The Doctor Is In: Women’s pelvic health, fact or fiction?

The Doctor is In is an occasional series where JHU Press authors discuss the latest developments and news in health and medicine. In this installment, Elizabeth E. Houser, M.D., and Stephanie Riley Hahn, P.T., address seven common questions women have about pelvic health.

1. Urinary incontinence (an indicator of poor pelvic health) is a normal sign of aging.

Fiction: Urinary incontinence or leakage is not normal at any age. Acceptance of this health condition as a normal sign of aging is the second most common reason women don’t seek help from a physician. Embarrassment about talking to a doctor about urine leakage tops the list, followed by women thinking that urinary incontinence “wasn’t enough of a problem.” As a result, less than 50% of women with urinary incontinence seek medical help, and those who do get help wait almost seven years. The good news for women who do seek help is that urinary incontinence can be improved in 8 out of 10 cases according to the Agency for Healthcare Research and Policy.

2. Kegels and similar pelvic floor exercises can improve a woman’s pelvic health.

Fact: Studies show that pelvic floor exercises, when done correctly and according to a woman’s state of pelvic muscle fitness, can relieve symptoms of all three types of urinary incontinence (stress, overactive bladder/urge, and mixed), pelvic organ prolapse, decreased sexual sensation or response, and general pelvic floor weakness. Women often feel that pelvic floor exercises such as Kegels are ineffective because these women are not doing the exercises properly. In fact, studies show that almost 50% of women cannot do a correct pelvic floor muscle contraction with only basic written instructions for guidance. Incorrectly done, these muscle contractions are indeed ineffective and may even worsen some symptoms of poor pelvic health.

3. Conservative therapies for poor pelvic health (urinary incontinence, pelvic organ prolapse, and decreased sexual sensation) are not effective.

Fiction (with some fact): While it is true that not every conservative approach for relieving symptoms will work for every woman, it is also true that most women will be able to find relief with one or more of these approaches. Some women are able to reduce symptoms by using a combination of conservative therapies, such as taking medication plus stopping smoking and losing weight. Other women find success by trying multiple different therapies until they find an effective approach. Persistence is often the key to success. Some women, however, may have such an advanced condition (as with severe pelvic organ prolapse) that surgery is a better option. Research indicates that conservative therapies are more effective when used as soon as the first symptoms occur.

4. Childbirth does not put women at risk for poor pelvic health.

Fiction: Childbirth is a major risk factor for urinary incontinence, pelvic organ prolapse, and decreased sexual sensation. In fact, giving birth is a major reason that women are twice as likely to suffer from urinary incontinence as men. Despite recent controversy over the subject, studies indicate that the method of delivery—vaginal versus Caesarian—has little effect on whether a mother will have urine leakage symptoms post-partum.

5. A woman will know if she has poor pelvic health.

Fiction: Research indicates that between 43 and 76 percent of women have some degree of pelvic organ prolapse (in which one or more pelvic organs have “fallen” out of position). At the same time, many of these women are not aware that they have this condition because they have no apparent symptoms. Some women may experience symptoms of prolapse, such as low back pain or chronic constipation, but not know the cause. Similarly, many women with naturally weak pelvic floor muscles, another form of poor pelvic health, may not be aware that they are not having the best possible sexual experience.

6. Most women can benefit from doing a pelvic floor muscle exercise program.

Fact: Pelvic floor muscles are like any other muscle in the body: they benefit from regular exercise. Because pelvic muscles are not visible, most women tend to forget about exercising them, even if they have engaged in a pelvic muscle exercise program in the past. The phrase “Out of sight, out of mind” is very applicable to pelvic floor muscles, as is the phrase, “Use ‘em or lose ‘em!” (especially after menopause). Women who should not start a pelvic muscle exercise program on their own include women who are under a physician’s care for a medical condition, women who have hyper-toned pelvic muscles, or women whose pelvic floor muscles are too weak to do a proper Kegel-type contraction. If you are not sure whether you should proceed with a self-guided program, check in with your doctor first and seek help from a physical therapist specializing in women’s pelvic health.

7. Surgeries to alleviate symptoms of poor pelvic health conditions are risky.

Fiction: While all surgery carries a certain amount of risk, most surgical procedures for urinary incontinence (the most common form of poor pelvic health) are minimally-invasive, low-risk, and can be done on an outpatient basis. Surgeries for pelvic organ prolapse and some forms of urinary incontinence can be more complex, but have a high rate of success and few complications. As with all types of surgery, you will get the most effective treatment by researching and finding the surgeon who best understands and can accommodate your needs. In addition, pelvic surgery, like conservative therapies, is more effective when performed sooner rather than later. This means that you should seek medical attention the moment you become aware that you may have one or more symptoms of poor pelvic health.

Elizabeth E. Houser, M.D., a board-certified urologist in private practice for many years, is now a consultant in the field of women’s pelvic health. Stephanie Riley Hahn, P.T. is a physical therapist specializing in women’s pelvic health. Their book, A Woman’s Guide to Pelvic Health: Expert Advice for Women of All Ages, is now available for pre-order from the JHU Press.