An estimated one-third of American women are affected by pelvic floor disorders, which include urinary and fecal incontinence, as well as uterine and vaginal prolapse.
Tissue that has been irradiated during cancer treatment often becomes weak and extremely delicate, making cancer survivors poor candidates for surgical repair.
By including PFD treatment at the start of a cancer patient’s regimen, existing problems can be successfully addressed.
Christopher Chung, MD is here to let you know your options when diagnosed with pelvic floor disorder.
Selected Podcast
Pelvic Floor Disorder: Treatments and Cures
Featured Speaker:
Learn more about Christopher Chung, MD
Christopher Chung, MD
Christopher Chung, MD is a urogynecologist and an assistant clinical professor in the Division of Gynecologic Oncology Surgery.Learn more about Christopher Chung, MD
Transcription:
Pelvic Floor Disorder: Treatments and Cures
Melanie Cole (Host): A gynecological cancer diagnosis can be life altering. However, as the cancer is being treated, there might be some complications with the pelvic floor that may affect your quality of life. My guest today is Dr. Christopher Chung. He is a urogynecologist specializing in female pelvic medicine and reconstructive surgery at City of Hope. Welcome to the show, Dr. Chung. Tell us what type of cancers would predispose a woman to having pelvic floor disorders?
Dr. Christopher Chung (Guest): Traditionally, any cancer that occurs in a woman’s pelvic floor, for example, GYN cancers like ovarian, uterine, cervix, or colorectal cancer, when you have surgery for these types of cancers, you damage the pelvic floor muscles and nerves. This predisposes a woman to urine incontinence, prolapse and fecal incontinence. Recently, at City of Hope, we’ve done several studies to look at other types of cancer. We found out that when you get treatment for any cancer – for example breast cancer, lymphoma, leukemia or lung cancer – the treatment that you receive such as radiation and chemotherapy can actually predispose you to have pelvic floor disorders. The best example would be the woman who receives chemotherapy for breast cancer. When a woman receives chemotherapy, the chemotherapy basically shuts down her hormone production in her body and that can predispose her to have bladder dysfunction such as frequency and urgency symptoms that she cannot make it to the bathroom in time or waking up at night to go urinate, or leaking urine. All of these problems.
Melanie: People don’t even think about that. That’s a great point, Dr. Chung. That’s something that you would think has nothing to do with the pelvic floor. When you speak about these disorders, you mentioned incontinence, fecal incontinence and prolapse, tell us what those are, what those mean.
Dr. Chung: There are several types of urine incontinence. It is a very embarrassing issue to talk about. This can be when a woman leaks urine when she coughs, sneezes or laughs or with physical activity. Then, there is another type of incontinence called “urgency incontinence” that means when a woman has urgency feelings that she cannot make it to the bathroom in time. There is another problem called “overactive bladder” that means that she has to go every hour or every two hours. She feels like she needs to go all the time or she cannot have a good night of sleep. She has to wake up every hour or every 30 minutes to go pee at night. You can imagine how detrimental that can be to a woman’s quality of life. The next topic is prolapse. This means that a woman has poor support of her pelvic floor muscles either due to vaginal deliveries, getting pregnant or tumors or surgeries of the pelvic floor, like hysterectomy or colon resection – these types of surgeries. This means that her bladder can drop down past the vaginal opening or the uterus can drop past the vaginal opening or the rectum drops down, too. When you have relaxation of the pelvic organs like the uterus, bladder or rectum, they can have the sensation that they cannot empty their bladder completely or they can have the sensation that they cannot empty their stool completely. Sometimes the woman has to push the vaginal area to help them empty urine or stool.
Melanie: As you pointed out, it is embarrassing and tough for women to talk about, Dr. Chung. How do you start that conversation when a woman is going through her cancer treatments and what treatments do you offer for some of these disorders?
Dr. Chung: The important thing is to tell your doctor about all of these symptoms. When you see your medical oncologist or your surgeon, they will ask you do you have any other issues that they can help you with. The important thing is to volunteer all of this information. I’m unique in a way that City of Hope, as a cancer center, provides pelvic floor service to our patients. If you tell your doctor, “I have bladder control issues” your doctor can refer you to see me. We can treat you either with conservative management – for example, pelvic floor physical therapy, medication, or nerve stimulation – or we can do a surgery to improve the patient’s quality of life. There are many options. Not everyone needs surgery. It depends on the diagnosis.
Melanie: Are there certain times when you can teach prevention? We hear about Kegel exercises and diet. We see so many medications on the market, too, Dr. Chung, for all of these issues. What do you tell women about those things?
Dr. Chung: First of all most women do Kegel exercise wrong.
Melanie: Really?
Dr. Chung: Yes. A lot of times, when I see a patient I ask her to contract her vaginal muscles, she actually pushes it out. When I ask them to push, she actually contract. I would say more than half of the women do Kegel exercises wrong. If they have overactive bladder symptoms or pelvic pain disorder, I can refer them to our pelvic floor physical therapists who are very specialized physical therapists who can use biofeedback. It is a method that they can teach you to do the correct Kegel exercise. They can see exactly which muscle you are contracting and teach you to do the correct Kegel exercise.
Melanie: It is important that we do that. How much does diet play a part any of this? Some women hear that they are supposed to drink more water or less water if they have urgent incontinence. Tell us about diet and its relationship to pelvic floor disorders.
Dr. Chung: Yes. When a woman is getting chemotherapy, her oncologist will tell her to drink a lot of water and you can imagine--the more water you are going to drink the more urine you are going to have. That can cause you to have frequency and urgency symptoms. But, when you are not on chemotherapy, you don’t need to drink that much water. That is a very common misconception. I always tell my patients to be moderate on the fluid intake. Drink when you are thirsty. You don’t have to drink three or four gallons of water a day. Just be moderate because the more water you drink, the more water is going to go to your bladder and that is going to cause frequency urgency symptoms and leakage of urine. In terms of diet, a lot of women experience fecal urgency and incontinence. They leak stool with diarrhea. The simplest way to treat this is to make your stool firmer so you don’t leak stool. A very good medicine to take for this is Loperamide, the stool bulking agent to make your stool firmer. You don’t need to have surgery for this.
Melanie: That’s absolutely great advice. What else would you like women to know about pelvic floor disorders that may be a complication or a side along to go with their cancer treatments , whether they are gynecological cancers or not?
Dr. Chung: I always tell my patients, “Don’t feel embarrassed about this. In the old days, your mom, your grandma learned to live with this,” but now we have many treatment options available - whether conservative management with physical therapy, medication, or surgery. The important thing is to tell your doctor about these symptoms and have an appropriate referral made to see a specialist who knows how to treat pelvic floor disorders.
Melanie: In just the last few minutes, Dr. Chung - you’re doing such great work – tell us what’s going on at City of Hope that is exciting in your department.
Dr. Chung: Traditionally, a urogynecologist doesn’t work in a cancer center so I’m unique in way that City of Hope sees the need for a specialist to treat patients with pelvic floor disorders, especially cancer patients. Here, we have come up with an innovative surgical technique to perform pelvic reconstructive surgery at the time of the patient’s initial cancer surgery. For example, if the patient has a GYN cancer and she has pelvic floor problems like leaking urine, stress incontinence or prolapse, we could do all of the reconstructive surgery at the same time of their initial cancer surgery. We believe that this is the best time to do surgery because if we don’t do the reconstructive part of the surgery as part of their initial surgery, she may need radiation and chemotherapy and she may not be a good candidate for pelvic floor reconstruction for the rest of her life. We can do a lot of things at one surgical setting. Also, we are very good at using the patient’s own tissue for reconstruction without the use of mesh. We don’t think mesh surgery is good, especially in cancer patients. You see on TV commercials that there is a lot of vaginal mesh placement issues and lawsuits. If you have a mesh placed in the vagina and you need radiation, that could be a big problem later on in your life. It could cause pain and bleeding and a lot of problems. We are very good that we can use the patient’s own tissue for reconstruction without the use of foreign materials.
Melanie: That’s excellent information. I applaud all of the great work that you are doing, Dr. Chung. Thank you so much for being with us today. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.
Pelvic Floor Disorder: Treatments and Cures
Melanie Cole (Host): A gynecological cancer diagnosis can be life altering. However, as the cancer is being treated, there might be some complications with the pelvic floor that may affect your quality of life. My guest today is Dr. Christopher Chung. He is a urogynecologist specializing in female pelvic medicine and reconstructive surgery at City of Hope. Welcome to the show, Dr. Chung. Tell us what type of cancers would predispose a woman to having pelvic floor disorders?
Dr. Christopher Chung (Guest): Traditionally, any cancer that occurs in a woman’s pelvic floor, for example, GYN cancers like ovarian, uterine, cervix, or colorectal cancer, when you have surgery for these types of cancers, you damage the pelvic floor muscles and nerves. This predisposes a woman to urine incontinence, prolapse and fecal incontinence. Recently, at City of Hope, we’ve done several studies to look at other types of cancer. We found out that when you get treatment for any cancer – for example breast cancer, lymphoma, leukemia or lung cancer – the treatment that you receive such as radiation and chemotherapy can actually predispose you to have pelvic floor disorders. The best example would be the woman who receives chemotherapy for breast cancer. When a woman receives chemotherapy, the chemotherapy basically shuts down her hormone production in her body and that can predispose her to have bladder dysfunction such as frequency and urgency symptoms that she cannot make it to the bathroom in time or waking up at night to go urinate, or leaking urine. All of these problems.
Melanie: People don’t even think about that. That’s a great point, Dr. Chung. That’s something that you would think has nothing to do with the pelvic floor. When you speak about these disorders, you mentioned incontinence, fecal incontinence and prolapse, tell us what those are, what those mean.
Dr. Chung: There are several types of urine incontinence. It is a very embarrassing issue to talk about. This can be when a woman leaks urine when she coughs, sneezes or laughs or with physical activity. Then, there is another type of incontinence called “urgency incontinence” that means when a woman has urgency feelings that she cannot make it to the bathroom in time. There is another problem called “overactive bladder” that means that she has to go every hour or every two hours. She feels like she needs to go all the time or she cannot have a good night of sleep. She has to wake up every hour or every 30 minutes to go pee at night. You can imagine how detrimental that can be to a woman’s quality of life. The next topic is prolapse. This means that a woman has poor support of her pelvic floor muscles either due to vaginal deliveries, getting pregnant or tumors or surgeries of the pelvic floor, like hysterectomy or colon resection – these types of surgeries. This means that her bladder can drop down past the vaginal opening or the uterus can drop past the vaginal opening or the rectum drops down, too. When you have relaxation of the pelvic organs like the uterus, bladder or rectum, they can have the sensation that they cannot empty their bladder completely or they can have the sensation that they cannot empty their stool completely. Sometimes the woman has to push the vaginal area to help them empty urine or stool.
Melanie: As you pointed out, it is embarrassing and tough for women to talk about, Dr. Chung. How do you start that conversation when a woman is going through her cancer treatments and what treatments do you offer for some of these disorders?
Dr. Chung: The important thing is to tell your doctor about all of these symptoms. When you see your medical oncologist or your surgeon, they will ask you do you have any other issues that they can help you with. The important thing is to volunteer all of this information. I’m unique in a way that City of Hope, as a cancer center, provides pelvic floor service to our patients. If you tell your doctor, “I have bladder control issues” your doctor can refer you to see me. We can treat you either with conservative management – for example, pelvic floor physical therapy, medication, or nerve stimulation – or we can do a surgery to improve the patient’s quality of life. There are many options. Not everyone needs surgery. It depends on the diagnosis.
Melanie: Are there certain times when you can teach prevention? We hear about Kegel exercises and diet. We see so many medications on the market, too, Dr. Chung, for all of these issues. What do you tell women about those things?
Dr. Chung: First of all most women do Kegel exercise wrong.
Melanie: Really?
Dr. Chung: Yes. A lot of times, when I see a patient I ask her to contract her vaginal muscles, she actually pushes it out. When I ask them to push, she actually contract. I would say more than half of the women do Kegel exercises wrong. If they have overactive bladder symptoms or pelvic pain disorder, I can refer them to our pelvic floor physical therapists who are very specialized physical therapists who can use biofeedback. It is a method that they can teach you to do the correct Kegel exercise. They can see exactly which muscle you are contracting and teach you to do the correct Kegel exercise.
Melanie: It is important that we do that. How much does diet play a part any of this? Some women hear that they are supposed to drink more water or less water if they have urgent incontinence. Tell us about diet and its relationship to pelvic floor disorders.
Dr. Chung: Yes. When a woman is getting chemotherapy, her oncologist will tell her to drink a lot of water and you can imagine--the more water you are going to drink the more urine you are going to have. That can cause you to have frequency and urgency symptoms. But, when you are not on chemotherapy, you don’t need to drink that much water. That is a very common misconception. I always tell my patients to be moderate on the fluid intake. Drink when you are thirsty. You don’t have to drink three or four gallons of water a day. Just be moderate because the more water you drink, the more water is going to go to your bladder and that is going to cause frequency urgency symptoms and leakage of urine. In terms of diet, a lot of women experience fecal urgency and incontinence. They leak stool with diarrhea. The simplest way to treat this is to make your stool firmer so you don’t leak stool. A very good medicine to take for this is Loperamide, the stool bulking agent to make your stool firmer. You don’t need to have surgery for this.
Melanie: That’s absolutely great advice. What else would you like women to know about pelvic floor disorders that may be a complication or a side along to go with their cancer treatments , whether they are gynecological cancers or not?
Dr. Chung: I always tell my patients, “Don’t feel embarrassed about this. In the old days, your mom, your grandma learned to live with this,” but now we have many treatment options available - whether conservative management with physical therapy, medication, or surgery. The important thing is to tell your doctor about these symptoms and have an appropriate referral made to see a specialist who knows how to treat pelvic floor disorders.
Melanie: In just the last few minutes, Dr. Chung - you’re doing such great work – tell us what’s going on at City of Hope that is exciting in your department.
Dr. Chung: Traditionally, a urogynecologist doesn’t work in a cancer center so I’m unique in way that City of Hope sees the need for a specialist to treat patients with pelvic floor disorders, especially cancer patients. Here, we have come up with an innovative surgical technique to perform pelvic reconstructive surgery at the time of the patient’s initial cancer surgery. For example, if the patient has a GYN cancer and she has pelvic floor problems like leaking urine, stress incontinence or prolapse, we could do all of the reconstructive surgery at the same time of their initial cancer surgery. We believe that this is the best time to do surgery because if we don’t do the reconstructive part of the surgery as part of their initial surgery, she may need radiation and chemotherapy and she may not be a good candidate for pelvic floor reconstruction for the rest of her life. We can do a lot of things at one surgical setting. Also, we are very good at using the patient’s own tissue for reconstruction without the use of mesh. We don’t think mesh surgery is good, especially in cancer patients. You see on TV commercials that there is a lot of vaginal mesh placement issues and lawsuits. If you have a mesh placed in the vagina and you need radiation, that could be a big problem later on in your life. It could cause pain and bleeding and a lot of problems. We are very good that we can use the patient’s own tissue for reconstruction without the use of foreign materials.
Melanie: That’s excellent information. I applaud all of the great work that you are doing, Dr. Chung. Thank you so much for being with us today. You’re listening to City of Hope Radio and for more information you can go to CityofHope.org. That’s CityofHope.org. This is Melanie Cole. Thanks so much for listening.