BREAK FREE. from Pelvic Floor Disorders WELCOME & INTRODUCTION 11/6/2017. Heidi Brown, Sarah McAchran, MD. Dobie Giles, MD, MS

Transcription

1 BREAK FREE from Pelvic Floor Disorders t w i t t e r. c o m / V o i c e s f o r P F D w w w. f a c e b o o k. c o m / Vo i c e s f o r P F D WELCOME & INTRODUCTION Heidi Brown, MD, MAS Sarah McAchran, MD UW Hospital and Clinics Gynecology Clinic Urology Clinic Dobie Giles, MD, MS Christine Heisler, MD, MS Meriter 1 South Park Angie Sergeant, NP Women s Pelvic Wellness Clinic

2 P R O G R A M OV E RV I E W INTRODUCTION TO PELVIC FLOOR DISORDERS RISK FACTORS FOR PFDS SOME YOU CAN CONTROL PELVIC ORGAN PROLAPSE ACCIDENTAL BOWEL LEAKAGE ANATOMY BASICS SYMPTOMS TYPES DIAGNOSIS TREATMENT ABOUT VOICES OF PFD QUESTIONS AND ANSWERS POP Quiz AS A WOMAN, YOUR CHANCE OF GETTING A PELVIC FLOOR DISORDER IS: A. 1 in 3 B. 1 in 6 C. 1 in 9 2

3 I N T R O TO P E LV I C F LO O R D I S O R D E R S About one in three women will experience a PFD in her lifetime Source: van Breda HMK, Ruud Bosch JLH, de Kort LMO. Hidden prevalence of lower urinary tract symptoms in healthy nulligravid young women. In Urogynecol J. 18 Jun [epub ahead of print] t w i t t e r. c o m / V o i c e s f o r P F D w w w. f a c e b o o k. c o m / Vo i c e s f o r P F D P E LV I C F L O O R D I S O R D E R S What is the Pelvic Floor? Set of muscles, ligaments and connective tissue in the lowest part of the pelvis Supports internal organs: Bladder Uterus Rectum Vagina Helps control pelvic organ functioning Pelvic floor 3

4 P E LV I C F L O O R D I S O R D E R S Pelvic Floor Problems Problems with bladder and/or bowel caused by weakened pelvic muscles or connective tissue that support the pelvic floor One or more symptoms: Feeling pelvic pressure or bulge in the vagina Urine leakage (urinary incontinence) Overactive bladder ( gotta go ) Difficulty emptying the bladder Problems having a bowel movement Gas or stool leakage (accidental bowel incontinence) POP Quiz WHICH OF THE FOLLOWING ARE RISKS FACTOR FOR PFDS: A. B. C. D. E. Pregnancy Age Being overweight Smoking All of the above 4

5 PFD RISK FACTORS IN YOUR CONTROL Life style: Don t smoke Maintain normal weight Be physically active Be cautious with extreme sports Limit caffeine and excessive intake of fluids Avoid constipation LESS CONTROLLABLE Life stage: Risk increases with age Pregnancy and childbirth Health conditions: Pelvic injury, pelvic surgery Chronic lung disease Neurological problems Maintaining good health: Keep pelvic floor healthy Control blood sugar U R I N A RY I N C O N T I N E N C E ( U I ) In the US, 18 million women have UI Source: Whitcomb EL, Subak LL. Effect of weight loss on urinary incontinence in women. Open Access J Urol. Aug ; 3: t w i t t e r. c o m / V o i c e s f o r P F D w w w. f a c e b o o k. c o m / Vo i c e s f o r P F D 5

6 URINARY INCONTINENCE Don t Wait to Talk with Your Doctor 26% of women wait over 5 years to seek help 33% wait 1 to 5 years 41% seek help within 1 year Source: Norton, P A et al. Distress and Delay Associated With Urinary Incontinence. BMJ, 297(5), November URINARY INCONTINENCE Urinary Incontinence Anatomy Basics Bladder Opening Vaginal Opening DID YOU KNOW? The urethra and vagina are separate openings 6

7 UI Anatomy Basics Your body stores urine in the bladder The bladder connects to a tube called the urethra Muscles and nerves help control the bladder and urethra HOW THE BLADDER WORKS When you go, these muscles and nerves signal the bladder to push urine out through the urethra UI Symptoms of Control Problems Problems with muscles and nerves that help to hold or release urine UI = urinary incontinence = loss of urine Some have difficulty emptying bladder (trouble starting the flow of urine) 7

8 of UI Continued Strong, sudden urge just before losing urine Involuntary loss of both small and large amounts of urine with activities such as coughing, laughing, or straining Slow or interrupted urine stream or sense of incomplete bladder emptying Sexual problems, e.g., leaking urine with sexual activity POP Quiz BLADDER CONTROL PROBLEMS ONLY OCCUR IN WOMEN AFTER MENOPAUSE A. True. B. False. 8

9 Women of All Ages Can Be Affected UI IS MORE COMMON IN OLDER WOMEN Up to 38% of those aged 80 or over 1 IN 4 YOUNGER WOMEN (20 39 YEARS) Weight pressing on the pelvic floor (pregnancy, overweight) Bodybuilding and intensive weight training is a risk for both urinary and bowel incontinence Pressure on the bladder Sources: Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. Women. Obstet Gynecol 2014;123:141 Nygaard I, et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 300(11), Sept Tahereh E., et al. The Frequency of Pelvic Floor Dysfunctions and their Risk Factors in Women aged Journal of Family and Reproductive Health 6(2), June 2012 UI Types STRESS INCONTINENCE URGE INCOTINENCE Overactive Bladder OTHER TYPES Urine leaks with activities Gotta go now (urgency) Mixed incontinence (stress and urge) Coughing, sneezing, laughing, lifting, exercising Gotta go now with leakage (urge incontinence) Continuous (unpredictable) incontinence Gotta go often (frequency) Going often during the night (nocturia) 9

10 POP Quiz MAKING CHANGES TO YOUR DIET MAY HELP CONTROL UI: A. True B. False UI Treatments Depends on out what treatment is best for YOU: Ask your doctor about risks, potential complications, and follow-up care For most, health care providers may recommend: Lifestyle changes Bladder diary Kegels (pelvic muscle exercises) Additional options for different types of urinary incontinence: Stress UI pessary, pelvic floor physical therapy, bulking therapy, surgery Urge UI (OAB) physical therapy, medicines, surgery A combination of treatments may be needed 10

11 UI Treatments Continued Lifestyle changes: Lose weight (if overweight) Limit alcohol and caffeine Avoid excess water/fluid intake and ask you health care provider if you are drinking too much Bladder diary Track of how often you go Try to schedule your bathroom trips Treatments-Overactive Bladder Lifestyle changes: Retrain your bladder Learn ways to control when you go Exercise your pelvic floor muscles and make diet changes I m Kegeling! #kegelface Physical therapy: Pelvic floor physical therapy May include biofeedback techniques Medicines: Bladder relaxant medicines May need to modify dosage and/or try different medicines 11

12 Treatments-Overactive Bladder Advanced Therapies different types: Botox bladder injections Peripheral tibial nerve stimulation (PTNS) Interstim bladder nerve stimulator (electrical stimulator or neuromodulator) Combination of treatments Image Source: Medtronic, Inc Treatments-Stress Urinary Incontinence For many women with stress urinary incontinence (SUI), a pessary helps control leakage: Silicone vaginal insert Different shapes and sizes Sized to fit each patient Inserted into the vagina Supports the bladder and urethra Image Source: 12

13 Treatments- Stress Urinary Incontinence Physical therapy: Biofeedback Bladder retraining Pelvic floor muscle nerve stimulation Exercises to help strengthen and control the pelvic floor muscles Treatments- Stress Urinary Incontinence Bulking therapy: Inject gel like material around the urethra Tightens the neck of the bladder to prevent urine leakage Typically repeated every 1 to 2 years Outpatient or office procedure Lower success rate than surgery, but may help improve quality of life 13

14 Treatments- Stress Urinary Incontinence Bladder Sling: Sling (hammock) placed under the urethra Made out of native tissue or mesh Aims to stop or reduce leakage Goal to improve quality of life A special guest would like to share her story 14

15 P E LV I C O R G A N P R O L A P S E ( P O P ) About half of women over 40 have some form of POP Source: Monga A, Dobbs S. Pelvic Organ Prolapse in Gynaecology by Ten Teachers, Nineteenth. CRC Press: Great Britain, 2011 t w i t t e r. c o m / V o i c e s f o r P F D w w w. f a c e b o o k. c o m / Vo i c e s f o r P F D P E LV I C O R G A N P R O L A P S E POP Anatomy Basics Pelvic floor muscles and ligaments are stretched or become too weak to hold organs in the correct position in the pelvis As it progresses, women can feel bulging tissue protruding through the opening of the vagina Cystocele Dropping of the anterior vaginal wall with the bladder Rectocele Dropping of the posterior vaginal wall with the rectum Uterine Prolapse Dropping of the uterus 15

16 P E LV I C O R G A N P R O L A P S E POP Symptoms Pelvic discomfort: Pressure and heaviness in pelvic area Some women also experience discomfort in lower abdomen Bulging: Feeling a lump in the vagina, or lump coming out of vaginal opening Urinary problems: Difficulty starting to urinate Weak or spraying stream of urine Bowel problems: Chronic straining or pushing to have bowel movements POP Treatments P E LV I C O R G A N P R O L A P S E Best treatment depends on how much symptoms bother you: POP is not life-threatening Treatments can help improve quality of life and sexual health Conservative approach: Watch and see how things go Dietary changes Pelvic floor muscle exercises Pelvic floor physical therapy Pessary: Support bladder, uterus and vagina 16

17 P E LV I C O R G A N P R O L A P S E POP Treatments, Surgery Every woman's situation is different No single operation is right for every patient Specific type of surgery depends on: Your body (anatomy) Overall health, other health problems Prior surgeries Desire to retain sexual function Experience and training of surgeon P E LV I C O R G A N P R O L A P S E POP Treatments MORE ON SURGERY Goals of surgery: Restore normal anatomy and support Repair vaginal wall and support layers of tissue Reduce bulge Improve quality of life Success or failure of someone else's operation should never be the deciding factor for you You and your doctor must decide what s best for you 17

18 POP Quiz IS LIVING WITH PFDS A NORMAL PART OF AGING? A. Yes B. No A special guest would like to share her story 18

19 Bowel Control 15 million U.S. women over age 40 experience accidental bowel leakage 1 in 5 women: occasional 1 in 12 women: every month 1 in 30 women: every week Less than 30% talk to a health care provider! National Institute of Diabetes and Digestive and Kidney Diseases. Fecal Incontinence, WH AA. Slide 19 of 44. August 2013 Bowel Control Don t Be Embarrassed Bowel control problems can be upsetting and embarrassing. Don t be ashamed to discuss with your doctor. Bowel control problems may be related to a medical problem. Bowel control problems can be treated. National Institute of Diabetes and Digestive and Kidney Diseases. Fecal Incontinence, WH AA. Slide 20 of 44. August

20 Bowel Control How Bowel Continence Works Muscles and nerves in the rectum and anus: Hold stool. Let you know when rectum is full. Signal when to release stool. Pelvic floor nerves and muscles work together to help with bowel and gas control. gi motility/disorders of the pelvic floor/ Bowel Control Symptoms of Control Problems Accidental loss of gas and/or bowel contents. Chronic constipation (4+ million people in U.S.): Bowel movement fewer than 2 times per week. Stool is hard, dry, small, and difficult to get out. Straining and bloating. Pain with bowel movement. Diarrhea: Loose, watery stools. Passing loose stools 3 or more times per day. More than 2 days may signal a problem. National Institute of Diabetes and Digestive and Kidney Diseases. Constipation. National Institute of Diabetes and Digestive and Kidney Diseases. Fecal Incontinence, WH AA. Slide 22 of 44. August

21 Bowel Control Treatments Diet Changes For constipation, diarrhea, and difficulty with defecation: Increase fiber intake to g/day gradually! Helps both constipation and diarrhea Promotes complete passage of stool Need to drink plenty of fluids For accidental bowel leakage: Avoid spicy food, caffeine, triggers For constipation: Avoid starch (white rice, bread, pasta) National Institute of Diabetes and Digestive and Kidney Diseases. Fecal Incontinence, fiber WH AA. Slide 23 of 44. August Bowel Control Treatments Medicines, PT Medicines: Stool softeners (soften stool) Laxatives (make you go) Antidiarrheals (stop you from going) Physical therapy (PT): Improves the pelvic muscle strength, tone, endurance, and coordination. May include biofeedback. Ask your doctor for a referral to a specialized physical therapist. Satish. Practice Guidelines: Diagnosis and Management of Fecal Incontinence. Am J Gastro, and pregnancy there safe stool softener WH AA. Slide 24 of 44. August

22 Bowel Control Treatments Rectal Insert renew medical.com Bowel Control Treatments Vaginal Insert

23 Bowel Control Treatments Surgery The goal of surgery is to improve bowel function: Improve bowel emptying. Improve bowel control. Help with bowel emptying at appropriate times. Types of surgery include: Sphincter repair (sphincteroplasty) Bulking agents Bowel pacemaker (neuromodulator) to help pelvic and anal sphincter muscles contract National Institute of Diabetes and Digestive and Kidney Diseases. Fecal Incontinence, Satish SCR. Practice Guidelines: Diagnosis and Management of Fecal Incontinence. American Journal of Gastroenterology, Break Free From PFDs! Pelvic Physical Therapists in Madison UW Health (608) Research Park & The American Center pedic surgery rehab/physical therapy for pelvic floor disorders/13428 Meriter UnityPoint Health Capitol Physical Therapy (608) (608) Madison, DeForest, Middleton, Monona, Wellness Center, West Verona, Madison, Mount Horeb, Sun Prairie, and Waunakee son/physical therapy for women.aspx Capitolphysical therapy.com WH AA. Slide 36 of 44. August

24 B R E A K F R E E W W W.V O I C E S F O R P F D. O R G PFDs are not a normal part of aging t w i t t e r. c o m / V o i c e s f o r P F D w w w. f a c e b o o k. c o m / Vo i c e s f o r P F D B R E A K F R E E W W W.V O I C E S F O R P F D. O R G You Are Not Alone Share stories Get support Ask experts about PFDs Join the 24

25 Thank you! We will now break up into groups Bladder Problems Pelvic Organ Prolapse Bowel Problems Please fill out the evaluations in the folder This will help us improve these presentations!! R E F E R E N C ES 1. Ellerkmann RM, et al. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol, 185(6), December Food and Drug Administration. Information for Patients for POP, 3. Gormley EA, et al. American Urological Association (AUA) Guideline: Diagnosis and Treatment of Overactive Bladder (non Neurogenic) in Adults: AUA/SUFU Guideline. May Hendrix SL, et al. Pelvic organ prolapse in the Women s Health Initiative. Am J Obstet Gynecol 186(6), Lawrence, JM, et al. Prevalence and Co Occurrence of Pelvic Floor Disorders in Community Dwelling Women. Obstetrics & Gynecology. 111(3), March Monga A, Dobbs S. Pelvic Organ Prolapse in Gynaecology by Ten Teachers, Nineteenth. CRC Press: Great Britain, National Institute of Child Health and Human Development. Pelvic Floor Disorders, 8. National Institute of Diabetes and Digestive and Kidney Diseases. Urinary Incontinence in Women, kidney.niddk.nih.gov/kudiseases/pubs/uiwomen 9. Norton, P A et al. Distress and Delay Associated With Urinary Incontinence. BMJ, 297(5), November Nygaard I, Barber MD, Burgio, KL, et al. Prevalence of Symptomatic Pelvic Floor Disorders in US Women. JAMA. 2008;300(11): Olsen AL, et al. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol 89(4), 1997.Pelvic Floor Institute. Pelvic Floor Muscle Training, floor patient.htm 12. Tahereh E., et al. The Frequency of Pelvic Floor Dysfunctions and their Risk Factors in Women aged J Family and Reproductive Health 6(2), June van Breda HMK, Ruud Bosch JLH, de Kort LMO. Hidden prevalence of lower urinary tract symptoms in healthy nulligravid young women. In Urogynecol J. 18 Jun [epub ahead of print] 14. Whitcomb EL, Subak LL. Effect of weight loss on urinary incontinence in women. Open Access J Urol. Aug ; 3: Wu J, et al. Forecasting the Prevalence of Pelvic Floor Disorders. Obstet and Gynecol, 114 (6), December Wu JM, Vaughan CP, Goode PS, et al. Prevalence and trends of symptomatic pelvic floor disorders in U.S. Women. Obstet Gynecol 2014;123:141 25