Amanda Wilde (Host): Pelvic floor issues affect at least 25% of women in the US and that can affect overall health and wellness. Women's Health Nurse Practitioner, Shannon Smith is here to explain and to advise on pelvic floor health. Welcome to the First Health and Wellness Podcast, connecting you to the people and medical services that make your life healthier.

I'm Amanda Wilde. Shannon, welcome. Thank you for being here.

Shannon Smith, WHNP: Yeah. Thank you so much for having me.

Host: What exactly is pelvic floor health and how does it affect overall health?

Shannon Smith, WHNP: That's a great question and I feel like a one sentence blurb is not enough justice to talk about the pelvic floor, but it truly is how well your muscles, your ligaments, your connective tissue are supporting and affecting your bladder, your uterus, and your bowels. And it ultimately, if one of those goes wrong, can affect your quality of life.

Host: And do you find there are common misconceptions about the pelvic floor?

Shannon Smith, WHNP: Yes. Every day I have some patient, at least one tell me, oh, my mom had urinary incontinence, or my mom had prolapse and she was fine, or she lived with it. Are these things common? Absolutely. But are they normal and do you have to live with them? No, you don't. There's things we can do about them.

Host: So a lot of women have been living with pelvic floor dysfunction, but how can a woman tell if her symptoms are pelvic floor dysfunction? What kind of symptoms should we be watching out for?

Shannon Smith, WHNP: Lots of things. The first thing I think if we're talking about prolapse, then you're going to feel a pressure. You're going to feel like you're sitting on a ball. You're going to feel bulge sometimes. Sometimes you can see something come outside of the vagina. That would be prolapse.

If you have leakage when you cough, laugh, sneeze, jump, sit to stand, walk sometimes. Then we're talking about weakness in the muscles around the urethra. And so stress urinary incontinence is what we're talking about there. You can see dysfunction by having urge incontinence or urinary frequency, feeling like you're constantly needing to go to the restroom or empty your bladder. And then you can have fecal incontinence.

A pain with intercourse can be something that affects your pelvic floor and cause pelvic floor dysfunction or, and the definition of pelvic floor dysfunction. I will say pain with intercourse can be a lot of different things, so typically, we would want you to get a baseline workup with gynecology just to make sure that it's not one of the numerous things that causes it.

But lots of things can cause pelvic floor dysfunction or tell you that you have pelvic floor dysfunction.

Host: So if you have any of those symptoms, you should talk to your doctor and see if it can't be resolved. Yeah.

Shannon Smith, WHNP: Yes, absolutely. Especially if it's affecting your quality of life, because there's things we can do about it.

Host: Well, in your experience, why do some people still view pelvic floor health as a sort of taboo topic?

Shannon Smith, WHNP: We live in the Bible Belt south, right? And so, as young Christians and children we're taught like, don't have intercourse, don't talk about the vagina, we don't talk about penises. So I think even those words, like saying them out loud is hard for a lot of people, so I think that probably contributes.

But one way we can go around and talk more about the pelvic floor is like, share it with your friends. Like your friends are in the same stage of life as you, and they're probably going through similar things to you. Like, Hey, is this normal in your life? So I think talking about it more is going to make it more common, and we're seeing that in America now.

Like more issues with women's health, more research in women's health, It's still terrible, but it's getting there. So I think the more we talk about it and the more we ask our friends, and the more you talk to your doctor about it, the more normalized it's going to be to do something about it.

Host: And conversations like the one we're having right now. Speaking of life stages how do pregnancy and childbirth impact the pelvic floor?

Shannon Smith, WHNP: It's a miraculous thing, right? Birthing a child, but it can for sure cause some problems in the pelvic floor. As we think about a baby stretching the walls of the vagina, oftentimes when the vaginal muscles come back together, they're just not the same anymore. So pregnancy whether it's c-section, more commonly vaginal delivery can cause prolapse or weakness in one of the vaginal walls.

It can cause urinary incontinence. Fecal incontinence, things like that. Oftentimes we see it happen in the short term. Right after delivery. And then we see it get a little bit better, the more postpartum that you are. But if things start to linger, then we want to see a urogynecologist or see someone to ask questions about it, make sure it's still normal, not normal in the postpartum phase that you're in.

And then ultimately I have a huge plug or here's a huge plug for pelvic floor physical therapy. I think anybody that's had a baby should see a pelvic floor physical therapist to assess your pelvic floor muscles, make sure you're strengthening your muscles where they need to go.

Host: Well, that's exactly what I was going to ask is what treatment options are there available for pelvic floor issues?

Shannon Smith, WHNP: There's so many, so there's tons of non-surgical options. So what we typically do at our first visit is we do a complete exam. We make sure that you understand what's going on and then we run through all of your options from non-surgical to possibly surgical, just depending on what you come in with.

But just some of the non-surgical options that we have, pessaries, we have Botox to the bladder, pelvic floor physical therapy is one thing we typically like to recommend. Going back to the non-surgical, sometimes I'll say, if it's not bothering you, it doesn't bother me.

And if you're emptying your bladder, great. So sometimes we have patients come in and I say, we don't have to do anything about it if you don't want to. So that's always an option too. And then for surgical options, our urogynecologist does minimally invasive approaches. So he does laparoscopic small incisions depending on what your chief concern is.

We do midurethral slings, which is a piece of mesh that goes under the urethra. So whenever you cough, laugh, sneeze, jump, you don't have leakage. There's a lot of non-surgical and surgical options, just depending on what the main concern is and where. Which we kind of develop a plan together at your consult.

Host: How successful have you seen these treatments to be?

Shannon Smith, WHNP: Oh my goodness. Life changing. The number one thing I hear at our post-op visits is women say, I wish I would've done this sooner. Because, if our mom tells us that urinary incontinence is normal, then we think it's normal and we find out that it's, it's not normal and you're no longer having it then I wish I would've done it sooner, is what I hear.

Host: And it sounds like pelvic floor dysfunction comes in all degrees and many types, but if you have it, you know you have something wrong. You will see symptoms. If you could give someone one piece of pelvic floor health advice, what would it be?

Shannon Smith, WHNP: I have lots of things coming into my mind, but the one thing I would say is know yourself. Like get a mirror, take it down there. Make sure you know where your clitoris is, where your urethra is, where your vagina is. Like make sure you know where your pieces are and just like become familiar with yourself.

Because that's one thing I've, again, living in the Bible Belt south, like most women don't do. So I think knowing yourself is super important. I could think of 8,000 other things to share, but that's the one thing I think I would say.

Host: Get to know yourself. It reminds me of how, I used to get injured or something, and like if I got a bruise, I wouldn't touch it. And I thought that was the best way to deal with it. And then I found out as an adult, no, you can massage it and it actually helps break up the ball. So, I mean, it's very similar to what you're saying.

It's not openly talked about a lot, but knowing your body is just really important so you can see any changes that might happen.

Shannon Smith, WHNP: Yeah. Agreed. A hundred percent agree.

Host: Well, Shannon, thank you for all of this great information. Really appreciate you educating us on pelvic floor health and keep normalizing those conversations.

Shannon Smith, WHNP: Yeah, absolutely. Thanks for having me.

Host: That was Women's Health Nurse Practitioner, Shannon Smith. For more information, visit firsthealth.org/medical-care/urogynecology. If you found this podcast helpful, please share it on your social channels and check out the full podcast library for other topics of interest to you.

This is First Health and Wellness Podcast brought to you by First Health of the Carolinas. Thanks for listening.