Re-Gaining Control of Your Pelvic Health

Intro: We’re taking wellness at MemorialCare Health System. It’s time for Weekly Dose of Wellness. Here’s Deborah Howell.

Deborah Howell (Host): Welcome to our show. This is your Weekly Dose of Wellness. I'm Deborah Howell, and today our guest is Dr. Jocelyn Craig, a urogynecologist with the Center for Women's Pelvic Health at Long Beach Memorial. She's double board certified in Female Pelvic Medicine and Reconstructive Surgery, and Obstetrics and Gynecology. Welcome, Dr. Craig.

Jocelyn Craig, MD: Thank you very much.

Deborah Howell (Host): Pelvic health issues are more common than one might think. Women of all ages can suffer from bladder and pelvic floor disorders, but they often ignore those symptoms because they assume that it's part of the normal aging process. So let's talk a little bit about our pelvic health. First of all, what is the pelvic floor?

Jocelyn Craig, MD: The pelvic floor is a combination of muscles, ligaments and connective tissue that is contained within the bones of the pelvis and supports the organs in the pelvis, including the bladder, the vagina, uterus and rectum. And when you think about it, really our entire torso rests upon this trampoline of muscles and connective tissues. The issue is that the pelvic floor can be weakened over time by a combination of conditions such as childbirth, repetitive heavy lifting, the effects of menopause and age, chronic constipation and chronic cough, and other medical conditions and neurological conditions.

Deborah Howell (Host): Aging is sometimes very unkind to women.

Jocelyn Craig, MD: It is. And it is more prevalent, these issues are more prevalent as we age, but I think as you already stated, there is a misunderstanding that this is a natural part of aging, and it's not. It's just that things happen to us as we age that make these issues more likely.

Deborah Howell (Host): That's right. Now who is in particular affected by pelvic floor conditions?

Jocelyn Craig, MD: Well, men and women can develop pelvic floor conditions, but again women are more susceptible to them, most likely due to our childbirth and also the effects of hormone changes throughout our lives.

Deborah Howell (Host): Okay. Now you say through our childbirth, are you talking about when a woman gives birth, or are you talking about the woman when she was born?

Jocelyn Craig, MD: When we give birth. So vaginal deliveries do put women at a higher risk for pelvic floor disorders, but it's not exclusive to that. Even women who have C-sections can be subject to some of these problems, just because of the weight and the strain of pregnancy itself.

Deborah Howell (Host): Okay. Alright. So what are the common signs and symptoms of pelvic floor conditions?

Jocelyn Craig, MD: So common signs and symptoms really would include leakage of urine that is involuntary, times when people are not expecting to use the restroom. So people will complain of leakage of urine when they cough, when they sneeze, when they laugh, with urgent trying to reach the restroom, they begin to urinate on themselves. Fecal incontinence, the involuntary passage of stool and gas when you're not socially ready to use the bathroom. Frequent voiding, or voiding that cannot be delayed, or getting up at night to urinate when you've been sleeping. Pelvic organ prolapse. The symptoms are really often a bulge in the vagina. And often people don't understand that any part of the walls in the vagina can come down. And behind those walls are the organs, the uterus, the bladder, and the rectum. So then it begins to push out and people will feel a bulge there.

Deborah Howell (Host): And is there pressure along with that bulge?

Jocelyn Craig, MD: There can be pressure. There sometimes can be pain, sometimes women will present saying they're having some bleeding, they feel some roughness there, and what you'll see is that the tissue has now become very irritated because it's exposed, and just like the skin that's inside our mouths, the vaginal tissue is very - well, not fragile - but it's typically moist and it's kept moist. And now with the organs and the walls hanging down, it becomes tender and dry and there can be some bleeding as well.

Deborah Howell (Host): Okay, alright. So what types of treatment options are available for some of these pelvic floor conditions?

Jocelyn Craig, MD: There's quite a range of options available. And it's important to understand that, again as we said, people often don't realize that it's not a natural part of aging, and often because there's so much shame involved with admitting that you have these problems, patients don't necessarily ask what's available or discuss this with their physicians. So the options range from very conservative treatments, really looking at lifestyle changes, physical therapy that is very specific to the pelvic floor, also you can use pessaries, which help with prolapse, the falling walls of the vagina, but it can also help with incontinence. Pessaries have been around for thousands of years, and they need to be fitted by a physician, but they can be a non-surgical option for managing prolapse but also incontinence. Vaginal cones are also available for strengthening of the pelvic floor. There's a wide range of medications that can be used, but there's also a wide range of surgical options that are open to patients.

Deborah Howell (Host): Are there any conditions that can be solved with exercise alone?

Jocelyn Craig, MD: Absolutely. Most women have been told by their physicians to perform Kegels. And Kegels can be effective if you're doing them correctly. The problem is, most women do not do them correctly. So it's really important to be instructed on how to do them. Physical therapy can be very useful to have an actual person help you learn how to do Kegels, but then also use biofeedback to help the patient understand how to do these exercises. So that on its own can be helpful, but sometimes that's not enough.

Deborah Howell (Host): Well, you have health, you have vitamins, you have, you know, lifestyle choices, you have exercises, but if all of those together aren't working, then you may have to go the medical, as in medicine, or surgical route. Is that correct?

Jocelyn Craig, MD: Correct.

Deborah Howell (Host): And what's the first thing you do when you see a patient coming in with some symptoms?

Jocelyn Craig, MD: Well, the first thing I do is I spend quite a bit of time taking a history, their medical history, their symptoms, and really listen to what's bothering them. And that is the key, because we're talking about quality of life here. So what is bothering the patient most? And then a physical exam to really evaluate what I see, what they feel, and then sit down and discuss the options for treatment. Often we need to do some additional testing before we consider surgery. So urodynamics is a functional study of the bladder. And that's something that's done in the outpatient setting. Also looking inside the bladder, which is called cystoscopy, is something that can be done before surgery. Sometimes we have to do specialized ultrasounds of the rectum and other imaging studies of the pelvis to understand a little bit more of what the connective tissue and defect is. But there's some workup that's done and then it's really listening, offering to the patient the options that are available for treatment, listening to what they want to do, listening what they're a candidate for. And then discussing the options we already discussed that are non-surgical, but also surgery, because really it's sort of a menu option of what is available and what's best in this certain situation for the patient.

Deborah Howell (Host): As you were talking, I was thinking about the physiology. People talk so often now and exercise about your core. Is strengthening your core something that would also benefit your pelvic floor?

Jocelyn Craig, MD: Absolutely. Strengthening the core can be very helpful. And as could exercises with yoga as well, but again, it's very important to undergo that kind of strengthening with someone who understands how those exercises work for the pelvic floor, and it's also important to understand that that may not be enough on its own.

Deborah Howell (Host): And I think each patient knows when enough is enough and their own exercise regimen is not quite cutting it. Time to go to the doctor and get a team on your side 'cause it's a great day to be a pelvic patient, right?

Jocelyn Craig, MD: It really is. There's a lot, there's a lot available.

Deborah Howell (Host): And where can women go to learn more about the Center for Women's Pelvic Health at Long Beach Memorial?

Jocelyn Craig, MD: Women who are interested in hearing more about the treatment options available can call 1-800-MEMORIAL and ask to be connected to the Center for Women's Pelvic Health.

Deborah Howell (Host): Easy enough. Thank you so much, Dr. Craig, for coming on the show today. And to learn more or to listen to a podcast of this show, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness. Have yourself a fantastic day!