Maggie McKay (Host): A woman's body is complex. And oftentimes, there are things about it even a woman isn't aware of, unless someone she knows experiences a problem. And even then, does the subject of things like the pelvic floor prolapse and Kegels come up in conversation? Probably not that often until there's a reason to talk about it.

joining me today to talk about not just Kegels, but what's going on down there is Dr. Cristina Saiz, Co-medical Director of Urogynecology and Pelvic Reconstructive Surgery for Valley Medical Group at Valley Health System.

Welcome to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. Our podcast goes beyond broad everyday health topics to discuss very real and very specific subjects impacting men, women, and children. We think you'll enjoy our fresh take. Thanks for listening. I'm Maggie McKay. Doctor, thank you so much for making the time to be here with us today. I have a lot of questions, so let's just dive right in. For starters, what is a urogynecologist?

Dr Cristina Saiz: That's a question that I get all the time because it's not a subspecialty that people are familiar with. And it's bit of a hard question to answer in a simple way. Basically, over the years, we realized that women suffer from a lot of pelvic floor disorders and they ended up bouncing between neurologists and gynecologist without finding someone that truly was an expert at the matter. So, they created a fellowship and it could be two to three years that basically trains a physician to take care exclusively of women that have pelvic floors disorders. But in order to complete this fellowship, you have to either be a urologist or a gynecologist.

Maggie McKay (Host): And what is pelvic organ prolapse?

Dr Cristina Saiz: That's one of the things that we most commonly see as urogynecologists. And it basically is a condition that develops as women get older, especially after menopause. And it has to do with weakening of the pelvic floor that leads to a hernia occurring through the vaginal wall. So, they will refer to this as having something bulging or protruding from the vagina. It's not painful, but it's certainly uncomfortable. And people oftentimes say, "My bladder dropped" or "My womb is very low." And that's just a common way of describe it even though it's not really accurate because bladder is not falling out of you. It's just that it descends since the pelvic floor is no longer holding these organs in the proper position. But it's basically a hernia.

Maggie McKay (Host): And what organs depend on a healthy pelvic floor?

Dr Cristina Saiz: The bladder, the bowel, the rectum, and the womb.

Maggie McKay (Host): And you touched on it a little bit, but what happens to the body when prolapse occurs? What are the symptoms?

Dr Cristina Saiz: The main symptom is that the patient would start feeling some pressure at the vaginal opening. They may see or feel something bulging from the vagina. And a lot of times, there's other associated symptoms, although having those alone doesn't mean that someone has prolapse. The main indicator of prolapse is that you feel something bulging out of the vaginal opening. Other symptoms that go hand in hand have to do with the urinary system, having difficulty urinating, going often to the bathroom. Sometimes, it's very common to have someone having leakage of urine at the same time that they have a prolapse. But like I said, the main symptom is you feel something bulging out.

Maggie McKay (Host): And what are the different types of urinary incontince?

Dr Cristina Saiz: Well, that's a separate topic from pelvic organ prolapse. Urinary incontinence refers to when women would have leakage of urine. It could be drops, it could be larger amounts, but the point of the matter is that urine leaks out and there are different kinds. The most common one is what we call stress urinary incontinence, which basically refers to someone that will leak urine when they cough, when they sneeze, when they laugh, when they jump. And there's also what we call urge urinary incontinence. It's very different that when someone would say, "If I have to go use the bathroom, I got to get there right away, because otherwise I feel I'm not going to make it. And sometimes, I will start to lose urine before I reach the toilet." Many times, women will have a combination of both stress and urge incontinence.

Maggie McKay (Host): Is that the same as overactive bladder?

Dr Cristina Saiz: Overactive bladder is the leading cause of urge incontinence. So, it's similar to saying urge urinary incontinence because overactive bladder is when the bladder nerves don't work properly to control the bladder. So, the bladder is having sort of like spasms that make the patient feel they have to go often to the bathroom, like if they're not emptying very well and then having those kind of rushes of, "I got to go right away." And oftentimes, they start to leak urine.

Maggie McKay (Host): And what treatment options are there for incontinence?

Dr Cristina Saiz: It depends on what type of incontinence they have. And like I said, many times they would have a combination of both main types of incontinence. But with something as simple as going for pelvic floor physical therapy, it could be something where they have to change their lifestyle, like losing weight, eliminating acid from the diet, like coffee, carbonation. It could be medications. It could be a procedure in the office, in the operating room. There's so many treatments and it all comes down to what's the main cause of the incontinence. And you start with the most simple thing and then you go up if they're not responding.

Maggie McKay (Host): And what causes prolapse? Are there different types?

Dr Cristina Saiz: The main reason what women will develop prolapse is a combination of factors. One is genetics. It tends to run in the family. We're basically predisposed to this condition by having a very weak connective tissue. People that have prolapse, they also tend to have abdominal wall hernias, which is another indicator of weak connective tissue. But there are factors, having babies, going through menopause, getting older, and then anything that will put pressure on the pelvic floor like obesity, constipation, having a job that requires you to lift heavy objects, all of that adds up and it results in a prolapse.

Maggie McKay (Host): And is it a natural part of aging, would you say? You mentioned it is genetic, but what age would people expect to see prolapse happen and how common is it?

Dr Cristina Saiz: I don't like to define this as natural aging because then people will think, "Well, this is what happens when I get old, and I just have to put up with it." I don't think it's natural aging. I think it's very common. Just like someone who has high blood pressure, everybody at certain age would start to find other friends that have high blood pressure, but that's not natural aging. That's just a condition that is more prevalent as we age. The classic patient in my office will be postmenopausal. Late 50s, 60s and 70s, that's when you start seeing these pelvic organ prolapse symptoms develop.

Maggie McKay (Host): Can someone who has never had children experience prolapse?

Dr Cristina Saiz: They can, but it would be less likely, much less likely that someone who had children. I can see prolapse in patients who are morbidly obese, patients who have chronic constipation. But in general, you would see these conditions in women who had children.

Maggie McKay (Host): And what sort of doctor can help someone experiencing symptom?

Dr Cristina Saiz: Well, that's why they created urogynecology as a subspecialty, so that women would know who to to go to.

Maggie McKay (Host): Okay. And there are exercises that someone can do to help treat or prevent prolapse. Is that Kegels?

Dr Cristina Saiz: So, Kegels is just what we commonly known as something that you squeeze down there and it's supposed to help. But the reality is that the pelvic floor has a layer of muscles and to be able to adequately reinforce the pelvic floor and contract those muscles, the best way is to find someone in the physical therapy world that specializes in pelvic floor, because there's many exercises beyond what we know as Kegel exercises that will help strengthen the pelvic floor.

Maggie McKay (Host): And if someone does have prolapse, are there things they should or shouldn't do? Like should they avoid lifting heavy things or what?

Dr Cristina Saiz: If they have prolapse, they should avoid anything that would put pressure down on the pelvic floor. They should try to maintain an ideal body weight. They should try to do exercises that give you core strengthening like Pilates, Barre, yoga, anything that will give you a core. They should avoid high-impact exercises like jumping or very heavy lifting. They should avoid constipation. They should find a pelvic floor physical therapist that can help them do-- I would call it like a personal trainer for the pelvic floor.

Maggie McKay (Host): And is surgery ever necessary? And if so, what's done during it?

Dr Cristina Saiz: There are a lot of patients that unfortunately end up having to have surgery because the condition progresses over time. There are many different kinds of surgery that we can do. Most procedures are done either vaginally or laparoscopically with the use of the robot. It's rare nowadays that someone would have an open surgery for prolapse and their recovery is not bad because they're done in a minimally invasive way. But you're still looking at a major surgery where most patients will stay one night in the hospital. But like I said, their recovery's not too bad, not like back in the day when people have open surgery for these conditions and their recovery will be much more cumbersome.

Maggie McKay (Host): You mentioned the bulging. Is it possible to have prolapse and not even know it, have no symptoms?

Dr Cristina Saiz: That would be very uncommon. I sometimes have patients in my office that say, "I'm here because I was told I have a prolapse. Someone examined me. They say I have a prolapse. I'm worried about it,." And then, I ask them about any symptoms and they have absolutely no symptoms. When I examine them, I notice someone for their age, let's say, 50s, 60s, who had babies, and there's some relaxation of the pelvic floor, but there's not an actual prolapse. So, the main indicator is if the patient doesn't have a symptom of a bulge or pressure, it's very, very unlikely that they would have a prolapse.

Maggie McKay (Host): And if someone suspects they do have a prolapse, should they go to the doctor right away or how does that work?

Dr Cristina Saiz: So, if they have symptoms of prolapse, they can look with a mirror to see if they see anything protruding from the vaginal opening. Or if they don't feel comfortable looking, they could be evaluated by their general gynecologist to confirm the diagnosis and then seek the expert opinion of a urogynecologist, or they could just directly go to see a urogynecologist.

Maggie McKay (Host): So, we talked about surgery, we talked about Kegels. If you have prolapse, it doesn't just go away, right?

Dr Cristina Saiz: No, it doesn't go away. There's another option we haven't mentioned, which is the use of pessaries. Pessaries are devices made out of silicon. It looks like the diaphragm back in the day. But basically, it's a ring silicon support that you will place inside the vagina to help support the pelvic floor. And a lot of my patients will be using pessary, so they don't require to go through surgery, and they're very happy with this. We teach them how to take care of the device, which involves taking it out and cleaning it every so often, but they can live their lives as normal without having to have surgery just by using a pessary.

Maggie McKay (Host): And do you have to avoid intimacy while you have prolapse?

Dr Cristina Saiz: No, there's no need to avoid intimacy, although a lot of patients feel very self-aware and embarrassed about the condition, and they don't feel comfortable talking to their partners about it, so they start to avoid it. Others may experience some discomfort during intercourse because they feel as if the prolapse is in their way, but the prolapse will not get worse because you're sexually active.

Maggie McKay (Host): Well, this has been so educational and helpful. Thank you again for shedding some light on this important topic that a lot of people never discuss until they have to, like we said earlier. Anything else you'd like to share that we didn't cover?

Dr Cristina Saiz: I just wanted to say thank you for taking time to bring awareness for pelvic floor disorders because many women that suffer in silence, they are embarrassed about these conditions. They don't know who to go to. They think they're alone. Women talk about everything with their friends, breast disease, this, that, my blood pressure, my cholesterol, but they feel very shy about saying something is down there, or "I'm buying pads because now I have incontinence," and I think we need to normalize that these conditions are extremely common and that there are specialists that can help you improve your quality of life.

Maggie McKay (Host): Definitely. Thank you so much, Dr. Saiz.

Dr Cristina Saiz: Thank you.

Maggie McKay (Host): For more information about urogynecology at Valley, please visit valleyhealth.com/urogynecology or call 201-221-0504 to schedule an appointment. If you found this podcast helpful, please share it on your social channels and for topics of interest to you, check out our entire library of podcasts.

Thanks for listening to Conversations Like No Other, presented by Valley Health System in Ridgewood, New Jersey. For more information on today's topic or to be connected with today's guest, please call 201-291-6090 or email valleypodcast@valleyhealth.com. I'm Maggie McKay. Be well.