Sam Greenberg (Host): This is UAMS Health Talk. I'm Sam Greenberg. And with me today is Dr. Sallie Oliphant. She's a urogynecologist at the University of Arkansas for Medical Sciences. And today, we'll discuss everything you need to know about pelvic floor and bladder health. Doctor, thank you so much for your time.

Sallie Oliphant, MD: Thanks for having me.

Host: It's my pleasure. So to start us off, let's go broad spectrum. What exactly is the pelvic floor, and why is it so important to overall physical health?

Sallie Oliphant, MD: The pelvic floor is basically the hammock of muscles and connected tissue that supports the pelvic organs. And for females, that's providing support for the bladder, the vagina, and the rectum. And so, having good pelvic floor health really impacts urinary function, bowel function, sexual function, and can be impactful for conditions like pelvic pain, urinary incontinence, frequent urinary tract infections, pelvic organ prolapse, kind of a multitude, bowel incontinence, lots of different things that can go awry if the pelvic floor is not in good health.

Host: So, what are some common misconceptions that you hear about pelvic floor function or, say, weak bladder issues?

Sallie Oliphant, MD: Sure. So, a lot of patients, I think, have the idea that some of these issues are just a normal part of aging. And while they're very common, and they do get more common as women age, they're not something that we should consider normal or not necessarily intervene for, especially if they're causing bother or impacting a woman's quality of life.

So, a lot of patients also think not only is this just kind of, "Oh, I have to kind of just deal with this because of aging," we also hear a lot from patients that they feel like their only option would probably be surgery. And some patients are sort of, you know, reluctant to intervene if it has to have surgery. And there's a lot of non-surgical options that we have. So, those are probably the two biggest things I would want to stress.

Host: So, what are some of the key symptoms or warning signs that should prompt someone to talk with a doctor about their pelvic floor or bladder?

Sallie Oliphant, MD: Again, kind of impact on quality of life. So, if urinary function is really something that you're having to think about a lot during the day, whether that's going too frequently or feeling like you're not able to empty your bladder, frequent urinary tract infections, urinary leakage. If it's something that's causing you to avoid activities or you're kind of having to plan your day, you know, where is every bathroom, that kind of thing, that's definitely something that we would want to hear about so we can try to make an impact and get pa- people back to enjoying their life and not having to think about their bladder.

From the perspective of some of the other pelvic floor disorders, similarly, if they're not able to have satisfying sexual intercourse, if they're having pelvic pain, discomfort that's keeping them from being able to do activities, exercise, play with your kids, play with your grandkids, those kind of things, bowel function that is causing pain, discomfort, change in quality of life. All of those factors are things that we talk about with patients every day.

Host: So really, the keys are those impacts to daily life is when you should really pick up the phone and seek some medical attention.

Sallie Oliphant, MD: Absolutely.

Host: Doctor, can you walk us through maybe some of the different types of bladder issues that women may experience?

Sallie Oliphant, MD: Sure. So, probably one of the more common things that we see patients coming in for around the time that they are pregnant or maybe their first delivery would be urinary incontinence that we call stress incontinence. And so, stress incontinence is leakage of urine with cough, sneeze, laugh, exercise, I hear a lot jump on the trampoline. You know, anything that's really causing increased abdominal pressure. That's probably one of the first types of leakage that a lot of women will experience.

And then, overactive bladder can be common. It gets a little bit more common with each decade of aging. That's symptoms like frequency, urgency. That's the patient who's describing that they know where every bathroom is, or they visited every bathroom in Target or Walmart or whatever. So, having to go more frequently throughout the day, going frequently at night, which can be very impactful for sleep. And of course, sleep is so important for our health. Having to get up frequently at night is very upsetting. And then, that type of leakage is called urgency incontinence. So if there's some overactive bladder components and people kind of can't make it to the bathroom, they're having to rush to the bathroom and they're leaking on the way, then we see that a good bit as well.

And the treatment strategies for those two types of leakage are different. So, that's kind of why we try to tease those out and kind of think about this a little bit differently. And then, we also see a lot of women with recurrent urinary tract infections. So, they're starting to get two urinary tract infections in six months or three urinary tract infections within a year. So, we want to try to intervene there because, of course, it's not going to give patients good quality of life to be having frequent infections.

And then, the other common bladder issue that we see is bladder pain. So, there's a condition called interstitial cystitis or bladder pain syndrome that basically kind of mimics the symptoms often of a bladder infection. But there's actually not truly bacteria growing. And so, it's more of an inflammatory type of a condition that can cause a lot of distress.

Host: Going along with that, Doctor, what are some of the main treatment options for urinary incontinence?

Sallie Oliphant, MD: So as I said before, we kind of think about the stress incontinence versus the urgency incontinence a little bit differently because they're kind of physiologically caused by different problems. So, the stress incontinence is the leakage that's happening with the increased pressure. So you're jumping on the trampoline, you're coughing, you're sneezing.

And so, for that, the issue is typically that the urethra is not as well stabilized. So, the female urethra has some suspensory ligaments that support the urethra, kind of like a hammock being pulled tight between two trees. And the classic time we see it is pregnancy, childbirth, but just aging in general kind of lets those ligaments get a little saggier, so the hammock's kind of a little looser. And so, we want to do something to stabilize that urethra.

And so, one of the first things that we often do is muscle strengthening. So, back to that pelvic floor. Strengthening the pelvic floor can really help support the urethra, and that often involves even pelvic floor physical therapy. So, there are physical therapists who specialize in pelvic floor work and that can be very impactful. We also have some silicone devices called pessaries that women can utilize inside the vagina to give additional support to the urethra to help with that type of leakage.

And then, we have some procedural interventions. So, there is a procedure called urethral bulking, where we take the urethra itself and we go in with a little camera and kind of inject under the surface of the urethra to help it close a little more snugly. Almost like people put filler in cosmetically to kind of increase their maybe lip volume or something like that. It would be basically kind of help the urethra close more tightly.

And then, we also have slings. So, you can put a little hammock underneath the urethra to support it surgically. So, kind of a variety of options, and that's one of those things we would sort of sit down and discuss and see what was the right answer for the patient.

Then, that other type of common urinary leakage, that urgency type, that also oftentimes can be managed with pelvic floor exercises, back to that pelvic floor again, with strengthening pelvic floor physical therapy. We can look for behavioral strategies. So, stopping smoking, reducing caffeine can be beneficial. Kind of looking at overall fluid volumes. Of course, you, you know, women need to stay hydrated, but drinking excessive amount of fluids, sometimes we'll see that with patients who are trying to be more healthy, so they're drinking a fair amount of fluid. And, you know, what goes in must come out. So to some degree, if there's too much fluid coming in, sometimes that can contribute.

Then, we look at medications. So, there's a variety of bladder medicines that help relax the bladder muscle so that it can be a better storage vessel and people are less likely to leak with that. And then we even have treatments beyond the medications. So, we can inject Botox in the bladder. So, a lot of people have heard about using Botox for wrinkles, but it actually works to relax the bladder muscles, so we do that a good bit. And we have some nerve stimulation treatments that some are done in the office and some are surgically implanted tohelp kind of calm down some of the hyperactivity of the nerves that control the bladder.

And then, of course, there can be other associated factors with leakage. So, a good pelvic exam is always helpful to make sure there's not something else going on that would be a contributing factor so that, you know, we might want to address something that's kind of causal.

Host: Doctor, when does someone with bladder or pelvic floor issues need to simply stop putting up with it and seek specialized care? Is it simply those impacts on daily life, or is there something broader?

Sallie Oliphant, MD: I would say yes. I mean, I think, as I said, I have patients who come to me and feel like, "Oh, I thought this was just normal aging, and then I talked to my friend and I realized there was something I could do about it." And so, anytime it's impacting your quality of life, absolutely.

You know, the other thing to, I guess, point out would be even if it weren't necessarily bothering you, or there's some things that you might say, "Well, I probably need to get that checked out anyway." So, I would say if women are experiencing frequent UTIs, even if they're not considering that a big bother, that's probably worth checking just to make sure that there's not some other factor going on. Anytime anyone sees, you know, visible blood in their urine or blood in their stool, those kind of things would definitely warrant an exam. Or if they felt like they really weren't emptying their bladder. So, sometimes those things, even if you wouldn't necessarily deem them quality of life impactful, I would say that warrants an exam.

Host: For women who feel like they've simply tried everything without any success, what advances in urogynecology or new treatments are out there that may give them hope?

Sallie Oliphant, MD: Recently, we have made some headways with some newer bladder medications. So, I oftentimes see women who have tried bladder medications in the years past and had a lot of side effects. And there's some newer medications that don't have quite as many side effects and are a little better tolerated.

We've also made some pretty significant advances in neuromodulation. So, back to kind of that nerve pathway that can be overactive for patients. And so, there's some less invasive ways of stimulating those nerves that weren't around in years past. And then, we've also made some pretty good developments in that urethral bulking, the injection of the urethra I was speaking about earlier.

So historically, that was something that had to be repeated very frequently, and we have newer products that really have better staying power. So, it's not necessarily something that people have to continue to get done. It can kind of be a one and done in a lot of situations.

Host: While bladder health may be something that's taboo to a lot of people, it's a taboo topic for some, I know this information and your expertise will really help everybody and prompt them to pick up the phone and call their doctor. So, thank you again for joining me.

Sallie Oliphant, MD: Absolutely. Thank you, Sam.

Host: It's been my pleasure. To make an appointment at UAMS, call 501-686-8000. If you enjoyed this podcast, please share it on your social channels and check out the entire UAMS Health Talk Library for topics of interest to you. This is UAMS Health Talk.