Overactive bladder. Incontinence. Pelvic organ prolapse. The National Institutes of Health estimates that one in four women will experience some form of pelvic floor disorder at some point in their lives. Yet, while the numbers of those affected is huge, most will suffer needlessly, too self-conscious and ashamed to reach out for help.
“This is a problem that is very common yet people don’t talk about it because it is embarrassing,” said Dr. Gena Dunivan, assistant professor of obstetrics and gynecology and Associate Fellowship Director of Female Pelvic Medicine and Reconstructive Surgery in the Department of Obstetrics and Gynecology at the UNM Health Sciences Center. “Too many women think they are the only ones who have these problems but there are a myriad of resources available to them.”
Dunivan also serves as the Women's Health Services medical director at the UNM Sandoval Regional Medical Center (SRMC), where a multi-disciplinary team is working with women to provide a comprehensive treatment approach for pelvic floor disorder which range from an overactive bladder – and that ‘gotta go’ impulse – to accidental bowel leakage and pelvic organ prolapse.
“Our patients come from all walks of life,” said Dunivan. “Age is the great equalizer and the rates of women suffering from pelvic floor disorders are expected to rise sharply as the population ages, but the truth is, these conditions can occur at any age. It might be a young mother who had a complicated delivery or a diabetic patient at 40 who is suffering from urinary leakage.”
Overactive bladder and incontinence can be associated with a number of factors such as drug side effects, diabetes, smoking, infections and obesity. While a common denominator for pelvic organ prolapse is childbirth, other causes range from genetics, heavy lifting or chronic straining due to chronic constipation or cough.
Symptoms vary, even within the different conditions. For example, in the case of a pelvic organ prolapse, some patients will feel abdominal or pelvic pressure. “They might feel like they are sitting on an egg or that they will take a shower and notice something dropping down,” said Dunivan. For others, it will be more dramatic and frightening. “They feel a bulge and think they must have cancer."
“Many women end up not being able to leave their homes because they are afraid they will have an accident. They become house bound – yet they have years and years of life ahead of them,” said Dunivan. “This is a problem that can be helped. We want them to know that.”
One fear that many women have is that their only option will be surgery, but that isn’t true, she said.
“Actually, we recommend that many of our patients start out with the conservative measures. Education is important. Our initial new patient visits can take a long time. The first visit will typically include a full history and pelvic examination. But we also spend a great deal of time talking about what is happening to them and reviewing their options. We want to make sure they are comfortable and we do a lot of education at that time,” she said.
For many, the next step in their treatment after the initial visit will be booking appointments for behavioral or physical therapy. Professionals in both fields can provide benefits for a number of conditions. For example, cutting down on caffeine, citrus and spicy foods can help calm an overactive bladder. Increasing fiber and water intake can help accidental bowel leakage; learning exercises to strengthen the pelvic floor muscles can help with urinary incontinence as well as pelvic organ prolapse.
Other patients may be scheduled into a UNM specialized midwife clinic where they can be fitted with a vaginal pessary – a removable device designed to support areas of pelvic organ prolapse or reduce urinary incontinence.
“We constantly get notes from people about how caring the staff is,” said Dunivan. “But then we know that, for many women, it has been a very stressful journey to get to our clinics. They didn’t know where to start – with a primary care physician? With an urologist? Or they arrived terrified because they have never heard of these things happening to other women.”
When surgery is required, it can often be done as either day surgery or one needing only an overnight stay in the hospital. Patients should plan on a six-week recovery period and doctors also ask that they not pick up anything heavy for three months, she said.
“This really isn’t a problem – unless you have it. Then it can be devastating for women," Dunivan said.
In 2011, Dr. Rebecca Rogers, professor of obstetrics and gynecology and division chief of Female Pelvic Medicine and Reconstructive Surgery, received a $1.6 million dollar grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development to establish a Pelvic Floor Disorders Network Center at UNM. It's one of only eight such centers around the country.
The research projects generated through the center provide another level of resources for patients, said Dunivan.
“This means a comprehensive approach for patients. Regardless of their insurance, they have the opportunity to participate in some of the of the most advanced research studies available for pelvic floor problems – some treatments that may only be available in the state at UNM.”