Although 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, cultural constraints keep many sufferers from discussing their conditions, or seeking treatment.
If you have bladder control issues such as frequent urination or incontinence, extreme vaginal dryness, pelvic prolapse and wide vaginal openings due to multiple births, pelvic pressure or pain, or stool control issues, City of Hope can address the problem.
Solutions range from physical therapy and medication to Botox injections and surgery.
Many conditions can be cured, and almost all can be successfully managed.
Kristina Wittig, MD is here to explain that with enhanced urinary diversion techniques that minimize interference with everyday life, you can live a better quality of life and not let pelvic floor disorders slow you down!
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Pelvic Floor Disorders: Don’t Let Them Slow YOU Down
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Learn more about Kristina Wittig, MD
Kristina Wittig, MD
Kristina Wittig, M.D., is a urologic surgeon and an assistant clinical professor of surgery. Dr. Wittig attended medical school at SUNY Downstate Medical Center College of Medicine. She was a recipient of multiple awards and honors including Magna Cum Laude / Alpha Omega Alpha Medical Honor Society. Dr. Wittig completed her urology residency at University of Connecticut Health Center. Dr. Wittig went on to complete her Urologic Oncology Fellowship at City of Hope, Duarte.Learn more about Kristina Wittig, MD
Transcription:
Pelvic Floor Disorders: Don’t Let Them Slow YOU Down
Melanie Cole (Host): Although 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, cultural constraints and embarrassment keep many sufferers from discussing their conditions or seeking treatment. My guest today is Dr. Kristina Wittig. She is a urological surgeon at City of Hope. Welcome to the show, Dr. Wittig. What is the pelvic floor?
Dr. Kristina Wittig (Guest): Pelvic floor are the muscles that hold your bladder and your uterus and vagina in place, basically. After you have children or when you get older, the pelvic floor muscles relax and you can have a prolapse of the bladder; you can have prolapse of the uterus and the vaginal wall. Those can cause various symptoms such as incontinence or other lower urinary tract symptoms. Also, pressure and pain in that area.
Melanie: What are some of these disorders? We see those commercials, Dr. Wittig, for women, adult diapers, and medications for incontinence. What are some of the pelvic floor disorders that we’re speaking about?
Dr. Wittig: There are different types of incontinence. You can have stress incontinence. You have urgency incontinence. Some women just have some irritating voiding symptoms, such as they have urinary frequency and urgency. Those things can definitely interfere with your quality of life because your life pretty much revolves around the bathroom. Also, you can have pelvic organ prolapse such as urinary prolapse, vaginal wall prolapse, or bladder prolapse.
Melanie: Is there a certain cause you can point to for these disorders? You mention having a baby.
Dr. Wittig: Yes. Most of them are child-bearing, just because that is one of the important factors which can cause relaxation of the pelvic floor muscles.
Melanie: So, what do we do about it? If women are incontinent, and, of course, this is something very embarrassing but if women come to you to discuss this or they’ve had one of the urologic cancers and as a result now suffer from pelvic floor disorder, what do you do for them?
Dr. Wittig: Depending on what type of incontinence or what symptoms they are experiencing, there are medications that we can try that helps relax the bladder and reduce the amount of incontinence or reduce the urgency and frequency sensation. There are also some conservative options that we try if somebody has urge-related incontinence we can try Botox injections to the bladder to try to relax the bladder muscle. There is also sacral nerve stimulation for women with urgency frequency and urgency incontinence, but also some women who are enduring urinary retention that could work and sacral nerve stimulators implantation of a little device like a pacemaker into your sacral spine, a little electrode goes into your spine, and you have this pacemaker-like device implanted into your upper buttocks and that stimulates the nerves that control the bladder and are very effective in reducing urgency frequency and urgency incontinence symptoms. Then, there are surgical options such as repair of the pelvic floor prolapse. There are various surgical options, depending on what you present with.
Melanie: Is there any issue with working on Kegel exercises if you are somebody with some kind of urologic cancer – doing those exercises before you do surgery or after? Is there therapy that you recommend women do to help strengthen their pelvic floor muscles?
Dr. Wittig: Kegel exercises are something that all women should do, actually--especially women who are having children or had children, even women who haven’t had children. Those are just good general things to do to keep your pelvic floor muscles strong. Also, not only women but males who have a prostatectomy for prostate cancer also end up with stress incontinence and we also encourage them to do Kegel exercises before their surgery and after their surgery because they have a similar type of problem.
Melanie: If they go on medications that you were mentioning, or do biofeedback or Botox, is this something that they would have to do again? Would they have to be on the medications for a long time or is it something that maybe would come and go?
Dr. Wittig: Also, I forgot to mention pelvic floor physical therapy. That has shown to be very effective also because physical therapist teach them more effective techniques than just Kegel exercises to try to strengthen the pelvic floor. As far as the medication, if the medication is helping you – the medication that was taken to relax the bladder – if it’s helping then it’s a lifelong daily medication that you take. Botox is something that would usually have to be injected about every six months because it is not something that is permanent.
Melanie: What about the pelvic sling? Women hear about this. We hear about commercials and see things in the media. Tell us a just little about the pelvic sling and what’s involved in having one put in.
Dr. Wittig: A pelvic sling is usually performed for women who suffer from stress incontinence which is incontinence that you have when you are coughing, sneezing, laughing, jumping, and any kind of stressful physical activity, basically. It is a sling that is put in that holds your urethra up and helps prevent the leakage. I know there has been a lot of talk in the media about vaginal mesh and various lawsuits related to that; however, that does not apply to the pelvic sling so much. But, for women who are very reluctant to undergo this type of surgery because they are worried about the mesh and all the bad publicity that it has gotten we do offer an autologous sling, which basically is an option to harvest your own piece of fascia from the lower abdominal wall and then you use that as a sling material to do the same thing.
Melanie: Wow. That’s really fascinating. In just the last minute here, Dr. Wittig, what do you tell women that come and they are embarrassed about talking to you about painful intercourse, urination or even fecal incontinence, just something they don’t want to think about or discuss but it is affecting the quality of their life? What is your best advice and why should they come to City of Hope for their care?
Dr. Wittig: I usually tell them this is nothing to be embarrassed about at all. I see a lot of women suffering from the same problems. If there is something we can do to help and even improve their symptoms even just a little bit, I think it can make a tremendous difference in their quality of life.
Melanie: Why should they come to City of Hope for their care?
Dr. Wittig: Because City of Hope has the best trained physicians. The majority of us who do this type of surgery or any kind of cancer surgery are fellowship trained. We can offer the latest, the best techniques to perform these procedures.
Melanie: Thank you so much, Dr. Wittig. Its great information and so important for women. 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 Disorders: Don’t Let Them Slow YOU Down
Melanie Cole (Host): Although 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, cultural constraints and embarrassment keep many sufferers from discussing their conditions or seeking treatment. My guest today is Dr. Kristina Wittig. She is a urological surgeon at City of Hope. Welcome to the show, Dr. Wittig. What is the pelvic floor?
Dr. Kristina Wittig (Guest): Pelvic floor are the muscles that hold your bladder and your uterus and vagina in place, basically. After you have children or when you get older, the pelvic floor muscles relax and you can have a prolapse of the bladder; you can have prolapse of the uterus and the vaginal wall. Those can cause various symptoms such as incontinence or other lower urinary tract symptoms. Also, pressure and pain in that area.
Melanie: What are some of these disorders? We see those commercials, Dr. Wittig, for women, adult diapers, and medications for incontinence. What are some of the pelvic floor disorders that we’re speaking about?
Dr. Wittig: There are different types of incontinence. You can have stress incontinence. You have urgency incontinence. Some women just have some irritating voiding symptoms, such as they have urinary frequency and urgency. Those things can definitely interfere with your quality of life because your life pretty much revolves around the bathroom. Also, you can have pelvic organ prolapse such as urinary prolapse, vaginal wall prolapse, or bladder prolapse.
Melanie: Is there a certain cause you can point to for these disorders? You mention having a baby.
Dr. Wittig: Yes. Most of them are child-bearing, just because that is one of the important factors which can cause relaxation of the pelvic floor muscles.
Melanie: So, what do we do about it? If women are incontinent, and, of course, this is something very embarrassing but if women come to you to discuss this or they’ve had one of the urologic cancers and as a result now suffer from pelvic floor disorder, what do you do for them?
Dr. Wittig: Depending on what type of incontinence or what symptoms they are experiencing, there are medications that we can try that helps relax the bladder and reduce the amount of incontinence or reduce the urgency and frequency sensation. There are also some conservative options that we try if somebody has urge-related incontinence we can try Botox injections to the bladder to try to relax the bladder muscle. There is also sacral nerve stimulation for women with urgency frequency and urgency incontinence, but also some women who are enduring urinary retention that could work and sacral nerve stimulators implantation of a little device like a pacemaker into your sacral spine, a little electrode goes into your spine, and you have this pacemaker-like device implanted into your upper buttocks and that stimulates the nerves that control the bladder and are very effective in reducing urgency frequency and urgency incontinence symptoms. Then, there are surgical options such as repair of the pelvic floor prolapse. There are various surgical options, depending on what you present with.
Melanie: Is there any issue with working on Kegel exercises if you are somebody with some kind of urologic cancer – doing those exercises before you do surgery or after? Is there therapy that you recommend women do to help strengthen their pelvic floor muscles?
Dr. Wittig: Kegel exercises are something that all women should do, actually--especially women who are having children or had children, even women who haven’t had children. Those are just good general things to do to keep your pelvic floor muscles strong. Also, not only women but males who have a prostatectomy for prostate cancer also end up with stress incontinence and we also encourage them to do Kegel exercises before their surgery and after their surgery because they have a similar type of problem.
Melanie: If they go on medications that you were mentioning, or do biofeedback or Botox, is this something that they would have to do again? Would they have to be on the medications for a long time or is it something that maybe would come and go?
Dr. Wittig: Also, I forgot to mention pelvic floor physical therapy. That has shown to be very effective also because physical therapist teach them more effective techniques than just Kegel exercises to try to strengthen the pelvic floor. As far as the medication, if the medication is helping you – the medication that was taken to relax the bladder – if it’s helping then it’s a lifelong daily medication that you take. Botox is something that would usually have to be injected about every six months because it is not something that is permanent.
Melanie: What about the pelvic sling? Women hear about this. We hear about commercials and see things in the media. Tell us a just little about the pelvic sling and what’s involved in having one put in.
Dr. Wittig: A pelvic sling is usually performed for women who suffer from stress incontinence which is incontinence that you have when you are coughing, sneezing, laughing, jumping, and any kind of stressful physical activity, basically. It is a sling that is put in that holds your urethra up and helps prevent the leakage. I know there has been a lot of talk in the media about vaginal mesh and various lawsuits related to that; however, that does not apply to the pelvic sling so much. But, for women who are very reluctant to undergo this type of surgery because they are worried about the mesh and all the bad publicity that it has gotten we do offer an autologous sling, which basically is an option to harvest your own piece of fascia from the lower abdominal wall and then you use that as a sling material to do the same thing.
Melanie: Wow. That’s really fascinating. In just the last minute here, Dr. Wittig, what do you tell women that come and they are embarrassed about talking to you about painful intercourse, urination or even fecal incontinence, just something they don’t want to think about or discuss but it is affecting the quality of their life? What is your best advice and why should they come to City of Hope for their care?
Dr. Wittig: I usually tell them this is nothing to be embarrassed about at all. I see a lot of women suffering from the same problems. If there is something we can do to help and even improve their symptoms even just a little bit, I think it can make a tremendous difference in their quality of life.
Melanie: Why should they come to City of Hope for their care?
Dr. Wittig: Because City of Hope has the best trained physicians. The majority of us who do this type of surgery or any kind of cancer surgery are fellowship trained. We can offer the latest, the best techniques to perform these procedures.
Melanie: Thank you so much, Dr. Wittig. Its great information and so important for women. 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.