UK HealthCare offers a programme to treat pelvic floor problems, providing up-to-date care and a better quality of life for women

By Hilary Brown
University of Kentucky

A woman’s pelvic floor, whether she realizes it or not, is under constant pressure. Pregnancy, obesity, and physically demanding jobs can strain the pelvic floor muscles, which form the network of tissues that support the bowels, bladder, urethra, rectum, cervix, uterus, and vagina.

These muscles are responsible for a number of functions, including regulating urination and bowel movements and supporting the organs in the pelvis. A weak or dysfunctional pelvic floor can lead to a number of symptoms, ranging from occasional urinary incontinence to pelvic organ prolapse, which occurs when an organ in the pelvis slips out of its normal position.

UK Healthcare has a new subspecialty program to treat pelvic floor disorders called the Urognecology and Reconstructive Pelvic Surgery program. The providers are Dr. Gerardo Heredia Melero and Dr. Johnnie Wright Jr. and advanced practice provider Briana Bell.

This team of experts in pelvic medicine and reconstructive surgery works with patients to develop a treatment plan. These 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 often go undiagnosed,” Wright said. He said the program offers “comprehensive and tailored treatments for women.”

He said time is a factor because these conditions need to be addressed early before they become beyond surgical intervention. “Most patients come to us for treatment of pelvic floor prolapse,” Wright said. “Probably 40 percent of them experience some degree of urinary dysfunction — either urgency, frequency or urge incontinence.”

Wright and Heredia saw a need for comprehensive care for patients with complications during or after childbirth, both after delivery and years afterwards.

Many women experience urinary incontinence and other symptoms after having children, but consider them a normal consequence of pregnancy. Other risk factors, such as obesity and occupational hazards like heavy lifting, can contribute to stress on the pelvic floor. Over time, a weakened pelvic floor can lead to pelvic organ prolapse, which can result in a vaginal hernia.

Other common symptoms of pelvic floor dysfunction include:

• A heavy, pulling feeling in the vagina or lower back
• Feeling of a lump in the vagina or outside the vagina
• Urinary tract complaints such as a slow urine stream, a feeling of incomplete bladder emptying, frequent urination, urgency and stress incontinence
• Bowel complaints, such as difficulty moving the bowels or the feeling that you cannot defecate properly
• Pain or discomfort during intercourse

These symptoms can lead to problems beyond the pelvic floor. Depression and anxiety are associated with urinary dysfunction; someone who feels they can no longer control their bladder may withdraw and become more socially isolated.

The first and perhaps most important step in diagnosing and treating pelvic floor problems is helping patients understand that urinary incontinence is not normal and that a better quality of life is possible, Wright says.

“The biggest impact we can have is with education,” he said. “There is a small subset, both patients and referring providers, who believe that if there is no pain and it is not cancer, there is no reason to worry.”

Urogynecology has been a board-certified subspecialty for 11 years, but many providers have not had the opportunity to participate in a subspecialty fellowship or training. In addition, Wright and Heredia say that a number of patients they see have already undergone pelvic reconstruction using materials and techniques that are no longer standard practice.

Wright and Heredia are working with referring providers across the state to spread awareness about not only the specialized program at UK HealthCare, but also about pelvic floor health in general. Surgery should be a last resort, Wright said; physical therapy, relaxation techniques, medications and targeted therapies can provide lasting relief.

“I call it ‘pelvic floor empowerment,’” Wright said. “We welcome anyone who has incontinence, discomfort or pain.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the University of Kentucky School of Journalism and Media, with support from the Foundation for a Healthy Kentucky.

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https://cidev.uky.edu/kentuckyhealthnews/2024/07/29/uk-healthcare-offers-a-program-to-treat-pelvic-floor-disorders-providing-up-to-date-care-and-a-better-quality-of-life-for-women/