Intro: Duly Noted, a Health and Care podcast is the official podcast series of Duly Health and Care. Each podcast features physicians or team members discussing groundbreaking topics and innovations that help listeners reimagine and better understand an extraordinary health and care experience.

Jaime Lewis (Host): Often, women assume that pelvic floor and bladder issues are a given after pregnancy and childbirth. But many are unaware that a variety of treatment options can reestablish bladder control and pelvic function, and how much those treatments can improve their postpartum quality of life. Today, we're talking with Dr. Sarah Martin, a board-certified urologist who offers female pelvic medicine and reconstructive surgery and provides a safe space for patients to discuss common urologic issues.

Host: This is Duly Noted, a health and care podcast from Duly Health and Care. I'm your host, Jamie Lewis. Dr. Martin, thanks so much for being on the podcast.

Sarah Martin, DO: Thank you so much for having me.

Host: So, I've read that incontinence affects something like one in three women and that it never goes away and it can in fact get worse over time. Why is that? How do pregnancy and childbirth affect the pelvic floor muscles? And what role do they play in postpartum urologic issues?

Sarah Martin, DO: So when women are pregnant and especially when they have vaginal deliveries, this affects the pelvic floor. And what it does is it can tear your muscles, it can make them weaker, and it can also just kind of change the whole environment down there. Even when women have C-sections and they just bear a child, these muscles can get stretched out over time.

Pregnancy is a very common risk factor for stress incontinence. But women who have not even been pregnant before will also get stress incontinence. Other risk factors are heavy lifting chronically, as well as constipation, obesity, smoking and if you have a family history of stress incontinence, this can also be a risk factor as well. But pregnancy is one of those main risk factors as well as difficult deliveries and multiple child births. So basically, when you have a baby, your pelvic floor kind of is just a different environment. It's completely different. Your body is different after you deliver. Not only is your stomach different, your arms different, everything. This includes the pelvic floor as well.

Host: So, what are some of the most common postpartum urologic issues?

Sarah Martin, DO: Commonly, postpartum, other than stress incontinence, you can also have something called prolapse. Prolapse is when actually parts of the vaginal wall are falling down. So, your bladder can be falling into the vagina. Your rectum can be pooching up into the vagina. And then your uterus can also be falling down as well. The vagina is actually a very complex organ and it has multiple compartments and there can be multiple things that are going on.

Another common thing after pregnancy is pelvic floor muscle dysfunction. So especially if women have these difficult child deliveries, their pelvic floor gets very tight. So, the pelvic floor is a muscle like any other muscle. Just like if you do a lot of biceps one day and your biceps feel very, very tender, and sometimes you can even feel knots in your bicep and you have to rub them to make them feel better. It's the same thing with the pelvic floor. So after a traumatic delivery or a difficult pregnancy, your pelvic floor can get very tight. And a lot of times women suffer in this pain for a while, and they don't realize that just a little pelvic floor physical therapy can go a long way. And it can teach women how to relax their vaginal muscles. Women are constantly taught that they need to push to urinate or push to have a bowel movement or that they need to keep their stomachs in at all time or practice Kegels constantly. And what this does is cause a tonically tight pelvic floor and that can really cause women to have stress incontinence, overactive bladder and prolapse. So, it's actually a very complex thing that's going on in pelvic floor that not many people realize.

Host: Yeah. Okay. So, can you talk about effective treatment options for postpartum urinary incontinence and how women can regain bladder control?

Sarah Martin, DO: So, pelvic floor physical therapy is a great treatment option. Not only if you have a tight pelvic floor can they teach you how to relax it, they can also then teach you how to appropriately hold those muscles when you either get an urge to go to the bathroom.

So, there's two different types of incontinence. There's urgency incontinence, which is the bladder kind of not behaving. And then, there is stress incontinence, which is the urethra not behaving or the outlet. And there are two completely different treatment options for both of these types of incontinence. So, a lot of women think that, you know, if you treat one that everything will get better. And sometimes women actually need treatment for two.

For urgency incontinence, there's things that we can do like medications. We can do something called Botox in the bladder, and we can also do something called sacral neuromodulation. So, those are all kind of things that help the bladder and help the bladder behave better is what I like to tell my patients.

As far as the urethra, if your main complaint is coughing, sneezing, laughing, then we can do something like a small injection into the urethra. At my surgery center, I do these all under local with little risks and they have very good subjective efficacy for patients, it's called Bulkamid, or you can do something such as a sling which is a more invasive surgical approach, but that works very very well for prevention of stress urinary incontinence. So, those are kind of things that we can do for incontinence issues.

And then, as far as prolapse, there's something called a pessary. A pessary is more for a woman that's not sexually active, or for a woman that feels comfortable taking it in and out. Now, it doesn't fix the prolapse, but what it does is it helps to reduce the prolapse. So, it takes away those bulge symptoms from a woman. Women often, I'll ask them, "Do you feel like something is coming out of your vagina or do you feel a bulge?" And they're like, "Well, how would I know?" And I tell them all the time, "If you had it, you would know." It kind of feels like there's a baseball or constantly a tampon in your vagina. It's very uncomfortable. It can be a pressure, and it can be worse with working out when you're constipated and everything like that. So, the other option is surgery. And there's a bunch of different surgical approaches that I talk women through with keeping your uterus, with taking your uterus out as well, and also kind of what we can do vaginally versus abdominally. So, every patient's prolapse is different and every patient is different. And my job as a female pelvic medicine and reconstructive urologist is really finding that perfect operation that will help the patient to the best of my abilities.

Host: Is there any way to get ahead of these issues during pregnancy, like preventative measures or exercises women can incorporate before and after childbirth to minimize the risk of urologic issues?

Sarah Martin, DO: Not necessarily. Making sure not excessive weight gain, not having smoked prior, trying to prevent constipation. These are all kinds of things that can contribute to worsening of your prolapse. But a lot of times, you know, with these symptoms, you can't control how your child is going to come into this world. So sometimes, no matter what you do, you can still have issues with your pelvic floor after pregnancy.

Host: How about lifestyle modifications and habits that can positively impact postpartum urologic health?

Sarah Martin, DO: Not really, unfortunately. The best thing that I recommend for females is for them to do pelvic floor physical therapy after they deliver. A lot of women don't realize how different their pelvic floor is, after they deliver and they have painful intercourse and they think that this is supposed to happen. They leak when they cough, sneeze or laugh. They leak with urgency. They feel like something's coming out of their vagina. So, I think the best thing to do to prevent everything long-term is not while they are pregnant, but after they deliver, and that's to see a pelvic floor physical therapist after they deliver, so they can learn different techniques to prevent things down the road.

Host: Well, the sensations and condition of having a UTI can be similar to those of urinary incontinence. After they've had a baby, how could a woman tell the difference?

Sarah Martin, DO: So, a UTI is when you are going to have burning with urination, blood in the urine, lower abdominal pain associated with increased urgency and frequency. And this is going to be prolonged for a couple of days. And if they're feeling these symptoms and it's worsening, that more points to a urinary tract infection. And then, an easy way to tell if something is going on is also to get a urine culture done with a primary care doctor, with their GYN, and then we can see if they really do have an infection or if this is just normal postpartum issues.

Host: So, in closing, what urologic symptoms should a woman look out for after childbirth? And if they're experiencing those symptoms, what should they do?

Sarah Martin, DO: I think the best thing for women to know is that they're not alone, and this is not normal. So, I get so many women that come in and say, "Well, you know, I leak all the time when I cough, sneeze, or laugh. But that's normal, right? That's normal. Every woman has that." No, that's not normal. And if it's bothersome to you, there's things that we can do about it.

As women, we suffer in silence so much, and we don't seek the attention, either because we're embarrassed by it, We don't want to talk to a male physician about how we're wetting our pants or how we feel like our vaginas are falling out, society as a whole making it sound like it's gross. So, I think the most important thing for women to do is if you do not feel the same as you did before pregnancy, you should see a urologist and there's things that we can do. And I highly recommend to see a urologist that specializes in female urology because there's a lot of tips and tricks that we have versus other urologists. It's the same as when you have cancer. When you have cancer, right, you want to see a urologist that specializes in cancer. And when you have these issues of incontinence and prolapse, you really want to see a urologist that specializes in female urology.

Host: That makes sense. Dr. Martin, thank you for discussing all these solutions to a problem that so many women suffer from. I appreciate your time and expertise.

Sarah Martin, DO: Thank you so much.

Host: Looking for information on how to prevent or treat bladder incontinence and pelvic floor dysfunction after childbirth? Visit dulyhealthcare.com for resources and access to medical professionals like Dr. Martin who can help. I'm your host, Jamie Lewis. And this has been Duly Noted, a Health and Care Podcast from Duly Health and Care.