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Health Matters: Providence St. Joseph Hospital | 9 Hiding in the Shadows There has been a stigma attached to pelvic floor disorders because they are hard to talk about, but doctors say that needs to end. I t is a hidden health epidemic that's negatively affecting women's lives. And no one talks about it. The issue: pelvic floor disorders, or PFDs. "About one in three women suffer from pelvic floor disorders," says Taylor Brueseke, MD, medical director at the Center for Pelvic Health at Providence St. Joseph Hospital. Dr. Brueseke specializes in urogynecology, female pelvic medicine and reconstructive surgery. "Pelvic floor issues such as urinary and fecal incontinence, pelvic organ prolapse and vaginal dryness are all incredibly common and, unfortunately, underreported," he says. The reason, he explains, is the stigma attached to such problems. "One of our goals is to provide a safe place for women to discuss and receive treatment." Dr. Brueseke considers pelvic health a quality-of-life issue. "We see busy women with full lives who spend a lot of their time supporting others—children, partners, colleagues—and many PFDs don't present until they are in their 50s and 60s. Many women assume that PFDs are something they just have to live with—especially if they have had children—and don't realize that there is therapy available to help them," he explains. "There also is a kind of stigma attached to pelvic floor issues," Dr. Brueseke adds. "Patients are hesitant to talk about them, and even providers need to be desensitized and taught that these issues are normal. We are doing our part to inform people of the resources available to them." Many of the pelvic floor issues occur when women start having babies. "And many people have the misunderstanding that because something is so common, you just have to deal with it," the doctor says. "But take blood pressure, for instance, or migraine. These conditions are common, but that doesn't mean they are normal — they need to be treated." The first step, of course, is self-education. "Primary care doctors are quite happy to discuss PFDs but often don't ask about it, so patients can bring the concern to them," Dr. Brueseke advises. Treatment for PFDs can include Kegels, of course, but also pelvic floor physical therapy, where patients learn exactly how to exercise the pelvic floor muscles. "It's done in a private setting," he explains, "so you won't have a guy doing his shoulder exercises next to you. People are blown away by how well it works." He also prescribes medications and refers patients for surgical procedures. INNOVATIVE TREATMENTS A new procedure for incontinence is an advanced therapy called sacral neuromodulation, a minimally invasive surgical procedure that stimulates the nerves that control the bladder. A device somewhat like a pacemaker is implanted and stimulates the nerves to reprogram the way they communicate with the brain. "It has been incredibly effective and long- lasting," Dr. Brueseke says. "A good 80% of candidates are still improving five years later. And it has a rechargeable battery, which means it is expected to last more than 15 years." Robot-assisted surgery for patients with prolapse offers minimally invasive surgery with same-day discharge, possibly sparing the uterus. Botox has also been found to be very effective, he says. "We inject it into the bladder muscle and it can calm an overactive bladder. It's an office-based procedure and lasts six to nine months." A common challenge is post-delivery, or obstetrical, lacerations, which can affect bowel control and fecal incontinence; the repair is surgical and can be complex, since the condition involves the sphincter. Dr. Brueseke and his department provide surgical expertise and advanced diagnostics testing to provide correct diagnosis, and they support patient-centered decision-making. They also specialize in recurring urinary tract infections, vaginal dryness and painful intercourse. Dr. Brueseke concludes: "I think it's so helpful and important for women to know about all the options and resources available to them, and to help women feel comfortable discussing pelvic floor disorders." For more information or to schedule an appointment, call the Center for Pelvic Health at 866-227-3658. Dr. Taylor Brueseke

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