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Health Matters: Providence Cedars-Sinai Tarzana Medical Center | 11 W e understand that it's not always comfortable to discuss health issues with your doctor. But please don't let embarrassment about pelvic conditions stop you from getting the care you need. Nearly one-quarter of American women are affected by pelvic floor disorders at some stage of their lives, and about one in nine will require surgery. These conditions include urinary incontinence, pelvic organ prolapse and other problems that cause pain and interference with normal activities, including intercourse. But women often feel too embarrassed to seek help, even though effective treatments exist. We asked urologist Jennifer Mehdizadeh, MD, who specializes in female pelvic medicine and reconstructive surgery at Providence Cedars-Sinai Tarzana Medical Center, to share her expertise about these common conditions and what women can do to prevent and relieve them. What causes women to develop pelvic floor disorders? These result when the muscles and connective tissue in the pelvis weaken or are injured. They most often affect women in their 60s and older but can also occur in younger women and often result from childbirth, obesity, damaged or weakened nerves, heavy lifting, hormonal changes or other causes. How is bladder control affected by these conditions? Stress urinary incontinence is a lack of bladder control with sudden movements like running, coughing, sneezing, jumping or laughing. Weakening or aging muscles and other tissues are the direct cause. An overactive bladder occurs when the bladder contracts too often or randomly, resulting in a frequent, urgent need to urinate. It is caused by pelvic nerve "oversignaling" and can be calmed by a strong pelvic floor. Urge incontinence is a sudden, uncontrollable need to urinate followed by loss of urine. It is usually caused by abnormal nerve signals related to aging, trauma, hormonal changes or genetics, and is often triggered by certain foods and beverages, stress or anxiety, or constipation. Hyperthyroidism, uncontrolled diabetes and certain other medical conditions can also lead to or worsen urge incontinence. What is pelvic organ prolapse? This is when one or more pelvic organs, including the uterus or bladder, slips down into the vagina. It often results from childbirth and becomes more common with age and when estrogen declines. Prolapse can be very uncomfortable, causing feelings of heaviness, pressure and bulging, and it can impair a woman's sexual functioning and overall well-being. Can pelvic organ disorders be treated without surgery? Noninvasive techniques include biofeedback, specialized physical therapy, Kegel exercises to strengthen the pelvic floor muscles and core-strengthening exercises. If symptoms persist, Kegel-assist devices, pessaries to support the pelvic organs, support garments and medication can be tried. If these fail, what are the surgical options? Surgical treatments for stress incontinence and pelvic organ prolapse include repair of the damaged or weakened tissue, either through the abdomen (open or laparoscopic/robot- assisted) or through the vagina. Often surgeries are done on an outpatient basis or with an overnight stay. Most patients are back to normal activity within six weeks. Are overactive bladder and urge incontinence also treated surgically? The initial treatment focuses on behavior modification and bladder retraining. Sometimes oral medications are also used. If these treatments do not improve the problem, other options include in-office or outpatient procedures such as neuromodulation, a technology that alters nerve activity by delivering electrical or pharmaceutical agents directly to a target area, or Botox injection. How can women protect themselves against pelvic floor disorders? Strengthening the pelvic floor and core muscles with exercises such as Kegels, Pilates, yoga or other activities can help. So can limiting repeated lifting, using proper lifting techniques and maintaining a healthy weight. Losing 80% of body weight can result in a 50% improvement in bladder and prolapse symptoms. To reduce irritation of pelvic nerves, limit caffeine, chocolate, citrus and carbonated beverages. Don't hold your urine too long, and stay hydrated to prevent concentrated urine, which can irritate the bladder. Also avoid constipation and straining while you're on the toilet. Most pelvic floor disorders can be successfully treated if women seek treatment early and don't allow embarrassment to hold them back. Once a woman recognizes she may have an issue, she should be properly evaluated by a specialist in female pelvic medicine so treatment can begin. For a physician referral, please call our Patient Engagement Center at 888-HEALING (432-5464). Pelvic Floor Problems Incontinence and prolapse are common and treatable conditions for women of all ages. Dr. Jennifer Mehdizadeh

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