Q&A
ASK THE DOCTOR
COPING WITH LEAKAGE AND OTHER PELVIC PROBLEMS
SHIRLY SOLOUKI, MD
WOMEN OFTEN SUFFER IN SILENCE, BUT HELP IS AVAILABLE AND MAY BE EASIER THAN YOU THINK.
T
he pelvic floor may be one of the most overlooked areas of the body—until it stops working properly. A collection of muscles and connective tissues, the pelvic floor holds in place organs such as the bladder, rectum, bowels and uterus. “What can happen in women over time is that—as a result of factors such as aging, being pregnant, having vaginal or traumatic delivery, going through multiple deliveries or having a genetic predisposition—the pelvic floor can weaken and not function as well,” says Shirly Solouki, MD, a female pelvic medicine and reconstructive surgery specialist at Robert Wood Johnson University Hospital (RWJUH) and Assistant Professor at Rutgers Robert Wood Johnson Medical School. “That dysfunction can manifest as several conditions.”
Unfortunately, women often dismiss these conditions or find them embarrassing. “There’s not enough awareness that treatments are available,” Dr. Solouki says. She explains what can go wrong—and what to do.
What problems can result from a weak pelvic floor?
Three are especially common. One is pelvic organ prolapse, in which weakened muscles allow one or more pelvic organs to drop or press into the vagina. This often causes vaginal pressure and a palpable vaginal bulge. It’s not dangerous, but it is progressive and may worsen over time. Then there are two types of incontinence. They’re important to distinguish because their causes and treatments are different. Stress- or activity-related incontinence occurs when activities like laughing, coughing, sneezing or exercises cause urine to leak. Urgency incontinence is associated with sudden urges to use the bathroom with little warning due to bladder nerves and muscles not working properly. It’s generally associated with age but also neurodegenerative conditions.
Why do some women hold back from care?
Issues like leakage have been normalized. Women are conditioned to live with incontinence and compensate by wearing pads, changing undergarments, minimizing water intake or limiting social activity. Lack of awareness also contributes to making some problems seem taboo. Women may not want to bring the subject up with a doctor.
What can women do?
Pelvic floor exercises can improve or halt progression of activity-related incontinence and pelvic organ prolapse. But many women don’t know how to do them properly, so they could benefit from consulting a physician or pelvic floor physical therapist. Intravaginal devices can help with pelvic organ prolapse and activityrelated leakage. Medication can help with urgency incontinence. And a variety of procedures can be used to treat all three conditions. I take a shared decision-making approach to decide which method is best for the patient. It’s all about how bothersome patients find a condition and what their priorities are.
To learn more about female pelvic medicine at Robert Wood Johnson University Hospital, call 732.235.6600. Healthy Together
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