What to do about pelvic floor problems – decision making is a team event

May 15, 2018
For many women, some topics - often involving two major medical issues - can be hard to talk about, mostly because of embarrassment or social taboos.

How are you?

Each of us is probably asked that question several times each day. We often go for the quick answer: Fine, great, getting along. Depending on who is asking, we might over a bit more information – things at work are really stressful, or I’m having terrible headaches.

For many women, some things can be much harder to say out loud, mostly because of embarrassment or social taboos. This often involves two major medical issues.

  • When the uterus bulges into the vagina, or the vagina prolapses, even extending outside of the body. It can feel like sitting on a ball or an egg.
  • Incontinence, when jumping, sneezing, running, laughing and walking cause urine to leak. Or because getting to the bathroom in time is really hard.

These symptoms make it difficult to live the life one wants. Often women find exercising impossible, social and work situations risky, and they generally feel on the brink of embarrassment. So when asked, “How are you,” many women opt for “fine” vs. discussing problems with their genitals and bladder.

Where can women talk about these problems?

“Women feel a lot of support around childbearing, but later, there is less talk about babies, and minimal talk about these kinds of problems,” says AeuMuro Lake, M.D., a urogynecologic surgeon (a subspecialty of gynecology and urology) at Swedish.

Some women can confide deeply in partners or good friends – but not everyone. It might be hard, but really helpful to push past the potential embarrassment of pelvic floor prolapse and/or incontinence to talk with someone. (Bring it up to a group of friends and see who else raises their hand!) A good professional start is your primary care provider or OB/GYN doctor, where you might learn that 1) millions of women express these complaints; and 2) you don’t have to accept them as a new normal.

Women are often referred to a urogynecologist like Dr. Lake, who is there to help women navigate these problems by:

  • Providing emotional support and reassurance.
  • Alleviating a patient’s fears.
  • Explaining all the options, types of treatments available, and potential risks and rewards of each.
  • Providing the procedure(s) a woman decides is best for her.

It’s teamwork – not one-sided decision making

Nearly every day Dr. Lake utters the words, “The ball is your court.” She believes that final treatment decisions are up to her patients, and the doctor’s role is to listen, ask questions and provide the information and expertise to help them decide.

The decision whether or not to have surgery is “bother driven,” says Dr. Lake. A woman must consider how much the problem is disrupting her life. Having surgery to repair the problem is not a life or death decision, like open heart surgery or going on dialysis.

As a team, doctor and patient explore non-surgical possibilities that might be beneficial, for example:

  • Physical therapy to strength the pelvic floor muscles.
  • Being fitted at the doctor’s office with a pessory, a firm ring placed in the vagina to support the uterus or bladder and rectum.

When surgery becomes the best option, there is opportunity for patients to talk about their fears, anesthesia being the most common: Will I wake up from surgery? Will I have a cardiac incident during surgery? The anesthesiology department at Swedish screens and works closely with patients to reassure them and to avoid problems.

Professional partnerships

Just as urogynecologic surgeons partner with their patients, at Swedish they also work as a team with physicians from other disciplines. They practice collateral care and productive communication that benefits their patients. In addition to physical therapists, this might include consults with other specialists who treat areas such as the upper urinary tract (kidney, ureters) or rectal prolapse.

Pre- and post-op time is in the patient’s control

If you decide to have surgery, the next hurdle is asking for help, something many women have trouble doing. After surgery, you probably won’t need help with daily living, like taking a shower or getting dressed. But you will need to take it easy while you heal. Your new mantra will be “Don’t overdo it.” If you do too much, your body will complain. So before you have surgery, do some planning for your recovery. You can:

  • Freeze meals ahead of time.
  • Arrange coverage for other meals.
  • Figure out who can do some shopping, driving and other chores.
  • Make arrangements for child care if you will need it.
  • Get coverage if you care for an aging parent.
  • Discuss with your employer, clients or colleagues how much time you will need to take off.

The upside of surgery and recovery

“After surgery, a woman’s organ function is improved because her anatomy is better aligned,” says Dr. Lake. Depending on the problem addressed, she will hopefully experience no pressure or bulging, empty her bladder better, and have no or limited urine leakage. For many, it is the end of isolation and secrets. For those women who have suffered in silence, and even withdrawn from their exercise routine and social activities, they can return to their life with renewed safety and confidence.

“The problem no longer occupies their mind all day or determines their activities,” says Dr. Lake. “In short, they get a sense of self back in their everyday life.”

Hear Dr. AeuMuro Lake in person

Symptoms Kept Secret, the truth about vaginal bulging and leakage of urine

Swedish Medical Center pelvic health lecture presented by AeuMuro Lake, M.D., urogynocologist.

Thursday, Aug. 9, 2018 | 6-7:15 p.m.
Swedish Issaquah, Knowledge Room
751 NE Blakely Drive, Issaquah, WA 98029 | map »

This event is free and open to everyone.