukacz, half the women ages 50 -70 suffer some form of organ prolapse.  Organs prolapse when the muscles and ligaments holding them together stretch inside the pelvis.  However, as long as the prolapsed organs stay within the opening of the vagina it is typically not symptomatic.  In fact, 80% of the time prolapse will stay the same year to year, 15% of the time it will get worse, and 5% of the time it will get better.  

Being bothered by organ prolapse becomes a quality of life issue.  As for risks and causes of prolapse, the recurring themes include childbirth, straining, obesity and some type of pelvic surgery, such as a hysterectomy. 

The most common symptoms of organ prolapse include:  

• Pressure
• Heaviness in the pelvic/abdominal area
• Something falling from the vagina
• Difficulty initiating urination or emptying our bowels
• Pain during intercourse
• Pressure from feeling the bulge

Getting familiar with the terms cystocele and rectocele is important as they are the most common forms of organ prolapse. A rectocele is a bulging of the front wall of the rectum into the back wall of the vagina. Rectoceles are usually due to thinning of the recto-vaginal septum (the tissue between the rectum and vagina) and weakening of the pelvic floor muscles. A cystocele occurs when the supportive tissue between a woman's bladder and vaginal wall weakens and stretches, allowing the bladder to bulge into the vagina. 

As for recommending surgery, Dr. Lukacz offers strong words of caution:  no one single surgery works for every woman.   Surgery for organ prolapse will depend on various factors:  what your goals are,  your level of investment in surgery, recovery time and how long will the fix last.    Surgery should focus on restoring a normal anatomy, getting rid of the bulge and increasing our quality of life.  

For additional resources on anything and everything related to pelvic floor health, Dr. Lukacz recommends visiting Voices for Pelvic Floor Disorders.org

About Dr. Emily Lukacz:

Dr. Lukacz has completed three years of fellowship training in the subspecialty of Female Pelvic Medicine and Reconstructive Surgery and joined the UC San Diego Women's Pelvic Medicine Center in 2003. She focuses her efforts on evaluating and treating women with urinary incontinence, pelvic organ prolapse and other pelvic floor disorders. 

About the Doris A. Howell Foundation:

The Doris A. Howell Foundation for Women’s Health Research is committed to keeping the women we love healthy, advancing women’s health through research and educating women to be catalysts for improving family health in the community.

The organization does so by funding scholarships to scientists researching issues affecting women’s health;   providing a forum for medical experts, scientists, doctors, researchers, and authors to convey the timely information on topics relevant to women’s health and the health of their families through its Lecture and Evening Series, and by funding research initiatives that will create women’s health awareness and advocacy in the community.    For more information about the Doris A. Howell Foundation, please visit www.howellfoundation.org.