Women’s Pelvic Health - What you Need to Know

We're talking wellness at MemorialCare Health System. It's time for Weekly Dose of Wellness. Here's Deborah Howell.

Deborah Howell (Host): And welcome to our show. We're so pleased to have you here. I am Deborah Howell, and this is your Weekly Dose of Wellness. Today's guest is Varuna Raizada. Dr. Raizada was born and raised in the small town of Jammu, nestled in the Himalayan mountain range. She attended medical school at Kasturba Medical College in India. In 2007, she completed her residency in obstetrics and gynecology at Loma Linda University Medical Center. Her passion for female pelvic health led her to the University of California, San Diego, where she completed a two-year postdoctoral research fellowship. Dr. Raizada is also a board-certified OB/GYN with Orange Coast Memorial Medical Center. Welcome, Dr. Raizada.

Varuna Raizada, MD: Thank you, thank you for having me on the show.

Deborah Howell (Host): You know, your pelvis is something you usually don't ever think about unless you have a problem with it. Maybe you can tell us, what is a healthy pelvis?

Varuna Raizada, MD: Well, a healthy pelvis is one that's doing everything the way it should be doing. So, a healthy pelvis basically governs how well you are urinating, how well are you having your bowel movements, and especially whether you're having any problems with your reproductive organs, their function. Healthy pelvis is one which does not give you any problems be it with leakage of urine or leakage of bowels, does not give you any problems that directly leads to constipation or loss of stool that's out of your control and also is responsible for giving adequate support to your pelvic organs whereby you know they stay in their normal position and don't fall through the opening of the vaginal canal and that's also known as prolapse. And lastly, they're not supposed to cause any pain during intercourse. So a healthy pelvis is one that's doing all those things and not causing any problems.

Deborah Howell (Host): That's a big job!

Varuna Raizada, MD: Yes it is and you don't see it so you don't think it exists. Most women are surprised when you say, "Hey, your pelvis is doing all these things for you.”

Deborah Howell (Host): Right, right. Again, you don't think about it, you just sort of take it for granted. Well, I'm going to stop doing that. What are some pelvic disorders that affect women?

Varuna Raizada, MD: So, I should say in the order of frequency or, you know, increased prevalence, one of the most common reasons for women to show up to me or to other providers in my field would be bladder problems, which includes loss of urination, either because, you know, every time you cough, sneeze, and a little spurt comes out and just kind of you lose a little bit, or loss of control of urination, whereby women complain that they cannot make it to the restroom in time and they don't have control over their bladder. It's that typical key-in-door syndrome. You put the key in and you just cannot hold, you know, you can't delay the act of urination. Some women also come to me because they have problems initiating urination. Other women will come to me, and this would be the second big group of diseases, that would be the support of the pelvic organs. So our bladder, our vagina, uterus and rectum are held in place by a trough-like muscle known as the pelvic muscle and it's a huge group of pelvic muscles that you actually don't see so you don't think they exist. These are the muscles that you're engaging when you're doing your Kegel exercises. So sometimes women will come to me because the vaginal walls have lost their support and the vaginal walls also are responsible for keeping the bladder and the bowel in place. So they'll come to me typically complaining, "Hey, I see or I feel a big bulge coming out of my vagina." And that would be issues with loss of support of the pelvic organs also known as prolapse. And lastly, women and even though this group is small in comparison to the rest of the groups, it's the one that causes most discomfort and really disrupts the lives of people and that would be fecal issues or problems with not being able to control your bowels. That can be very, very limiting for both men and women. And lastly, constipation which actually is quite frequent but goes hand in hand for many people who are having loss of control of bowels because sometimes the original problem may just be constipation or poorly managed constipation. And then I have a small subset of women who come to me because any disruption in pelvic floor function may cause pain or spasm, especially during intercourse for women, which of course can be very disruptive to their relationships. So that would be another group of women that come to me and these would be, you know, the typical symptoms.

Deborah Howell (Host): That's why you're so busy all the time, because there's so many things that can go awry! Now, so what are some of the signs and symptoms of a pelvic disorder that women should be aware of?

Varuna Raizada, MD: The first thing women need to take away from this is, you know, that traditional thinking that, you know, this is just normal, this is something that we have to deal with. That said, the next thing to think about would be, "Hey, do I leak urine often enough where I, you know, once in a while you have the really bad flu and you know you've had a lot to drink and you sneeze or you cough really hard and a little urine escapes out of you?" And that's okay. We're talking about where it gets to a point where you're having leakage almost every day. It is keeping you from exercising, it's keeping lifting your children, from doing your household chores, be it vacuuming or lifting your laundry basket, where it's actually disrupting your life and you know is impacting your social life the way you exercise, the quality of life basically. So the other thing to watch out for would be, hey you know I'm urinating but every time I go just a little bit comes out or you know it takes me forever to start urinating. I have to bear down to do all these maneuvers on the toilet just to get started and that's that could even be very dangerous for your kidney health because when you're not eliminating well you have frequent bladder infections because bacteria find a happy home to grow and multiply and they also affect the way kidney functions because of the back pressure that's transmitted into your kidneys.

Deborah Howell (Host): It's all connected.

Varuna Raizada, MD: Absolutely, it is.

Deborah Howell (Host): So if you're having some of these symptoms that would be the time to care right then, at the beginning?

Varuna Raizada, MD: Absolutely, because one is you know early, if I were to see them early, some simpler interventions may actually help them and they might just avoid a surgery going forward. Other symptoms to watch out for would be anything that's coming out of the vagina, you know that looks like a bulge or piece of pink tissue or something that shouldn't belong there. Sometimes women come to me and they say they have to push on it in order to just get their, you know, bowels and their bladder movements done, that's definitely not normal. If the bulge is big enough where it's chasing constantly, you can't even wear an underwear and feel comfortable, you know, don't wait that long. Come sooner because there's so many things we can do that can fix the problem without any invasive interventions.

Deborah Howell (Host): Let's talk about some of those treatment options, can we?

Varuna Raizada, MD: Yeah, absolutely.

Deborah Howell (Host): So if somebody comes to you bulge, what is the first thing you do?

Varuna Raizada, MD: So, you know, medicine as usual, history and physical examination is the center of our diagnosis and care plan, how we make our care plans. We get detailed history, do a detailed physical examination and during physical examination, we try to figure out what the extent of the prolapse is or what way the vagina is affected and how are they affecting other organs? That said, we also try to assess the pelvic muscle strength. The first few things that we begin with in terms of treatment options would be to do some kegel exercises to strengthen the pelvic muscles so that now these organs have better support. We let women try these treatments either on their own or with the help of a therapist, pelvic floor physical therapist and if these simple things do not work, then we have other treatment options which range from non-surgical options like a pessary. A pessary is like a device that could be shaped like a disc or sometimes it can even look like a binky which acts as a truss to push the prolapse back into its normal place or if for some reason that pessary is not working for women or women are not comfortable with it, we can talk about surgical options which range from more minimally invasive options where we approach the prolapse through the vagina and even extending to you know robotic surgeries where we actually suspend and reconstruct the pelvic or the vaginal and the vaginal walls and restore the strength which of course have long-lasting effect and you know can have really good results especially women who have really bad vaginal prolapse.

Deborah Howell (Host): And those are long-lasting results?

Varuna Raizada, MD: Yes, absolutely. Now when these surgeries are done, we do more reconstruction, so these surgeries tend to do better than some of our older traditional vaginal surgeries.

Deborah Howell (Host): Okay. Are there any lifestyle changes someone can make to prevent some of these pelvic disorders in the first place?

Varuna Raizada, MD: Absolutely. Smoking. So smoking has a way of, you know, women know, as do men, that smokers have more wrinkles because the connective tissue that supports the skin gets degraded very quickly. It's the same thing that happens in the pelvis. So stay away from smoking, stay away from secondhand smoking.

Deborah Howell (Host): Fantastic. I'm so sorry, please finish your thought and then we have about 30 seconds remaining on the show. So I'm sorry about that.

Varuna Raizada, MD: Sure, no problem. And the second thing would be to watch your weight because women who weigh a lot, they put a lot of pressure on their pelvic organs. And lastly, avoid any kind of chronic straining. For instance, chronic constipation, that's one big no-no. And rest of the things, you know, there are things that you just can't stop in life. You can't stop lifting your babies, can't stop having those babies, so those are out of your control.

Deborah Howell (Host): That's no way to live. So thank you so much, Dr. Raizada, for those tips and for coming on our show today to talk to us about women's pelvic health. We really appreciate it.

Varuna Raizada, MD: No problem.

Deborah Howell (Host): To learn more or to listen to a podcast of the show, please go to MemorialCare.org. That's MemorialCare.org. I'm Deborah Howell. Join us again next time as we explore another weekly dose of wellness. Have yourself a fantastic day!