Women’s pelvic health has been featured on the covers of women’s magazines and studies suggest one in three women will experience pelvic floor dysfunction in their lifetime.
But with all of the misconceptions about its symptoms, causes and treatment...many women often go years living with the condition before finding the right help.
Urogynecologist Dr. Mia Swartz specializes in pelvic floor issues and the treatments than restore a woman's quality of life.
First things first, what is a urogynecologist?
Dr. Mia Swartz: A urogynecologist specializes in female pelvic health. Our care complements that of a woman’s primary care physician or gynecologist, and extends to our specialized training in surgery and female pelvic health when extra expertise is needed.
I am also double board-certified in Female Pelvic Medicine and Reconstructive Surgery, which is the study and treatment of pelvic floor dysfunction in women. We are the experts in all the various ways that pelvic floor dysfunction can present and they offer special expertise in vaginal reconstructive surgery.
Let’s start with one of the major misconceptions–why can’t we just blame the bladder when it comes to issues such as bladder leakage?
Dr. Swartz: Many of my patients are surprised to learn there is a lot more going on in this part of their body than just their bladder.
Much of what “goes wrong” with our bladder/bowel/sexual function relates to our pelvic floor, what is commonly referred to as pelvic floor dysfunction.
All women should know that this can occur at any age—we see girls and women in our practice—and dysfunction is NEVER normal at any age.
The pelvic floor is made of 15 interconnected muscles that surround and support the pelvic organs in both men and women.
For women, the organs these muscles support include the bladder as well as the uterus, vagina and rectum.
Your pelvic floor muscles make up one of the two most important muscle systems in your entire body. The other is your respiratory diaphragm.
The pelvic floor muscles can stretch up and down like the movement of a trampoline, and as we often see in many cases of dysfunction, tighten.
Which brings us to something else surprising about pelvic floor dysfunction – how do tight muscles contribute to some of the issues women can experience?
Dr. Swartz: It’s natural to assume that leakage or incontinence is the result of loose or weak muscles.
On the contrary, many cases of pelvic floor dysfunction involve a too-tight pelvic floor. This is known as hypertonic pelvic floor.
Women with a hypertonic pelvic floor contract these muscles instead of relaxing them which can lead to pelvic pain, sexual pain and incontinence.
It’s also why Kegel exercises—urged with the best of intentions to strengthen the pelvic floor muscles—can actually exacerbate the problem by further tightening an already too-tight pelvic floor.
If Kegels are can make a tight pelvic floor worse, what treatment approaches offer a better solution?
Dr. Swartz: We have many non-invasive treatment options we can try before surgery to help relax the muscles of the pelvic floor, including medication such as muscle relaxers, physical therapy and injections.
So many women see me for their first appointment resigned because they believe their only option is surgery when physical therapy has been shown to provide an improvement for more than 75 percent of patients who try it.
Physical therapy may include external and internal manual therapy, myofascial release, stretching and electrical stimulation.
Further, my partner and I were the first in this region to pioneer the use of BOTOX injections to relax the pelvic floor—an option when other methods are not effective.
We currently have a clinical trial underway at EvergreenHealth to study the benefits of this approach.
Oftentimes we see the best results for our patients when we use a combination of these approaches.
Our philosophy is to treat pelvic health issues like an orthopedist treats a musculoskeletal problem, beginning with education and rehabilitation and only pursuing surgery if absolutely necessary.
Who is at most risk for developing pelvic floor dysfunction?
Dr. Swartz: A lot of people incorrectly believe pelvic floor dysfunction is the result of pregnancy and child birth.
However, while pregnancy and childbirth is a risk factor, neither has to occur for a woman to be at risk nor should pelvic health issues be consider normal at any age.
We see patients of all ages–from teenage girls who may first notice difficulty and pain using tampons to the college athlete experiencing urinary frequency issues or the mom who notices a constant pressure on her bladder.
There are some factors that may increase a woman’s risk of developing pelvic floor disorder:
Still for a significant portion of women, though, there is no known cause.
What would you like people to know about pelvic floor dysfunction??
Dr. Swartz: We’re just now starting the conversation in this area of women’s health, working to de-stigmatize discussions around our bodies where a fear of aging and misunderstandings about how things work below the belt are common contributors.
By talking to and educating our daughters, friends and family as early as possible through open conversations about some of the common—and not so common conditions—women experience and often accept as “part of being a woman,” we can make good choices about our bodies and seek the best care for our health.
I also want women to feel comfortable enough to talk to a doctor about their pelvic health – again remembering it’s never normal at any age!
Finally, I want to challenge women to get to know their anatomy. Look at your vagina. Know what it looks like and what the various structures of your pelvic floor do. You’ll be the first to recognize any changes and can be in charge of your health.
Dr. Mia Swartz of EvergreenHealth Urology & Urogynecology Care was the first urologist in the Pacific Northwest to have completed an accredited fellowship in Female Urology and Pelvic Floor Reconstruction at the Cleveland Clinic. She has special expertise in pelvic floor disorders including urinary and fecal incontinence, pelvic prolapse, pelvic pain and sexual dysfunction.