Roughly one quarter of all U.S. women are affected by a pelvic floor disorder, according to research conducted by the National Institute for Health.
Weakened pelvic muscles may result in incontinence, discomfort and activity limitation.
Dr. Varuna Raizada, a specialist in Urogynecology and a board certified OB/GYN with Orange Coast Memorial Medical Center, discusses these disorders, how to prevent weakened pelvic muscles and treatment options for women who suffer from pelvic floor disorders.
Selected Podcast
Women's Pelvic Health - What you Need to Know
Featured Speaker:
Varuna Raizada, M.D
Dr. Raizada was born and raised in the small town of Jammu, nestled in the Himalayan mountain range. She attended medical school at Kasturba Medical College, in the southern part of India. In 2007, she completed her residency in obstetrics and gynecology at Loma Linda University Medical Center. Her passion for female pelvic health led her to the University of California, San Diego where she completed a two-year post-doctoral research fellowship. Dr. Raizada is also a Board Certified OB/GYN. She acquired valuable skills in female pelvic ultrasounagraphy and used it to study women with urinary and fecal incontinence. Thereafter, she completed her training in the sub-specialty of female pelvic medicine and reconstructive surgery while obtaining a Master’s Degree in clinical investigation at the University of Rochester in upstate New York.Organization: Orange Coast Memorial Medical Center
Transcription:
Women's Pelvic Health - What you Need to Know
Deborah Howell (Host): Today’s guest is Dr. Varuna Raizada. Dr. Raizada was born and raised in a small town of Jammu nestled in the Himalayan Mountain Range. She attended medical school at Kasturba Medical College in India. In 2007, she completed her residency in obstetrics and gynecology at Loma Linda University Medical Center. Her passion for female pelvic health led her to the University of California, San Diego where she completed a two-year postdoctoral research fellowship. Dr. Raizada is also a Board Certified OB/GYN with Orange Coast Memorial Centre. Welcome Dr. Raizada.
Dr. Varuna Raizada (Guest): Thank you, thank you for having me on the show.
Deborah: You know your pelvis is something we usually do not ever think about unless you have a problem with it, may be you can tell us what is a healthy pelvis?
Dr. Raizada: Well, a healthy pelvis is one that is doing everything, the way it should be doing, so a healthy pelvis basically govern how well you are urinating, how well are you having your bowel movements and especially whether you are having any problems with your reproductive organ and their function. A healthy pelvis is one which does not give you any problems be it with leakage of urine or leakage of bowels, does not give you any problems that directly leads to constipation or lots of stools that’s out of your control and also is responsible for giving adequate support to your pelvic organs whereby, you know the standard normal position and don’t fall through the opening of the vaginal canal and that’s also known as prolapse, and lastly they are not supposed to cause any pain during intercourse. So¸ a healthy pelvis is one that doing all those things and not causing any problems.
Deborah: That’s a big job.
Dr. Raizada: Yes it is and you don’t see it, so you don’t think it exist. Most women are surprised when you say, hey, your pelvis is doing all these things for you.
Deborah: Right, right again you don’t think about, you just sort of take it for granted and I am going to stop doing that. What are some pelvic disorders that affect women?
Dr. Raizada: So, I should say in the order of frequency or you know increased prevalence, one of the most common reasons for women to show up to me or to other providers in my field would be bladder problems which includes lots of urination, either because you know every time cough, sneeze, and a little spread comes out and just kind of you loose a little bit or loss of control of urination whereby women complained that they cannot make it to the restroom in time and they don’t have control over their bladder. It’s that typical key in the door syndrome, you put the key in and you just cannot hold, you know you can’t delay the active urination. Some women also come to me because they have problem initiating urination. Other women are come to me and this would be the second big group of diseases would be the support of the pelvic organs. So, our bladder, our vagina, uterus, and rectum are held in place by a trough-like muscle known as the pelvic muscle and it’s a huge group of pelvic muscle that you actually don’t see, so you don’t think they exist. These are the muscles that you are engaging when, you know, you are doing your Kegel exercises, so sometimes women will come to me because the vaginal walls have loss their support and the vaginal walls also are responsible for keeping the bladder and the bowel in place, so they will come to me to probably complaining of hey I see or I feel a big bulge coming out of my vagina and that would be issues with loss of support of the pelvic orangs also known as prolapse. And lastly a woman and even though, the group is small in comparison to the rest of the groups, it’s the one that that causes most discomfort and really disrupts the lives of people and that would be fecal issues or problems with not being able to control your bowels. That can be very, very limiting for both of men and women and lastly constipation which actually is quite frequent, but goes to hand in hand for many people who are having loss of control of bowels because sometimes the original problem may just be constipation or poorly managed constipation, and then I have a small subset of women who come to me because any distribution in pelvic floor function may cause pain or spasms especially during intercourse for women which of course can be very disrupted to their relationship, so that would be another group of women that come to me and these would be you know the typical symptoms.
Deborah: So, that’s why you are so busy all the time. There are so many things can go array. So, what are the some of the signs and symptoms of a pelvic disorder that women should be aware of?
Dr. Raizada: The first thing women need to take away from this is you know that traditional thinking that you know this is just normal, this is something that we have to deal with that’s sad, the next thing to think about would be hey do I leak urine often enough where I you know once in a while, you have the really bad flu and you know you had a lot to drink and you sneeze or you cough really hard and a little urine escapes out of you and that’s okay. We are talking about where it gets to a point where you are having leakage almost everyday, it is keeping you from exercising, it’s keeping you from lifting your children, from doing your household chores, being vacuuming or lifting your laundry basket, but it’s actually distrusting your life and you know is impacting your social life, the way you exercise, the quality of life basically.
Deborah: For sure.
Dr. Raizada: So, the other thing to watch out for would be hey you know, I am urinating, but every time I go just a little bit comes out, or you know takes me forever to start urinating, I have to bear down to do all these maneuvers on the toilet, just to get started and that could even be very dangerous for your kidney health because, when you are not eliminating well, you have frequent bladder infection because bacteria find a happy home to grow and multiply and they are also affect the way your kidney function because of the back pressure that’s transmitted into your kidney.
Deborah: Right, it is all connected.
Dr. Raizada: Absolutely, it is.
Deborah: So, if you are having some of these symptoms that would be the time to seek physician care right then at beginning.
Dr. Raizada: Absolutely, because one is you know early, if I able to see them early, some simple interventions may actually help them and they might just avoid the surgery going forward. Other symptoms to watch out for would be anything that’s coming out of the vagina, you know that’s looks like a bulge or piece of pink tissue or something that should not be long there, sometimes the women comes to me and they said they have to push on it in order to just get there, you know bowels and their bladder movements done, that’s defiantly not normal, if the bulge is big enough where it’s chasing constantly, you can’t even wear an underwear and feel comfortable, you know don’t wait that long, come sooner, because there are so many things we can do that can fix the problem without any invasive intervention.
Deborah: Let’s talk about some of those treatment options. Can we?
Dr. Raizada: Yeah absolutely.
Deborah: So, if somebody comes to you with a bulge, what is the first thing you do?
Dr. Raizada: So, you know, medicine as usual, history and physical examination is the centre of our diagnosis and care plan, how we make our care plans. We get detailed history, do a detailed physical examination and during physical examination, we try to figure out what the extent of the prolapse is or what wall of the vagina are affected and how are they affecting other organs. That said we also tried to assess the pelvic muscle strength, the first few things that we begin with in terms of treatment option would be to do some Kegel exercises to strengthen the pelvic muscle, so that now these organs have better support. We let women try these treatments either on there own or with a help of a therapist, pelvic floor physical therapist and if these simple things do not work, then we have other treatment options which range from nonsurgical options like a pessary. A pessary is like a device, it could be shape like a disc or sometime it can even look like a binky which act as a truss to push the prolapse back into its normal place or if for some reasons that therapy is not working for women or women are not comfortable with it, we can talk about surgical options which range from more minimally invasive options where we approach the prolapse through the vagina and even extending to you know, robotic surgeries where we actually suspend and reconstruct the pelvic or the vagina and the vaginal walls and restore the strength which of course have long-lasting effect and you know can have really good results for specially woman who have really bad vaginal prolapse.
Deborah: And those have long-lasting results.
Dr. Raizada: Yeah, absolutely. You know these surgeries are done we do a more reconstruction, so these surgeries tend to do better than some of our older traditional vaginal surgeries.
Deborah: Okay. Are there any lifestyle changes someone can make to prevent some of these pelvic disorders in the first place?
Dr. Raizada: Absolutely, smoking. So, smoking has a way of you know if women know as do men that smokers have more wrinkles because the connective tissue that supports the skin gets degraded very quickly, it is the same thing that happens in the pelvis, so stay way from smoking, stay away from second-hand smoking.
Deborah: Fantastic. Please finish your thought and then we have about 30 seconds remaining on the show, so sorry about that.
Dr. Raizada: Sure, no problem and the second thing would be watch or wait because women who you know, they put a lot of pressure on their pelvic organs and lastly, avoid any kind of chronic straining for instance, chronic constipation that’s one big to know and rest of the things you know there are things that you just can’t stop in life, you can’t stop lifting your babies, can’t stop having those babies, so those are out of your control.
Deborah: That’s no way to live. So, thank you so much Dr. Raizada for those tips and for coming on our show today to talk to us about women’s pelvis health. We really appreciate it.
Dr. Raizada: No problem.
Deborah: To learn more or to listen to the podcast of the show, please go to memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness. Have yourself a fantastic day.
Women's Pelvic Health - What you Need to Know
Deborah Howell (Host): Today’s guest is Dr. Varuna Raizada. Dr. Raizada was born and raised in a small town of Jammu nestled in the Himalayan Mountain Range. She attended medical school at Kasturba Medical College in India. In 2007, she completed her residency in obstetrics and gynecology at Loma Linda University Medical Center. Her passion for female pelvic health led her to the University of California, San Diego where she completed a two-year postdoctoral research fellowship. Dr. Raizada is also a Board Certified OB/GYN with Orange Coast Memorial Centre. Welcome Dr. Raizada.
Dr. Varuna Raizada (Guest): Thank you, thank you for having me on the show.
Deborah: You know your pelvis is something we usually do not ever think about unless you have a problem with it, may be you can tell us what is a healthy pelvis?
Dr. Raizada: Well, a healthy pelvis is one that is doing everything, the way it should be doing, so a healthy pelvis basically govern how well you are urinating, how well are you having your bowel movements and especially whether you are having any problems with your reproductive organ and their function. A healthy pelvis is one which does not give you any problems be it with leakage of urine or leakage of bowels, does not give you any problems that directly leads to constipation or lots of stools that’s out of your control and also is responsible for giving adequate support to your pelvic organs whereby, you know the standard normal position and don’t fall through the opening of the vaginal canal and that’s also known as prolapse, and lastly they are not supposed to cause any pain during intercourse. So¸ a healthy pelvis is one that doing all those things and not causing any problems.
Deborah: That’s a big job.
Dr. Raizada: Yes it is and you don’t see it, so you don’t think it exist. Most women are surprised when you say, hey, your pelvis is doing all these things for you.
Deborah: Right, right again you don’t think about, you just sort of take it for granted and I am going to stop doing that. What are some pelvic disorders that affect women?
Dr. Raizada: So, I should say in the order of frequency or you know increased prevalence, one of the most common reasons for women to show up to me or to other providers in my field would be bladder problems which includes lots of urination, either because you know every time cough, sneeze, and a little spread comes out and just kind of you loose a little bit or loss of control of urination whereby women complained that they cannot make it to the restroom in time and they don’t have control over their bladder. It’s that typical key in the door syndrome, you put the key in and you just cannot hold, you know you can’t delay the active urination. Some women also come to me because they have problem initiating urination. Other women are come to me and this would be the second big group of diseases would be the support of the pelvic organs. So, our bladder, our vagina, uterus, and rectum are held in place by a trough-like muscle known as the pelvic muscle and it’s a huge group of pelvic muscle that you actually don’t see, so you don’t think they exist. These are the muscles that you are engaging when, you know, you are doing your Kegel exercises, so sometimes women will come to me because the vaginal walls have loss their support and the vaginal walls also are responsible for keeping the bladder and the bowel in place, so they will come to me to probably complaining of hey I see or I feel a big bulge coming out of my vagina and that would be issues with loss of support of the pelvic orangs also known as prolapse. And lastly a woman and even though, the group is small in comparison to the rest of the groups, it’s the one that that causes most discomfort and really disrupts the lives of people and that would be fecal issues or problems with not being able to control your bowels. That can be very, very limiting for both of men and women and lastly constipation which actually is quite frequent, but goes to hand in hand for many people who are having loss of control of bowels because sometimes the original problem may just be constipation or poorly managed constipation, and then I have a small subset of women who come to me because any distribution in pelvic floor function may cause pain or spasms especially during intercourse for women which of course can be very disrupted to their relationship, so that would be another group of women that come to me and these would be you know the typical symptoms.
Deborah: So, that’s why you are so busy all the time. There are so many things can go array. So, what are the some of the signs and symptoms of a pelvic disorder that women should be aware of?
Dr. Raizada: The first thing women need to take away from this is you know that traditional thinking that you know this is just normal, this is something that we have to deal with that’s sad, the next thing to think about would be hey do I leak urine often enough where I you know once in a while, you have the really bad flu and you know you had a lot to drink and you sneeze or you cough really hard and a little urine escapes out of you and that’s okay. We are talking about where it gets to a point where you are having leakage almost everyday, it is keeping you from exercising, it’s keeping you from lifting your children, from doing your household chores, being vacuuming or lifting your laundry basket, but it’s actually distrusting your life and you know is impacting your social life, the way you exercise, the quality of life basically.
Deborah: For sure.
Dr. Raizada: So, the other thing to watch out for would be hey you know, I am urinating, but every time I go just a little bit comes out, or you know takes me forever to start urinating, I have to bear down to do all these maneuvers on the toilet, just to get started and that could even be very dangerous for your kidney health because, when you are not eliminating well, you have frequent bladder infection because bacteria find a happy home to grow and multiply and they are also affect the way your kidney function because of the back pressure that’s transmitted into your kidney.
Deborah: Right, it is all connected.
Dr. Raizada: Absolutely, it is.
Deborah: So, if you are having some of these symptoms that would be the time to seek physician care right then at beginning.
Dr. Raizada: Absolutely, because one is you know early, if I able to see them early, some simple interventions may actually help them and they might just avoid the surgery going forward. Other symptoms to watch out for would be anything that’s coming out of the vagina, you know that’s looks like a bulge or piece of pink tissue or something that should not be long there, sometimes the women comes to me and they said they have to push on it in order to just get there, you know bowels and their bladder movements done, that’s defiantly not normal, if the bulge is big enough where it’s chasing constantly, you can’t even wear an underwear and feel comfortable, you know don’t wait that long, come sooner, because there are so many things we can do that can fix the problem without any invasive intervention.
Deborah: Let’s talk about some of those treatment options. Can we?
Dr. Raizada: Yeah absolutely.
Deborah: So, if somebody comes to you with a bulge, what is the first thing you do?
Dr. Raizada: So, you know, medicine as usual, history and physical examination is the centre of our diagnosis and care plan, how we make our care plans. We get detailed history, do a detailed physical examination and during physical examination, we try to figure out what the extent of the prolapse is or what wall of the vagina are affected and how are they affecting other organs. That said we also tried to assess the pelvic muscle strength, the first few things that we begin with in terms of treatment option would be to do some Kegel exercises to strengthen the pelvic muscle, so that now these organs have better support. We let women try these treatments either on there own or with a help of a therapist, pelvic floor physical therapist and if these simple things do not work, then we have other treatment options which range from nonsurgical options like a pessary. A pessary is like a device, it could be shape like a disc or sometime it can even look like a binky which act as a truss to push the prolapse back into its normal place or if for some reasons that therapy is not working for women or women are not comfortable with it, we can talk about surgical options which range from more minimally invasive options where we approach the prolapse through the vagina and even extending to you know, robotic surgeries where we actually suspend and reconstruct the pelvic or the vagina and the vaginal walls and restore the strength which of course have long-lasting effect and you know can have really good results for specially woman who have really bad vaginal prolapse.
Deborah: And those have long-lasting results.
Dr. Raizada: Yeah, absolutely. You know these surgeries are done we do a more reconstruction, so these surgeries tend to do better than some of our older traditional vaginal surgeries.
Deborah: Okay. Are there any lifestyle changes someone can make to prevent some of these pelvic disorders in the first place?
Dr. Raizada: Absolutely, smoking. So, smoking has a way of you know if women know as do men that smokers have more wrinkles because the connective tissue that supports the skin gets degraded very quickly, it is the same thing that happens in the pelvis, so stay way from smoking, stay away from second-hand smoking.
Deborah: Fantastic. Please finish your thought and then we have about 30 seconds remaining on the show, so sorry about that.
Dr. Raizada: Sure, no problem and the second thing would be watch or wait because women who you know, they put a lot of pressure on their pelvic organs and lastly, avoid any kind of chronic straining for instance, chronic constipation that’s one big to know and rest of the things you know there are things that you just can’t stop in life, you can’t stop lifting your babies, can’t stop having those babies, so those are out of your control.
Deborah: That’s no way to live. So, thank you so much Dr. Raizada for those tips and for coming on our show today to talk to us about women’s pelvis health. We really appreciate it.
Dr. Raizada: No problem.
Deborah: To learn more or to listen to the podcast of the show, please go to memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness. Have yourself a fantastic day.