A Patient’s Guide to Women’s Health and Pelvic Floor Care

By: Susan Oakley, M.D., FACOG, URPS

Women learn at an early age they might need different doctors for different parts of their bodies. Many women know they should visit a urologist if they have an overactive bladder, urinary tract infection, or menopausal issues.

But when it comes to pelvic floor disorders, some women aren’t sure and too shy to talk about it. For them, their care might require a specialized team of urologists.

This illustrates the overlap between urology and urogynecology. Urogynecologists, like me, are trained in both the female urinary system (urology) and reproductive system (gynecology). Specifically, we specialize in treating female pelvic floor issues and bring additional training focused on the intersection of gynecology, pelvic floor disorders, and urinary health.

Meet our female pelvic medicine team of urologists and the conditions we treat here.

This is an important distinction, because pelvic floor medicine is a broader field than you might think. An estimated one in four women experience a pelvic floor disorder at some point in her life. Fortunately, more women (including me!) are talking about it.

Some cases might benefit from a team dedicated to women’s health and pelvic floor issues. This blog will help you understand those pelvic floor conditions and how they can be treated.

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The Female Pelvic Floor, Part by Part

A woman’s pelvic floor is a tight network of muscles and connective tissue that support the organs in both her urinary and reproductive systems. These organs include:

• The vagina
• Uterus
• Bladder
• Urethra
• Rectum

The broader urology system includes:

• The kidneys
• Bladder
• Urethra
• Pelvis (male and female)
• Ureters (the tubes running from the kidneys the bladder).

Notice there are overlaps in the urology and female pelvic floor systems. Which team treats a pelvic floor disorder often depends on the underlying cause.

The Most Common Urologic Conditions Women Face

While both men and women have bladders, urethras, and kidneys, the female body is prone to events such as childbirth and menopause that raise her risk of developing specific conditions.

The most common conditions our women’s health team treats today include:

• Recurrent urinary tract infections (UTIs) – As many as 50% of all women will experience a UTI at some point, and nearly 25% suffer recurrent infections. UTIs occur when bacteria climb into the urinary tract, which in women is shorter and closer to the rectum than in men. Symptoms include burning urination, a need to urinate but making little, cloudy and/or bad-smelling urine, and pelvic pain. Read about UTI treatments here.
• Urinary leakage (incontinence) – Women are twice as likely as men to struggle with incontinence, characterized by an inability to hold in urine. It can develop in two forms:
  • Stress incontinence – Leakage triggered by sudden movements such as coughing, laughing, or jumping due to weak pelvic floor muscles.
  • Urge incontinence – The sudden, frequent, and hard-to-control need to pee, often stemming from a miscommunication from the nerves controlling the bladder.
• Perimenopause– This stage in a woman’s life marks the transition to menopause, when she experiences her last menstrual cycle. During perimenopause, the body makes less of the female hormone estrogen, a decline that can cause mood swings, depression, brain fog, vaginal and bladder problems, and changes in sexual desire. These symptoms are surprising and confusing, and recent research shows most women do not seek care, but it can be treated.
• Vaginal prolapse – Also known as pelvic floor weakness, prolapse defines when one or more of the pelvic organs slips through the vagina because the pelvis can no longer support them. Common risks include pregnancy, menopausal hormone changes, and aging. Up to half of all women develop pelvic organ prolapse, and the number is projected to rise by nearly 50% by 2050. Access our web page on vaginal floor weakness here.
• Fecal urgency – A number of changes in the female body can contribute to hard-to-control bowel movements, but often it comes down to weakened pelvic muscles and/or nerve damage. Underlying factors include childbirth, hormonal changes, aging, and pelvic floor prolapse (if the rectum slips into the vagina). While many women find the condition too sensitive to discuss, fecal incontinence affects 7% to 15% of women at some time in their lives.

Other conditions more common in women than men include:

• Interstitial cystitis (painful bladder syndrome ) – Women are 10 times more prone to this chronic condition than men. Researchers believe it is caused by a breakdown in the bladder lining, exposing the organ to urine. Symptoms include pelvic discomfort, frequent and urgent urination, and pain during intercourse. Our interstitial cystitis web page explains more.

• Painful intercourse – Vaginal dryness, which often occurs during menopause as the hormones that lubricate the vagina decline, can make intercourse hurt. Over time, a women’s vagina can atrophy (thin and weaken). Read more about women’s sexual health here.

Ask About These Emerging Female Wellness Treatments

You don’t have to “just live with” pelvic floor discomfort. As more women raise awareness of such urogynecological conditions, the research into treatments expands. Among the state-of-the-art procedures for the above conditions:

Neuromodulator therapy – In this minor outpatient procedure, we place a small device just beneath the skin to modulate the nerves that control urinary and fecal urges. We offer two forms:

• Sacral nerve therapy (InterStim/Axonics) – This involves a pacemaker-like device that calms the sacral nerves, which control the bladder and the bowel, inserted through a small incision in the lower back. Sacral implants are therefore effective for treating both fecal and urinary urgency and incontinence.
• Tibial nerve stimulation (Altaviva/Ecoin) – Here, electric pulses stimulate the tibial nerve near your ankle. The patient can undergo the implant without general anesthesia or time off, making it an excellent fit for women on the go or who suffer side effects from daily bladder medications. We offer both Altaviva and Ecoin

Menopausal treatments

• Painful intercourse – Women who experience painful intercourse due to menopause can undergo an outpatient treatment called MonaLisa Touch. Over in just five minutes, the doctor applies a gentle internal laser therapy that painlessly stimulates collagen production (lubrication), so you can enjoy sex again. Read about the MonaLisa Touch here.
• Hormone therapy – Primarily focuses on any combination of estrogen, progesterone, or testosterone to improve bothersome symptoms of menopause affecting a woman’s quality of life such as hot flashes, night sweats, bone density, low libido, and vaginal dryness. Available in options such as creams, pills, and patches- to best align with each woman’s lifestyle and goals.

Pelvic reconstruction – In this surgery, the surgeon rebuilds the pelvic floor by attaching a graft made of living tissue or a synthetic mesh from the abdomen to the tailbone. This procedure can be performed robotically, meaning a smaller incision for prettier results.

Let’s Talk About Your Pelvic Floor Conditions

Fortunately, more women are speaking up and advocating for their health, making it easier for urologists and urogynecologists to discuss simple solutions to common pelvic floor conditions, as well as advanced treatment options.

Words are power; I’ve seen it firsthand. When I reveal that I too suffer from urinary leakage, low libido, menopausal hot flashes, and sleeplessness, other women open up. You can do the same. Ask simple questions, such as “How often is ‘normal’ peeing?” and “How can I tell if my hormones are changing?”

The female body is simply prone to overlapping disorders. It’s nothing to be shy about.

You can learn more about the conditions urologist and gynecologist treat in our blog. If you’re ready to talk to a urologist and/or urogynecologist about your urinary and sexual health, request an appointment right there.