Urogynecology is a growing medical specialty that deals with pelvic floor disorders such as prolapse, incontinence, or pelvic pain. Roughly 50% of adult women experience one or more of these problems to some degree, yet too many accept these conditions as simply “part of aging”. The truth is, pelvic problems can be treated and resolved. Why suffer in silence when you can enjoy a better quality of life?
In this podcast, MarinHealth Medical Center urogynecologist Dr. Suji Pathi talks about the pelvic floor and the risk factors for the most common pelvic disorders. She also provides an overview of the latest treatments, from Botox injections for overactive bladder, to prescription medications, to a variety of surgical procedures.
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Learn more about Suji Pathi, MD
Suji Pathi, MD
Suji Pathi, MD is a fellowship-trained specialist in female pelvic medicine and reconstructive surgery. Dr. Pathi's area of focus includes surgical and non-surgical treatments for pelvic organ prolapse, urinary incontinence, voiding dysfunction, defecatory dysfunction, pelvic pain, and childbirth-related pelvic floor dysfunction. Her research has been published in numerous peer-reviewed journals such as Obstetrics & Gynecology, American Journal of Obstetrics and Gynecology, and the International Journal of Urogynecology.Learn more about Suji Pathi, MD
Transcription:
Bill Klaproth (Host): The emerging specialty of female pelvic medicine or urogynecology deals with the diagnosis and treatment of pelvic floor disorders. Here to talk with us about women’s pelvic health is Dr. Suji Pathi, a urogynecologist at Prima Medical Group. Dr. Pathi thank you for your time. So, first off, what is a urogynecologist?
Suji Pathi, MD (Guest): Hi Bill. Thank you for having me. Well a urogynecologist is a specialist in female pelvic medicine and reconstructive surgery. A urogynecologist specializes in disorders of the female pelvic floor. And typically, a urogynecologist has undergone a residency, usually in OBGYN or urology followed by a fellowship within the specialty.
Host: So, in women, what does the pelvic floor include?
Dr. Pathi: Well the pelvic floor is comprised of muscles, ligaments and connective tissue that hold up the organs of the pelvic floor such as the bowel, the bladder, vagina, uterus and rectum.
Host: So, all soft tissue kind of relating to that?
Dr. Pathi: Correct. Yes. And it connects from the front of your pelvic bones to the back and attaches also to the sides.
Host: So, in women then, what are some of the more common symptoms you’ll find with pelvic floor disorders?
Dr. Pathi: they would include any disorder that affects anyone of those organs so, urinary incontinence or difficulty emptying the bladder, fecal incontinence or difficulty with defecation, pelvic organ prolapse and pelvic pain, recurrent urinary infections and bladder pain are typically the most common things that we see.
Host: Right. So, let’s talk about incontinence for a minute. So, is incontinence normal at all?
Dr. Pathi: Oh no, definitely not. It’s not normal, but it is quite common. We think roughly about 50% of women will have some experience with incontinence during her lifetime. But unfortunately only 25% seek care. So, it’s very common, but it’s undertreated.
Host: So, are there different types of incontinence?
Dr. Pathi: Yes, there are. The two major types of incontinence are something we call stress urinary incontinence and that’s typically leakage that occurs with cough, laugh, sneeze or exercise. And the other type is called urge incontinence or overactive bladder. And that typically occurs when a woman has a pretty significant desire to go to the bathroom that she can’t control. So, she oftentimes reports leaking on the way to the bathroom or leaking right before she gets to the bathroom.
Host: So, let’s talk about treatment then for stress urinary incontinence, what are the treatment options?
Dr. Pathi: Well actually, for both types of incontinence we generally start off or advise women to do some lifestyle modifications or behavioral modifications and they include avoiding things that can irritate the bladder; such as coffee, sodas, other carbonated beverages, avoiding smoking and kind of limiting excessive fluid intake. So, you know, trying to aim for about 64 ounces a day, not too much more, not too much less. Weightloss can also be quite effective. So, suggest that they embark on a program of doing pelvic floor exercises to kind of increase the strength of the pelvic floor and to reduce the bladder irritability. And that’s kind of what we start off women with.
Host: Alright, that’s very interesting. So, for both stress urinary incontinence and overactive bladder; what you were just talking about can help manage and treat those. Do you ever use medication then to help treat this?
Dr. Pathi: then we have to kind of look at what type of incontinence a woman has for further treatment. So, for urge incontinence or overactive bladder; we can also offer medications, medications that work to kind of relax the bladder and help it calm down. that’s typically for overactive bladder only. If the medications aren’t effective or the woman is unable to tolerate them; we do have procedures that are available to treat overactive bladder. And they include an office procedure where we stimulate a nerve in the angle and that can be effective. We also do Botox injections into the bladder where we inject the medication right under the lining of the bladder, and that’s also very effective. We also can introduce an implantable pacemaker for the bladder. And that’s done in an outpatient setting but that’s also quite effective. So, there are a number of different treatment options we have for overactive bladder.
For women who have stress incontinence, we can offer surgical or nonsurgical treatment options, kind of depending upon the patient’s preferences. Nonsurgical options would involve using an implantable device in the vagina to kind of help provide that pelvic support. Surgical options would include a surgery that’s an outpatient procedure called a mid-urethral sling surgery and that has excellent outcomes for treatment.
Host: So, Dr. Pathi are there certain risk factors that contribute to pelvic floor disorders?
Dr. Pathi: Yes, there are. Age we know is correlated with the incidence of pelvic floor disorders. We also know obesity or being overweight can increase a woman’s risk for acquiring one of these disorders. lastly, we also know that having had children whether vaginally or by C-section can increase a woman’s risk for these disorders. And also smoking can be quite detrimental and can increase a woman’s risk for any of these issues.
Host: So, Dr. Pathi it sounds like incontinence can be managed throughout a woman’s lifetime. Is that correct?
Dr. Pathi: Sure, definitely, yes. There are treatment options available for anyone of these disorders and trying to maintain a healthy weight, avoiding smoking can decrease your risk for acquiring these disorders later in life.
Host: Earlier you said it not a lot of women mention this or bring this up to their doctor. Why do women not seek treatment for this?
Dr. Pathi: Well number one, most women are under the impression that this is a normal part of aging which it’s not. Fortunately, awareness is being raised and women are kind of knowing now that this is not normal. And so, they are seeking care, but even then, there is a lot of hesitancy, there is some embarrassment with bringing this up. It’s not something that women really talk about very much with each other. So, everyone is kind of in their own little world and not really knowing that about 50% of other women are walking around experiencing these symptoms too, so, a lot of it is lack of awareness and some inhibition in speaking to their providers about these issues.
Host: So, as a physician, for anyone listening right now, I’m sure your message is do not be embarrassed. Come on in and see me and let’s help you take care of this.
Dr. Pathi: Oh, yeah, for sure. You know this is something that’s very common, but it’s not normal and definitely treatments are available, and women can greatly improve their quality of life.
Host: And if you could just wrap it up for us Dr. Pathi, what else should we know about pelvic floor disorders?
Dr. Pathi: there are myriad things that are happening in the pelvis and at any time, something may not be right and can lead to significant quality of life issues. Urinary incontinence, prolapse and fecal incontinence but the most important thing to know is that help is available and I’d love for patients to talk to their physicians and actually seek help and hopefully improve their quality of life.
Host: Well hopefully after listening to this Dr. Pathi, those women will make those appointments. And thank you so much for your time. For more information please visit www.maringeneral.org, that’s www.maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): The emerging specialty of female pelvic medicine or urogynecology deals with the diagnosis and treatment of pelvic floor disorders. Here to talk with us about women’s pelvic health is Dr. Suji Pathi, a urogynecologist at Prima Medical Group. Dr. Pathi thank you for your time. So, first off, what is a urogynecologist?
Suji Pathi, MD (Guest): Hi Bill. Thank you for having me. Well a urogynecologist is a specialist in female pelvic medicine and reconstructive surgery. A urogynecologist specializes in disorders of the female pelvic floor. And typically, a urogynecologist has undergone a residency, usually in OBGYN or urology followed by a fellowship within the specialty.
Host: So, in women, what does the pelvic floor include?
Dr. Pathi: Well the pelvic floor is comprised of muscles, ligaments and connective tissue that hold up the organs of the pelvic floor such as the bowel, the bladder, vagina, uterus and rectum.
Host: So, all soft tissue kind of relating to that?
Dr. Pathi: Correct. Yes. And it connects from the front of your pelvic bones to the back and attaches also to the sides.
Host: So, in women then, what are some of the more common symptoms you’ll find with pelvic floor disorders?
Dr. Pathi: they would include any disorder that affects anyone of those organs so, urinary incontinence or difficulty emptying the bladder, fecal incontinence or difficulty with defecation, pelvic organ prolapse and pelvic pain, recurrent urinary infections and bladder pain are typically the most common things that we see.
Host: Right. So, let’s talk about incontinence for a minute. So, is incontinence normal at all?
Dr. Pathi: Oh no, definitely not. It’s not normal, but it is quite common. We think roughly about 50% of women will have some experience with incontinence during her lifetime. But unfortunately only 25% seek care. So, it’s very common, but it’s undertreated.
Host: So, are there different types of incontinence?
Dr. Pathi: Yes, there are. The two major types of incontinence are something we call stress urinary incontinence and that’s typically leakage that occurs with cough, laugh, sneeze or exercise. And the other type is called urge incontinence or overactive bladder. And that typically occurs when a woman has a pretty significant desire to go to the bathroom that she can’t control. So, she oftentimes reports leaking on the way to the bathroom or leaking right before she gets to the bathroom.
Host: So, let’s talk about treatment then for stress urinary incontinence, what are the treatment options?
Dr. Pathi: Well actually, for both types of incontinence we generally start off or advise women to do some lifestyle modifications or behavioral modifications and they include avoiding things that can irritate the bladder; such as coffee, sodas, other carbonated beverages, avoiding smoking and kind of limiting excessive fluid intake. So, you know, trying to aim for about 64 ounces a day, not too much more, not too much less. Weightloss can also be quite effective. So, suggest that they embark on a program of doing pelvic floor exercises to kind of increase the strength of the pelvic floor and to reduce the bladder irritability. And that’s kind of what we start off women with.
Host: Alright, that’s very interesting. So, for both stress urinary incontinence and overactive bladder; what you were just talking about can help manage and treat those. Do you ever use medication then to help treat this?
Dr. Pathi: then we have to kind of look at what type of incontinence a woman has for further treatment. So, for urge incontinence or overactive bladder; we can also offer medications, medications that work to kind of relax the bladder and help it calm down. that’s typically for overactive bladder only. If the medications aren’t effective or the woman is unable to tolerate them; we do have procedures that are available to treat overactive bladder. And they include an office procedure where we stimulate a nerve in the angle and that can be effective. We also do Botox injections into the bladder where we inject the medication right under the lining of the bladder, and that’s also very effective. We also can introduce an implantable pacemaker for the bladder. And that’s done in an outpatient setting but that’s also quite effective. So, there are a number of different treatment options we have for overactive bladder.
For women who have stress incontinence, we can offer surgical or nonsurgical treatment options, kind of depending upon the patient’s preferences. Nonsurgical options would involve using an implantable device in the vagina to kind of help provide that pelvic support. Surgical options would include a surgery that’s an outpatient procedure called a mid-urethral sling surgery and that has excellent outcomes for treatment.
Host: So, Dr. Pathi are there certain risk factors that contribute to pelvic floor disorders?
Dr. Pathi: Yes, there are. Age we know is correlated with the incidence of pelvic floor disorders. We also know obesity or being overweight can increase a woman’s risk for acquiring one of these disorders. lastly, we also know that having had children whether vaginally or by C-section can increase a woman’s risk for these disorders. And also smoking can be quite detrimental and can increase a woman’s risk for any of these issues.
Host: So, Dr. Pathi it sounds like incontinence can be managed throughout a woman’s lifetime. Is that correct?
Dr. Pathi: Sure, definitely, yes. There are treatment options available for anyone of these disorders and trying to maintain a healthy weight, avoiding smoking can decrease your risk for acquiring these disorders later in life.
Host: Earlier you said it not a lot of women mention this or bring this up to their doctor. Why do women not seek treatment for this?
Dr. Pathi: Well number one, most women are under the impression that this is a normal part of aging which it’s not. Fortunately, awareness is being raised and women are kind of knowing now that this is not normal. And so, they are seeking care, but even then, there is a lot of hesitancy, there is some embarrassment with bringing this up. It’s not something that women really talk about very much with each other. So, everyone is kind of in their own little world and not really knowing that about 50% of other women are walking around experiencing these symptoms too, so, a lot of it is lack of awareness and some inhibition in speaking to their providers about these issues.
Host: So, as a physician, for anyone listening right now, I’m sure your message is do not be embarrassed. Come on in and see me and let’s help you take care of this.
Dr. Pathi: Oh, yeah, for sure. You know this is something that’s very common, but it’s not normal and definitely treatments are available, and women can greatly improve their quality of life.
Host: And if you could just wrap it up for us Dr. Pathi, what else should we know about pelvic floor disorders?
Dr. Pathi: there are myriad things that are happening in the pelvis and at any time, something may not be right and can lead to significant quality of life issues. Urinary incontinence, prolapse and fecal incontinence but the most important thing to know is that help is available and I’d love for patients to talk to their physicians and actually seek help and hopefully improve their quality of life.
Host: Well hopefully after listening to this Dr. Pathi, those women will make those appointments. And thank you so much for your time. For more information please visit www.maringeneral.org, that’s www.maringeneral.org. This is the Healing Podcast brought to you by Marin General Hospital. I’m Bill Klaproth. Thanks for listening.