A closer look at pelvic floor disorders with urogynecologist Dr. Bernard Taylor
There’s an unspoken understanding among women who’ve given birth. It’s the reason some quietly avoid jumping jacks and others subtly cross their legs when they laugh or sneeze. And though nearly 32% of women will experience a pelvic floor disorder in their lifetime—whether they’ve given birth or not—talking about sagging pelvic organs, incontinence and weak pelvic muscles still feels a bit private. For Roper St. Francis Healthcare urogynecologist Dr. Bernard Taylor, opening the discussion is step one in restoring quality of life to his patients.
Across the Spectrum
“The pelvic floor is a general term to describe muscles that help to support the pelvic organs, such as the bladder, urethra, vaginal walls, uterus and rectum,” explains Dr. Taylor. This important group provides control over our bladder and rectum. When they weaken and fail, accidents happen. Those accidents, called incontinence, can be especially distressing and embarrassing for people trying to go about their daily lives.
Leaking urine—often the first sign of a pelvic floor disorder—can occur with coughing, laughing or a sudden movement such as lifting. “Probably the most common initial presentation is with running,” he states. But it’s not just people with an active lifestyle who are impacted. “Those who don’t have a very active lifestyle may still notice symptoms while simply standing. Then there are some who develop more of a neurologic condition related to bladder sensation that results in what we call urinary urgency—a sudden urge or desire to go to the bathroom,” Dr. Taylor adds.
Ranging in age from college students to the elderly, Dr. Taylor’s patients most commonly arrive complaining of incontinence. “Imagine being a college student and not being able to do things with your friends because you’re avoiding having accidents or even having accidents in bed,” he says. “I also have patients who come in after having children and have incontinence that’s so destructive that they can’t even take care of their newborn.” And for his oldest patients, incontinence can lead to isolation and depression. “I’ve had grandmothers who aren’t able to visit their grandchildren because of the distance. They live far away and can’t sit in the car or take a flight because their incontinence is so profound. If we can resolve their issues, they can visit their families again,” he states.
Childbirth is the most common denominator in pelvic floor disorders, but weakness in the muscles that surround the base of the bladder can also be caused by surgery in the pelvis, certain cancers or traumatic events such as a car accident, Dr. Taylor explains. “Even surgery on the back or spinal cord may result in nerve injury that can affect those muscles around the urethra and base of the bladder.”
These conditions can affect men, as well. “Most men who develop pelvic floor disorders have had surgery of the prostate. Others have neurologic conditions such as a stroke, multiple sclerosis or cerebral palsy,” explains Dr. Taylor.
Some early evidence also points to a genetic link within families, predisposing individuals to these disorders. One particular study, published in 2009 in the American Journal of Human Genetics, identified a gene that may contribute to the development of pelvic floor disorders.
Preventive Measures
While studies have shown that pregnancy and childbirth can stress and damage the pelvic floor no matter the delivery method, don’t rule out having a baby for fear of a pelvic floor disorder. “Avoiding childbirth doesn’t guarantee that a person won’t develop a pelvic floor disorder,” states Dr. Taylor. Just as having children vaginally doesn’t automatically mean that you’ll develop a disorder. “We have no evidence that using C-sections decreases one’s risk to zero.”
Fortunately, there are a few controllable factors when it comes to avoiding a pelvic floor disorder. “A lot of the recommendations we provide are the same instructions we’d give anyone wanting to live a healthy lifestyle,” says Dr. Taylor. Avoid smoking, maintain a healthy weight and keep a regular bowel regimen. Also, be aware of your body’s limitations if you’re participating in high-intensity, heavy-lifting exercise programs. “There is some evidence that the chronic straining and lifting associated with certain popular workout classes can exacerbate pelvic floor weakness in some patients, accelerating their pelvic floor disorders, incontinence and prolapse. I always advise getting a full examination and making sure you’re healthy before starting any new exercise regimen,” says Dr. Taylor. A pelvic floor physical therapist can also help you modify these exercises as necessary, so that you can continue to participate and enjoy such classes.
“Pelvic floor contractions, which most of us know as Kegels, are certainly a good exercise to maintain pelvic floor strength, but 95 percent of people who come through my door are doing them wrong,” explains Cate Schaffer, a Roper St. Francis Healthcare affiliated pelvic floor physical therapist. “They’re often using their glutes, abs, back or inner thighs instead of just the pelvic floor muscles.” Beyond Kegels, Schaffer recommends dynamic core strengthening exercises such as planks, clams, bird dogs and bridges for boosting pelvic floor strength.
“The tricky thing with pelvic floor health is understanding if a patient’s muscles are too weak or too tight,” says Schaffer. An evaluation by either a doctor or physical therapist can help determine whether strengthening or stretching is needed. “If someone is experiencing pain in their pelvis during intercourse or bowel movements, we’ll work to relax those muscles and identify any trigger points in the pelvis. Then, if they’re still having problems with leakage, urgency or frequency, we add in strength exercises.”
Individualized Treatment
For many, seeking help can be as embarrassing as the problem itself, but it’s a necessary step in returning to a normal daily life. “Whenever there is any impact on quality of life or a noticeable change that is persistent and irritating, I say to go ahead and seek care or evaluation first by your primary care physician, who may refer you to a specialist,” encourages Dr. Taylor.
He meets with first-time patients to discuss their symptoms and history before completing a pelvic examination to evaluate for vaginal support, muscle strength and tone. Depending on what the urogynecologist finds, other “more invasive evaluations with special testing” may be necessary to rule out anything from bladder stones to bladder infections and even bladder cancer.
Individual treatment then begins with first-line therapies, including behavior and dietary modification. Some patients may work on muscle strengthening and toning with a pelvic floor physical therapist, while others may see benefit from instituting a bowel regimen to improve chronic constipation affecting their bladder and bowel control. “When those first-line therapies don’t work, we go on to second-line therapies, which may involve use of vaginal support devices and in some cases, even use of medications that help slow the bladder down,” explains Dr. Taylor. “If those therapies aren’t effective or aren’t meeting the patient’s desired goals, then we can move on to surgery. Surgeries are focused on alleviating symptoms and achieving results that get patients back to being functional and improving their quality of life.”
“We try to take it really slow at first, educate patients and then meet them where they are. The most fulfilling experiences are when we can actually give somebody their quality of life back after their disorder has negatively impacted relationships and things a lot of us take for granted. Their stories help to motivate us—the providers, the nurses and our care team—to really push forward in providing care and get the word out that we’re here,” he stresses.
Urogynecology vs. Gynecology
A gynecologist is a doctor specializing in the female reproductive system. Women typically see these doctors for routine annual well-woman exams, which include pap smears, STD screening, testing for vaginal infections and overall health of the female anatomy.
A urogynecologist is a doctor who has studied both gynecology and urology and specializes in disorders of the pelvic floor, primarily incontinence and prolapse.
Dr. Taylor recommends that his female patients first see a gynecologist to ensure there isn’t an underlying cause for their symptoms. “That evaluation helps the gynecologist determine if a patient is a candidate to be referred to us for further evaluation and/or treatment.”
Common Pelvic Floor Disorders
Pelvic organ prolapse: A herniation, or bulging, of the uterus, bladder or rectum into the vaginal canal due to weak supportive tissues in the pelvic region
Urinary incontinence: A loss of bladder control that can be classified as either stress incontinence, which occurs with increases in abdominal pressure such as sneezing or exercise, or urge incontinence, when you have a strong, sudden need to urinate followed by an involuntary loss of urine
Fecal incontinence: An inability to control your bowels due to an unstoppable urge to have a bowel movement or stool leaking from the rectum
Photographs by (mother & child) Evgeny Atamanenko; (Dr. Taylor) Mic Smith, (exercise) Scott Henderson
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