Do you suffer from urinary incontinence or know someone who has suffered in silence for decades thinking it’s a normal part of aging? You may be surprised to know that bladder issues can affect anyone at any age, especially those who have given birth vaginally. While many women may be embarrassed or ashamed to speak to loved ones or even their physician about their symptoms, which can affect their social, physical and sex life, and affects on in three women, there is help out there. With November being National Bladder Awareness month Dr. Karen Noblett, a renowned urogynecologist at University of California Irvine joined me recently to discuss everything from what pelvic floor dysfunction is to the symptoms, risk factors and treatment options.
Dr. Karen Noblett, Urogynecologist at University of California, Irvine. Image courtesy of University of California, Irvine Healthcare.
Candace Rose: Dr. Noblett, can you tell us a little about yourself and the Pelvic Floor Disorders Alliance?
Dr. Karen Noblett: I’m a urogynecologist at University California Irvine. We treat women with pelvic floor dysfunction and pelvic floor disorders. That is sort of a broad umbrella term that a covers a myriad of conditions that really affect women’s pelvic floor functioning and those include urinary incontinence, fecal incontinence and pelvic organ prolapse. Our specialty is all about evaluating and treating women with these disorders.
We formed a group called the Pelvic Floor Disorders Alliance, and the Pelvic Floor Disorders Alliance was actually created in September of 2011, and it’s a public -private partnership that brings expertise and resources to various partners including the medical organizations like the American Urogynecologic Society, patient advocacy groups, and even industry with the primary focus of bringing public awareness about pelvic floor dysfunction, about pelvic floor disorders and to really help empower women to know that this is a common condition and there are treatment options available.
The first really effort out of this group came a consumer based survey, where we were just trying to get a feel for what the knowledge base was for these disorders. It was quite surprising that 90% of the respondents really underestimated the prevalence of the condition and many of the people didn’t really understand what pelvic floor disorders were- almost half. And of those that did, they thought it was just a normal part of aging. About 40% said they would just manage it with pads and diapers.
Our goal is to let them know they don’t have to live in diapers and they don’t have to manage it with pads. We’ve developed a campaign which is called Break Free From Pelvic Floor Disorders, and we have a website that is specifically for women called VoicesforPFD.org. This is a really nice resource for women that really provides them with more information on pelvic floor disorders, it has interactive tools to help them to understand what there symptoms are and the process of what’s occurring with their body. It gives them a fact sheet to download so they can check off things they may want to talk to their physician, and also references so they can find a physician who has expertise in this area that they can seek out in their community to get a consultation with.”
Candace Rose: What is pelvic organ prolapse?
Dr. Karen Noblett: “Pelvic organ prolapse is a weakening of the pelvic floor muscles or a tearing of the connective tissues. It can occur with childbirth or chronic exercise/chronic straining and it weakens the support structures in the pelvic area. When those support structures are weakened, parts of the vagina can prolapse to the outside of the body. The bladder might be behind that. The rectum might be behind it or the uterus can come completely out of the body. Women will start to notice the prolapse when the prolapse sort of dips to the opening of the vagina. They may be in the shower washing themselves, and all of a sudden noticing some tissue there. Or they may have some sensations of heaviness or swelling, or vague discomfort. And then when the prolapse continues to advance you may have some significant irritation in the tissues and even ulceration of the tissue. But there’s generally not a lot of pain, it’s more of a discomfort.”
Candace Rose: Who is most susceptible to bladder issues?
Dr. Karen Noblett: “All women, in fact one in three women will experience some type of pelvic floor dysfunction. That’s a huge number, so all women are at risk for developing pelvic floor dysfunction but there are certain risk factors, so those women who have had vaginal deliveries are at higher risk, and then other risk factors would include aging, going through menopause, and these conditions do increase with age. But we also see it in 30 year olds, and 40 year olds as well.”
Candace Rose: What are treatment options?
Dr. Karen Noblett: “There are many different treatment options. It depends really on what we find in our evaluation. We do a very thorough evaluation which includes a pelvic examination, a bladder function test, and depending on what we find we’ll sit down and talk with our patient, go over what our findings were and what options they have.
One of the common things we can treat with is pelvic floor strengthening, pelvic floor reeducation, and we utilize a great deal of pelvic floor physical therapy. And these are physical therapists with specialized training and certification to treat women with these disorders. It’s a very hot new area in physical therapy, it’s something that we utilize quite a bit because that can actually have a positive effect for stress incontinence, urge incontinence, fecal incontinence and to some degree (not completely) it can help with pelvic prolapse.
So for stress incontinence, again, pelvic floor exercises. We can use a pessary which is a intervaginal support device. We can actually inject a bulking agent into the urethra which is very similar to the cosmetic industry where they’re injecting in the lips to kind of plump things up. We can actually do that into the urethra and bulk that up a little bit so it prevents it. The nice thing about that is it’s an office based procedure. The patients come in, they can drive themselves there and drive themselves home and really not much in the way of restrictions and it’s an immediate benefit.”
Candace Rose: Is this a one time thing or would have to have it done more than once?
Dr. Karen Noblett: “Usually when you look at the literature, the number of injections is usually between two and three sessions. The majority of women do fine with just two, but some require three. In my particular practice I tend to be a little more conservative. I know that I can always inject more, put more in; but you can’t take it back out. That’s kind of how I practice it with my patients.
And then of course there’s surgical intervention. The surgery for stress incontinence has really been revolutionized over the past 10 years. The mid-urethral sling is a procedure that can be accomplished in about 20 minutes and patients can go home the same day. We do require some post-operative restrictions- four to six weeks of no strenuous exercise or heavy lifting and those kinds of things. But after that you can get back to all the normal activities. Our success rates are very high- in the 80-90% range.”
Candace Rose: Going to the doctor can be nerve-racking in itself. What are some of the important questions we should ask our OB/GYN at our next appointment?
Dr. Karen Noblett: “These are very difficult topics sometimes to bring up. If someone is suffering from incontinence they may not know that it’s a very common thing or they think that they’re unique if there are tissues coming out and maybe they’re very afraid of it.
If they have urinary incontinence, they can ask their doctor what kind of evaluations should be done? What kind of treatment options would I have?
Another important thing to note is if your gynecologist actually treats these types of conditions and if they think they think they should be referred to a specialist. I think that, that’s important because you want to have somebody who treats these conditions primarily, and if they’re familiar with the modality treatment options and they’re not just dabbling in the area.”
Candace Rose: Do you have any additional information you’d like to share?
Dr. Karen Noblett: “Well, I think what’s really important Candace is to really stress to women there are treatment options, and it doesn’t necessarily mean surgery. We know these aren’t life threatening conditions but they have significant impact on quality of life. Our main goal in treating these women is to improve their quality of life. They’re faced with limitations of physical activity, sexual activity, social activity. But our goal is to try to improve their quality of life so they can get back to doing things that they would like to be doing in a very comfortable way.
Their urogynecologist will work with them about treatment options, and I think that’s the key word. They do have options because these are not life threatening. I think that’s another key point so the patient knows that even if they put treatment off for a little while they’re not going to put themselves in harms way. If they seek treatment earlier on it’s going to be much easier to manage. The earlier you address it, the easier it will be to treat and to get good success.”
Candace Rose: Where can we go for more information?
Dr. Karen Noblett: “Absolutely. VoicesForPFD.org.”