Selected Podcast
Pelvic Floor Disorders: More Common Than You Think
Dr. Muñiz (Urogynecologist) talks about Pelvic Floor Disorders. Dr. Muñiz discusses what are pelvic floor disorders (PFDs), the risk factors, and treatments.
Featuring:
Keila Muniz, MD
My name is Keila S. Muñiz and I am passionate about providing quality and compassionate care to women with urologic and gynecologic issues. I am a board-certified obstetrician gynecologist. I completed residency at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and completed fellowship training in Female Pelvic Medicine and Reconstructive Surgery at the Johns Hopkins School of Medicine/Bayview Medical Center in a Urology and Gynecology program. I am bilingual in English and Spanish. Transcription:
Prakash Chandran (Host): Pelvic floor disorder or PFD occurs when the pelvic muscles are weakened or injured, though we don't hear about this disorder as often as other medical topics, PFD is more common than we think. We're going to learn all about it today Keila Muniz, a Urogynecologist specializing in Female Pelvic Medicine and Reconstructive Surgery at St. Joseph's Health. This is St. Joseph's Health Med Cast. The podcast from St. Joseph's Health. My So Dr. Muniz, I really appreciate your time today. Thank you so much for being here. Let's just get started by you telling us a little bit more about what pelvic floor disorders are.
Keila Muniz, MD (Guest): Thank you so much. So pelvic floor disorders are essentially basically a group of conditions that affect the pelvic floor. And the pelvic floor is comprised of the muscles, ligaments and connective tissue that support the bowel, bladder, uterus, vagina, and rectum preventing them from falling down and basically helping them to function properly.
So a pelvic floor disorder, like you mentioned is due to a weakening of those muscles or connective tissue. And when it's weakened, it can't continue to provide the support that those organs need to work effectively and normal functioning can be affected of all those organs.
Host: Now it says it in your title that you specialize in female pelvic medicine, does pelvic floor disorders only affect females or do they also affect males?
Dr. Muniz: It also does affect males. I happen to specialize in females because my main training is an obstetrics and gynecology.
Host: Okay. Understood. So when we talk about these pelvic floor muscles being weakened, what exactly causes that to happen?
Dr. Muniz: So there are several risk factors that can actually lead to that sort of weakening of those, of the pelvic floor. This can include pregnancy or childbirth because it can put excessive strain on the pelvic floor during delivery and vaginal delivery is actually double the rate of pelvic floor disorders compared to a Cesarean delivery or in women who have never actually given birth. Age can also lead to weakening of the pelvic floor muscles over time and development of certain pelvic floor conditions like pelvic organ prolapse. Genetics also can play a role. So some women are actually born with weaker pelvic floor muscles, and then that puts them at greater risk for developing these pelvic floor disorders.
Obesity, can also increase the pressure on the pelvic floor and increase that development of developing things like pelvic organ prolapse or urinary incontinence in the future. And smoking can be a risk factor as well for developing some of these pelvic floor disorders. Two other kinds of lifestyle changes too, in people who have certain jobs that require heavy lifting or exertion or very repetitive, strenuous activity that can increase their risk or in lung conditions like chronic coughing that puts pressure on the pelvic floor that can increase their risk as well.
Host: Yeah, So there are a number of different things that can actually cause pelvic floor disorders. And just up at the top, I was talking about how common it is, you know, it just is, I'm reminded of my daughter's birth. My wife gave birth to my daughter vaginally and she had pelvic floor issues for a year and it was something she didn't expect.
And she thought she was alone in it. And it turns out that my wife's, or my best friend's wife also had pelvic floor issues. I mean, it, it feels like this happens quite a bit, but people don't expect it. On average. How many women suffer from pelvic floor disorders?
Dr. Muniz: Yeah, I'm glad you mentioned that. About one in four women, about twenty-five percent in women greater than 20 years of age suffer from some sort of pelvic floor disorder, and most actually suffer from more than one. So this can include pelvic organ prolapse or the dropping of the pelvic organs, urinary incontinence or accidental urinary leakage or fecal incontinence or accidental bowel leakage.
Host: Yeah. So I was just going to ask you what the most common symptoms of a pelvic floor disorder was. So you talked about urinary or fecal incontinence. Are there anything else that might tell a woman that she might be suffering from a pelvic floor disorder?
Dr. Muniz: Oftentimes I think if women start realizing that they might have trouble with leakage of either urine or their, their bowels or stools, or if they're having problems with emptying the bladder. Or the rectum, if they're having issues of pelvic pain or bladder pain, or if they've been examined and they feel, not only do they feel like something might be kind of falling or tissue coming out of their vaginal area, but they've been seen by somebody by, you know, a physician who has examining them who can tell them that that's actually happening to them as well.
Host: Yeah. So since this seems to affect many more people than I think we realize why is this such a taboo topic?
Dr. Muniz: It can be very difficult to talk about these issues because even with a healthcare provider, it can be something very personal and embarrassing to a lot of women and not so easily discussed even with, you know, their, their primary care physicians and some women have the belief that the conditions are unavoidable due to older age.
And often I think there's a lack of understanding or knowledge of the availability of treatment options for these conditions. Women just don't even bring it up. But I think it's important for women to know that there are physicians and there are specialists such as urogynecologists who are used to talking about these problems and they are able to get the proper treatment for whatever pelvic floor disorder they are suffering from.
Host: Because you mentioned treatments, can you talk about some of the different treatment options that are available to a woman who might have pelvic floor disorders?
Dr. Muniz: Sure. So sometimes very simple lifestyle changes can really significantly affect a woman's daily quality of life. And a urogynecologist can provide various different treatment options, depending on the severity of their symptoms and also a woman's general health. So it might actually be a combination of therapies that a physician might recommend.
So this can include some lifestyle and behavioral changes, or it can include procedures and even some surgeries. And the physician will discuss with the patient based on kind of their needs, their wants, and come up with a very customized plan for a treatment option.
Host: So when you say lifestyle or behavioral changes, what are those? Can you name some examples?
Dr. Muniz: Sure. Sometimes just changing certain things in the diet. There are certain things in the diet that can affect urinary symptoms, such as caffeine and alcohol. They can be very irritating to the bladder and affect sometime urinary leakage that patients are suffering from. There's also pelvic floor muscle exercises or what is often referred to as Kegel's that can often strengthen the pelvic floor. Techniques such as bladder retraining or bladder drills to help kind of alleviate leakage of urine issues. And then there's also certain devices that can be placed in the vagina that are non-invasive that can help with issues of pelvic organ prolapse or dropping of, you know, the vaginal walls.
Host: So, because this tends to be a taboo topic and oftentimes, perhaps women might deal with it in silence or kind of use doctor internet; at what point do you recommend that they actually go in to talk to their doctor and see someone?
Dr. Muniz: I think really once it's affecting their quality of life. You know, I think once it becomes something that's very bothersome to a woman, I think it's important to, to voice that to the, either their primary care physician, their gynecologist, or the urologist, whoever they're primarily seeing. And just understanding that there are urogynecologists that can provide additional expertise aside from their regular, regular doctors.
And I think if a woman is realizing that they're feeling some sort of vaginal protrusion, vaginal bulge, if they're having trouble with urinary leakage or bowel leakage, or if they're having issues with emptying the bladder or the bowels; I think it's very important to voice that, to bring that up to whoever they're following for their health care.
And then, you know, knowing, understanding that there are specialists that can treat them and that can provide that expertise in how to treat those options, those conditions.
Host: Dr. Muniz, one question that I always like to end on is given all of your experience specializing in female pelvic medicine, I'm sure that you've helped many women with pelvic floor disorders. What is one thing that, you know, to be true that you just wish more women knew before they came to see you?
Dr. Muniz: There are many different treatment options. And I feel like often I see patients who come to me who are like, doctor, I just want a surgery. And I think just educating women, empowering them, letting them know that often their condition doesn't actually require something very invasive, such as, such as the surgery.
But also making sure that a woman understands that, you know, they, their wishes and their desires will be heard. So whatever treatment option they, you know, they prefer will be, will be a joint decision between them and their physician so that they shouldn't feel forced into a certain treatment that they're not ready for.
Host: I think that's wonderful advice and really good for women to hear. I also just think that conversations like this are so helpful because, you know, I think part of what was so hard for my wife is that she didn't really anticipate any of this. If this was just brought up before that pelvic floor disorders and issues after pregnancy, you know, are fairly common than I think that we would have dealt with it differently. So conversations like this and just sharing the knowledge is just so important.
Dr. Muniz: I completely agree with you. And I think on that note, just letting women know that they are more common. It's just that nobody talks about it.
Host: Well, I'm glad we're doing it today. So thank you so much, Dr. Muniz. I really appreciate your time.
Dr. Muniz: Thank you so much.
Host: That was Dr. Keila Muniz, Urogynecologist, specializing in female public medicine and reconstructive surgery at St. Joseph's Health. For more information, you can visit sjhsyr.org. That's S J H S Y jhsysr.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
This has been St Joseph's health med cast from St. Joseph's health. My name is precaution. Thanks again, and we'll talk soon.
Prakash Chandran (Host): Pelvic floor disorder or PFD occurs when the pelvic muscles are weakened or injured, though we don't hear about this disorder as often as other medical topics, PFD is more common than we think. We're going to learn all about it today Keila Muniz, a Urogynecologist specializing in Female Pelvic Medicine and Reconstructive Surgery at St. Joseph's Health. This is St. Joseph's Health Med Cast. The podcast from St. Joseph's Health. My So Dr. Muniz, I really appreciate your time today. Thank you so much for being here. Let's just get started by you telling us a little bit more about what pelvic floor disorders are.
Keila Muniz, MD (Guest): Thank you so much. So pelvic floor disorders are essentially basically a group of conditions that affect the pelvic floor. And the pelvic floor is comprised of the muscles, ligaments and connective tissue that support the bowel, bladder, uterus, vagina, and rectum preventing them from falling down and basically helping them to function properly.
So a pelvic floor disorder, like you mentioned is due to a weakening of those muscles or connective tissue. And when it's weakened, it can't continue to provide the support that those organs need to work effectively and normal functioning can be affected of all those organs.
Host: Now it says it in your title that you specialize in female pelvic medicine, does pelvic floor disorders only affect females or do they also affect males?
Dr. Muniz: It also does affect males. I happen to specialize in females because my main training is an obstetrics and gynecology.
Host: Okay. Understood. So when we talk about these pelvic floor muscles being weakened, what exactly causes that to happen?
Dr. Muniz: So there are several risk factors that can actually lead to that sort of weakening of those, of the pelvic floor. This can include pregnancy or childbirth because it can put excessive strain on the pelvic floor during delivery and vaginal delivery is actually double the rate of pelvic floor disorders compared to a Cesarean delivery or in women who have never actually given birth. Age can also lead to weakening of the pelvic floor muscles over time and development of certain pelvic floor conditions like pelvic organ prolapse. Genetics also can play a role. So some women are actually born with weaker pelvic floor muscles, and then that puts them at greater risk for developing these pelvic floor disorders.
Obesity, can also increase the pressure on the pelvic floor and increase that development of developing things like pelvic organ prolapse or urinary incontinence in the future. And smoking can be a risk factor as well for developing some of these pelvic floor disorders. Two other kinds of lifestyle changes too, in people who have certain jobs that require heavy lifting or exertion or very repetitive, strenuous activity that can increase their risk or in lung conditions like chronic coughing that puts pressure on the pelvic floor that can increase their risk as well.
Host: Yeah, So there are a number of different things that can actually cause pelvic floor disorders. And just up at the top, I was talking about how common it is, you know, it just is, I'm reminded of my daughter's birth. My wife gave birth to my daughter vaginally and she had pelvic floor issues for a year and it was something she didn't expect.
And she thought she was alone in it. And it turns out that my wife's, or my best friend's wife also had pelvic floor issues. I mean, it, it feels like this happens quite a bit, but people don't expect it. On average. How many women suffer from pelvic floor disorders?
Dr. Muniz: Yeah, I'm glad you mentioned that. About one in four women, about twenty-five percent in women greater than 20 years of age suffer from some sort of pelvic floor disorder, and most actually suffer from more than one. So this can include pelvic organ prolapse or the dropping of the pelvic organs, urinary incontinence or accidental urinary leakage or fecal incontinence or accidental bowel leakage.
Host: Yeah. So I was just going to ask you what the most common symptoms of a pelvic floor disorder was. So you talked about urinary or fecal incontinence. Are there anything else that might tell a woman that she might be suffering from a pelvic floor disorder?
Dr. Muniz: Oftentimes I think if women start realizing that they might have trouble with leakage of either urine or their, their bowels or stools, or if they're having problems with emptying the bladder. Or the rectum, if they're having issues of pelvic pain or bladder pain, or if they've been examined and they feel, not only do they feel like something might be kind of falling or tissue coming out of their vaginal area, but they've been seen by somebody by, you know, a physician who has examining them who can tell them that that's actually happening to them as well.
Host: Yeah. So since this seems to affect many more people than I think we realize why is this such a taboo topic?
Dr. Muniz: It can be very difficult to talk about these issues because even with a healthcare provider, it can be something very personal and embarrassing to a lot of women and not so easily discussed even with, you know, their, their primary care physicians and some women have the belief that the conditions are unavoidable due to older age.
And often I think there's a lack of understanding or knowledge of the availability of treatment options for these conditions. Women just don't even bring it up. But I think it's important for women to know that there are physicians and there are specialists such as urogynecologists who are used to talking about these problems and they are able to get the proper treatment for whatever pelvic floor disorder they are suffering from.
Host: Because you mentioned treatments, can you talk about some of the different treatment options that are available to a woman who might have pelvic floor disorders?
Dr. Muniz: Sure. So sometimes very simple lifestyle changes can really significantly affect a woman's daily quality of life. And a urogynecologist can provide various different treatment options, depending on the severity of their symptoms and also a woman's general health. So it might actually be a combination of therapies that a physician might recommend.
So this can include some lifestyle and behavioral changes, or it can include procedures and even some surgeries. And the physician will discuss with the patient based on kind of their needs, their wants, and come up with a very customized plan for a treatment option.
Host: So when you say lifestyle or behavioral changes, what are those? Can you name some examples?
Dr. Muniz: Sure. Sometimes just changing certain things in the diet. There are certain things in the diet that can affect urinary symptoms, such as caffeine and alcohol. They can be very irritating to the bladder and affect sometime urinary leakage that patients are suffering from. There's also pelvic floor muscle exercises or what is often referred to as Kegel's that can often strengthen the pelvic floor. Techniques such as bladder retraining or bladder drills to help kind of alleviate leakage of urine issues. And then there's also certain devices that can be placed in the vagina that are non-invasive that can help with issues of pelvic organ prolapse or dropping of, you know, the vaginal walls.
Host: So, because this tends to be a taboo topic and oftentimes, perhaps women might deal with it in silence or kind of use doctor internet; at what point do you recommend that they actually go in to talk to their doctor and see someone?
Dr. Muniz: I think really once it's affecting their quality of life. You know, I think once it becomes something that's very bothersome to a woman, I think it's important to, to voice that to the, either their primary care physician, their gynecologist, or the urologist, whoever they're primarily seeing. And just understanding that there are urogynecologists that can provide additional expertise aside from their regular, regular doctors.
And I think if a woman is realizing that they're feeling some sort of vaginal protrusion, vaginal bulge, if they're having trouble with urinary leakage or bowel leakage, or if they're having issues with emptying the bladder or the bowels; I think it's very important to voice that, to bring that up to whoever they're following for their health care.
And then, you know, knowing, understanding that there are specialists that can treat them and that can provide that expertise in how to treat those options, those conditions.
Host: Dr. Muniz, one question that I always like to end on is given all of your experience specializing in female pelvic medicine, I'm sure that you've helped many women with pelvic floor disorders. What is one thing that, you know, to be true that you just wish more women knew before they came to see you?
Dr. Muniz: There are many different treatment options. And I feel like often I see patients who come to me who are like, doctor, I just want a surgery. And I think just educating women, empowering them, letting them know that often their condition doesn't actually require something very invasive, such as, such as the surgery.
But also making sure that a woman understands that, you know, they, their wishes and their desires will be heard. So whatever treatment option they, you know, they prefer will be, will be a joint decision between them and their physician so that they shouldn't feel forced into a certain treatment that they're not ready for.
Host: I think that's wonderful advice and really good for women to hear. I also just think that conversations like this are so helpful because, you know, I think part of what was so hard for my wife is that she didn't really anticipate any of this. If this was just brought up before that pelvic floor disorders and issues after pregnancy, you know, are fairly common than I think that we would have dealt with it differently. So conversations like this and just sharing the knowledge is just so important.
Dr. Muniz: I completely agree with you. And I think on that note, just letting women know that they are more common. It's just that nobody talks about it.
Host: Well, I'm glad we're doing it today. So thank you so much, Dr. Muniz. I really appreciate your time.
Dr. Muniz: Thank you so much.
Host: That was Dr. Keila Muniz, Urogynecologist, specializing in female public medicine and reconstructive surgery at St. Joseph's Health. For more information, you can visit sjhsyr.org. That's S J H S Y jhsysr.org. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.
This has been St Joseph's health med cast from St. Joseph's health. My name is precaution. Thanks again, and we'll talk soon.