8 common causes of pelvic pain

1) Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus grows outside the uterus, which can cause pelvic pain. This tissue can be found on the ovaries, fallopian tubes or other pelvic structures. Endometriosis can lead to inflammation, scarring and the formation of adhesions within the pelvic area, resulting in chronic pelvic pain. Endometriosis can cause pain that feels like severe menstrual cramps, lower back pain, painful urination and discomfort during sexual intercourse.

Endometriosis also can contribute to pelvic pain through the development of endometriomas, a type of ovarian cyst that forms when endometrial tissue grows within the ovaries and becomes filled with old blood, leading to sharp pelvic pain and discomfort. Scar tissue caused by pelvic adhesions can form from endometriosis, which can cause some pelvic organs to stick together. This can cause pelvic organ prolapse or pelvic floor dysfunction, both of which can make pelvic pain worse. Advanced endometriosis may be treated through minimally invasive gynecologic surgery.

2) Ovarian cysts

Ovarian cysts are fluid-filled sacs that can develop on the surface of the ovaries. These cysts can vary in size and may form as a result of the normal monthly ovulation process, when they are known as functional cysts, or due to other underlying conditions. Ovarian cysts can cause pelvic discomfort when they grow large, rupture, bleed or twist the ovary, leading to sudden and sharp pain in the lower abdomen. The sudden onset of severe pelvic pain sometimes may be an indication of a ruptured ovarian cyst, which requires immediate medical attention to prevent further complications.

3) PCOS
Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that often leads to the formation of multiple small cysts on the ovaries, along with other symptoms such as irregular menstrual periods, excessive hair growth and hormonal imbalances. The hormonal imbalances characteristic of PCOS can disrupt the normal menstrual cycle and result in irregular or missed periods. Additionally, the hormonal fluctuations in PCOS can trigger inflammation in the pelvic region, increasing symptoms of pain or discomfort.

4) Pelvic floor myalgia

Pelvic floor myalgia refers to the chronic contraction and spasm of the muscles in the pelvic floor, which can lead to ongoing pain and discomfort in the pelvic region. These persistent muscle contractions can result from various factors such as stress, trauma or repetitive strain, causing the muscles to become tense and inflamed over time.

Chronic tightness or spasms in the pelvic floor muscles can irritate nearby nerves and cause pain. This condition can cause chronic pelvic pain by impairing the normal function of the pelvic floor muscles, which support proper function of the pelvic organs, including bladder and bowel control, and sexual intercourse.

Physical therapy can help treat pelvic floor conditions by focusing on strengthening and relaxing the muscles in the pelvic area. Through tailored exercises and techniques, a pelvic floor physical therapist can help you improve your pelvic floor muscle function and relieve pain. Additionally, physical therapists can provide education on proper body mechanics and lifestyle modifications to help you manage symptoms effectively.

5) Uterine fibroids

Uterine fibroids are noncancerous growths that develop in the uterus. When these fibroids enlarge or press on surrounding organs, they can cause pelvic pain. Fibroids that grow large can press on nearby pelvic muscles or structures that resulting in chronic pelvic pain, extreme menstrual cramps or pain during intercourse. In some cases, the location and size of the fibroids also can contribute to lower back pain or abdominal pain.

6) Pelvic inflammatory disease

Pelvic inflammatory disease is an infection of the female reproductive organs, often caused by sexually transmitted infections, such as chlamydia or gonorrhea. When left untreated, it can lead to inflammation and infection of the uterus, fallopian tubes and ovaries, resulting in chronic pelvic pain. 
 

7) Urinary tract infection

A urinary tract infection (UTI) or interstitial cystitis are common causes of pelvic pain in women. UTIs occur when bacteria enter the urinary tract and cause infection, leading to symptoms such as pelvic pain, frequent urination and a painful or burning sensation during urination. Treatment for UTIs typically involves antibiotics to clear the bacterial infection, which in turn alleviates the pelvic pain. Drinking plenty of water and maintaining good hygiene practices can help prevent UTIs. 

8) Interstitial cystitis

Interstitial cystitis is a chronic condition characterized by bladder pain and urinary urgency. The inflammation of the bladder wall in interstitial cystitis can result in pelvic pain that is often described as a constant, dull ache in the lower abdomen and pelvic region. Managing interstitial cystitis may involve a combination of dietary changes, bladder training, physical therapy and medications to help reduce inflammation and alleviate symptoms of pelvic pain.

Other causes of pelvic pain 

Not all causes of pelvic pain are due to an underlying gynecologic health condition. For example, some women may experience normal cramping during their period or ovulation. More causes of pelvic pain involve other organs, muscles, diseases or conditions.

Treating pelvic pain

It is important to work with your health care provider to discuss any symptoms of pelvic pain that you are experiencing. They can help detect or rule out any underlying causes of your pelvic pain, diagnose conditions and help treat your symptoms effectively. 

Treatment options can vary, depending on a patient’s unique condition, including age, a desire to get pregnant, preexisting conditions or health concerns. Treatments also can vary based on a patients’ diagnosis, and may include medications (including hormonal medications, such as birth control, for some conditions), physical therapy or minimally invasive gynecologic surgery (MIGS).

A MIGS procedure may be considered for patients with certain complex conditions. Patients should speak to their provider about a referral for a MIGS evaluation for the following conditions: 

• Advanced endometriosis (affecting bladder, gastrointestinal tract, diaphragm, etc.)
• Chronic pelvic pain without apparent cause
• Frozen pelvis
• Severe scar tissue
• Large leiomyomas (fibroids)
• Large ovarian cysts
• Conditions that may make surgery more complicated, such as obesity, diabetes, chronic anticoagulation, circulatory issues, etc.

Norton Women’s Care Pelvic Health Program specializes in caring for patients with pelvic health conditions.

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Irregular periods are characterized by variations in the length of the menstrual cycle or the amount of bleeding. There are multiple conditions that can contribute to irregularities in the menstrual cycle.

Abnormal bleeding

• An abnormal period may involve:
• Irregular bleeding
• Heavy menstrual bleeding
• Severe period pain
• Pelvic pain
• Menstrual irregularity
• Abnormal uterine bleeding

“There are multiple causes of abnormal uterine bleeding. Some of the ones we see most often include fibroids, adenomyosis, endometrial polyps, clotting disorders and hormonal issues. Rarely, abnormal bleeding can be a sign of a more serious health condition, so it’s important to talk to your doctor and get it checked. Pinpointing the exact cause is usually possible after an exam in the office, an ultrasound and lab work” said Steven J. Radtke, M.D., FACOG, FMIGS, minimally invasive gynecologic surgeon at Norton Urogynecology Center, part of Norton Women’s Care.

Symptoms of abnormal bleeding may include:

• Bleeding between periods
• Bleeding after sex
• Irregular, unpredictable periods
• Menstrual flow that is much heavier than usual
• Bleeding after menopause
• Bleeding that is accompanied by severe pain or cramping
• Bleeding that lasts for more than seven days

New or sudden changes to your menstrual cycle, including amount of flow or more painful cramps, potentially can indicate other health conditions. Worsening pain is another red flag.

It is important to address any concerns regarding painful or irregular periods with your provider to determine the underlying cause and develop an appropriate management plan tailored to your individual needs and health goals, such as family planning.

“Nowadays there’s a wide range of treatment options available, surgical and nonsurgical, that can help address these symptoms and improve a patient’s quality of life — tailored to their particular circumstances and goals. It’s always a good first step to talk to your primary care doctor or OB/GYN about your concerns,” Dr. Radtke said.

Period pain

Dysmenorrhea, commonly known as period pain, is a condition that affects many people during their menstrual cycle. The primary symptom of dysmenorrhea is cramping in the lower abdomen, which can range from mild to severe, and often can radiate to the lower back and thighs. Other symptoms that are associated with dysmenorrhea may include nausea, vomiting, diarrhea, headaches and fatigue.

Treatment options for dysmenorrhea aim to alleviate pain and discomfort. Over-the-counter pain medications, such as ibuprofen or acetaminophen, often are recommended to help manage cramps and reduce inflammation, in addition to the use of a heating pad. For more severe cases, a health care provider may prescribe birth control or higher-strength nonsteroidal anti-inflammatory drugs for pain relief. Additionally, lifestyle changes such as regular exercise and dietary modifications can help alleviate symptoms of dysmenorrhea.

Primary dysmenorrhea and secondary dysmenorrhea are two distinct conditions that involve painful menstrual periods. Primary dysmenorrhea is typically related to normal menstrual processes, while secondary dysmenorrhea is caused by an underlying medical condition and requires specific treatment to address the root cause of the pain.

Primary dysmenorrhea refers to common menstrual cramps that occur in the absence of any underlying gynecological issues. These cramps typically are caused by the contractions of the uterus as it sheds its lining during menstruation. The pain usually is felt in the lower abdomen and can be managed with over-the-counter pain medication and lifestyle changes.

Secondary dysmenorrhea involves period pain that is a symptom of an underlying medical condition, such as endometriosis, fibroids or pelvic inflammatory disease. The pain with secondary dysmenorrhea is often more severe and may worsen over time. Treatment for secondary dysmenorrhea targets the underlying cause and may involve medications or surgery.

If you are experiencing dysmenorrhea, especially severe or new pain, you should consult with your health care provider.

Uterine fibroids and endometriosis

Uterine fibroids and endometriosis are two common gynecological concerns. Period pain from uterine fibroids or endometriosis is considered secondary dysmenorrhea. Both conditions also may cause painful periods and chronic pelvic pain.

Fibroids are noncancerous growths or tumors that develop in the uterus, often causing symptoms like heavy menstrual bleeding and pelvic pain. Endometriosis is a condition where tissue similar to the inside lining of the uterus starts growing in places where it doesn’t belong, such as the pelvic sidewall, bladder, rectum, etc.  This produces an inflammatory response that worsens during menstrual cycles. Common symptoms include severe pain, bloating, painful vaginal intercourse, painful urination and painful bowel movements. Some patients also may experience infertility.

“A patient is considered to have advanced endometriosis when: No. 1, there is a high burden of disease, for instance, if lesions are covering a large percentage of the pelvis. And No. 2, if endometriosis implants are located on critical structures, such as the bladder, ureters, intestines, diaphragm, etc.,” Dr. Radtke said.

Symptoms of endometriosis often are controlled with hormonal medications such as birth control pills, or medications that temporarily decrease estrogen levels in the body. However, surgery may be recommended in cases where symptoms are severe, are not improving with conservative measures, if advanced disease is suspected, or if a patient does not want to take hormonal medications. Surgery involves removing the tissues affected by endometriosis, allowing the body to regenerate new healthy tissue in its place (excisional surgery).

“Chronic pelvic pain in reproductive-age females is caused by endometriosis 70% of the time, but there can be other issues that cause it as well, such as ovarian cysts, scar tissue, issues with the bladder, intestines or pelvic floor muscles,” Dr. Radtke said. “It is important to talk to your doctor in order to start investigating possible causes.”

Minimally invasive surgical treatments

There are numerous minimally invasive gynecologic surgery (MIGS) options for patients, including those who desire to get pregnant.

“For patients with endometriosis who desire to preserve fertility and want to avoid hormonal medications, the surgical treatment involves making small incisions — less than 1 centimeter — in the abdomen and ‘stripping’ the endometriosis off the affected structures,” Dr. Radtke said. “During this process, scar tissue is also removed in order to restore normal anatomy. We also test the fallopian tubes to make sure they are not blocked.

“When patients are done with childbearing, performing a hysterectomy at the time of endometriosis surgery significantly decreases the chances of it coming back in the future. We usually recommend not removing the ovaries, unless they are very abnormal.”
A MIGS procedure may be considered for some patients with complex conditions.

Patients should speak to their provider about a referral for a MIGS evaluation for the following complex conditions: 

• Advanced endometriosis (affecting bladder, gastrointestinal tract, diaphragm, etc.)
• Chronic pelvic pain without apparent cause
• Frozen pelvis
• Severe scar tissue
• Large leiomyomas (fibroids)
• Large ovarian cysts
• Conditions that may make surgery more complicated, such as obesity, diabetes, chronic anticoagulation or circulatory issues

Addressing the root cause of painful or irregular periods is crucial for maintaining reproductive health and overall well-being. Consulting with your provider for proper diagnosis and treatment options is essential when it comes to managing your reproductive and overall health.

“If you feel like your life revolves around pelvic pain, or worrying about your next menstrual cycle, we’re here to help you get your life back,” Dr. Radtke said.

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“Among American adults, 42.6 million have an overactive bladder,” said Stephanie A. Flaspoehler, APRN, nurse practitioner with Norton Urogynecology Center. “That’s more people than are diagnosed with diabetes, asthma, Alzheimer’s disease or breast cancer — and the prevalence increases with age.”

Urinary incontinence is marked by frequent or urgent urination, leaking urine before you reach the bathroom, and/or urinating more than twice a night or eight times during the day.

As symptoms progress, incontinence can be functionally and socially debilitating. Out of fear or embarrassment, people start to limit activities.

“It can also negatively affect sleep patterns and often places seniors in nursing homes prematurely,” said Stephanie, who wishes more people knew that they don’t have to view this chronic condition as a normal part of aging.

At Norton Urogynecology Center, many people see lifechanging results through evidence-based diagnosis and treatment guidelines set by organizations that promote high standards of health care, such as the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction and the American Urology Association. Currently, these standards treat urinary incontinence with behavioral modifications, medication and advanced therapy — in that order.

“Behavioral modifications are simple things patients can do, such as diet changes to avoid things that aggravate bladder symptoms. These include coffee, tea, soft drinks, spicy foods, chocolate and acidic food,” Stephanie said.

Some people benefit from bladder and pelvic floor training guided by a physical therapist.

Medications are another option, but, for many reasons, they don’t suit everyone.

“A lot of patients try medications,” Stephanie said, “but they may or may not work for them, or they may have issues with cost or side effects.”

The most affordable medications, a class of drugs known as anticholinergics, are not recommended for long-term use by women over age 55 because of a link to cognitive decline, dementia and Alzheimer’s disease, according to a 2019 study published in the Journal of the American Medical Association.

Specialists usually encourage people to try at least two medications, aiming for at least a 50% improvement in self-reported symptoms. If medication fails to achieve results or you’re averse to taking medications regularly, you may find relief in three advanced therapies Norton Healthcare offers for overactive bladder.

Percutaneous tibial neuromodulation (PTNM) therapy is a noninvasive treatment that restores bladder function by gently stimulating the tibial nerve through nerve modulation.

“Patients come to a provider’s office once a week for 12 weeks for a 30-minute treatment session, followed by monthly maintenance sessions. Stephanie said. “The tibial nerve is stimulated using an acupuncture like needle near the ankle.”

PTNM is effective, covered by most insurance and has few, if any, side effects.

Botox injections to the bladder are another in-office treatment. They take no more than 30 minutes and require no sedation other than local numbing. Botox works by relaxing the bladder muscles, giving the patient more time to get to the bathroom when they have the urge. Within a week, most patients see improvements that last between four and six months. Side effects are rare.

“Less than 5% of the time, Botox can relax the bladder too much, which can prevent patients from urinating naturally,” she said. That’s easily resolved with a urinary catheter until the Botox wears off. 

Finally, there is sacral neuromodulation therapy. Unlike medication and Botox, which work with the bladder’s muscular function, this technique restores communication between the brain and pelvic floor, improving bladder function through modulating nerve activity. People who receive this therapy are prescreened by a test that lasts three to seven days to determine whether their incontinence is related to the nervous system rather than muscles.

If your condition responds to the test, you are eligible for a device that regulates bladder function. The device is implanted under light sedation or general anesthesia. Operating much like a pacemaker for the heart, the battery-operated device lasts 10 to 15 years. At that point, the batteries are replaced and the device remains in place.

“I think the important thing to know is that you don’t have to live with this condition,” Stephanie said. “If you don’t see progress with behavioral modifications or medication, that’s when this third tier of advanced treatments may be worth considering.”

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Urinary incontinence — bladder control issues more common than you think

One in 4 women over age 18 experience episodes of urinary incontinence, according to the National Association for Continence. In addition to physical discomfort, women experience emotional pain and embarrassment, isolation and fear of ridicule that often prevent them from seeking treatment. On average, a woman will live with incontinence for more than six years before seeking medical advice, due to embarrassment or believing myths such as “incontinence is just a part of aging or being a woman” or “it’s brought on from sexual activity or drinking too much water.”

“Think of a woman’s pelvic floor muscle like a trampoline,” said Sarah M. Kane, M.D., urogynecologist with Norton Urogynocology Center. “Sometimes the muscles wear out through a lifetime of activity, including heavy lifting, chronic coughing, constipation and childbirth. If the muscles of the pelvic floor and urethra are weak, this can allow leaking.”

Chances of weakened pelvic muscles increase with subsequent pregnancies, and there’s also evidence of a genetic predisposition to incontinence issues. Other risk factors for stress incontinence include obesity and previous gynecologic surgery such as hysterectomy.

Treating the most common bladder control issues — stress incontinence and urge incontinence

The two most common types of bladder control issues that lead to urinary incontinence are:

• Urinary stress incontinence: This type includes an involuntary leaking of urine when a woman coughs, sneezes or laughs. This is the most common type and is often a symptom of a weakened pelvic floor.
• Urge incontinence: In this type, the bladder contracts when it shouldn’t, and urine leaks through the sphincter muscles that hold the bladder closed. It is sometimes called overactive bladder.

A common treatment for both types is Kegel exercises to strengthen the pelvic floor. A woman can find the muscles by stopping and starting the urine stream. Regular exercises to strengthen these muscles can improve bladder control symptoms. A urogynecologist or pelvic floor physical therapist can evaluate if the patient is doing the exercises effectively or if there are additional exercises to perform.

A urogynecologist can help a patient evaluate the full range of treatments available and offer a customized solution. Whether that is medication, surgical procedures, internal or external devices, physical therapy, behavior modification, injections or a combination of treatment options, a urogynecologist can help the patient reach her treatment goals.

The Norton Women’s Care Pelvic Health Program specializes in caring for women with pelvic conditions. A full range of specialists, therapists and health care professionals are available to ensure you get back to the life you were meant to live — full of joy, activity, intimacy and strength.

The post Why do I pee when I sneeze? appeared first on Norton Healthcare.

While most people think of Botox as for wrinkles or to help migraine, it helps calm the nerves that stimulate your bladder muscles and make you think you need to use the bathroom. Overactive bladder is something many patients deal with, but they usually wait around eight years before they seek help.

Up to 50% of women have some kind of issue with bladder control, with overactive bladder affecting approximately 40 million in the U.S. The average age of a woman dealing with overactive bladder is 50, but urogynecologists see a wide range starting at 20 and up to the mid-90s. Women who have had multiple pregnancies or are overweight have a higher risk.

“I know an awful lot of women my age are going through this,” said Letitia, 85. “For most people it’s not something you want to talk about, but I’m not ashamed or afraid to talk about it.”

A diagnosis of overactive bladder is made when a woman has at least two of the following:

• An urgent need to urinate right away
• Urinating at least eight times during the day, or more than twice at night
• Frequently leaking urine

“I started to urinate a lot,” Letitia said. “I was making multiple trips to the bathroom during the day and night. I started with a urologist and medication, but it didn’t seem to help. No one I talk to believes you can have Botox in your bladder. I saw a difference in a matter of days.”

Botox for overactive bladder

The Botox is injected into the bladder muscle in the office, and sedation is not required. On average injections last around nine and can be safely repeated if symptoms return.

In many cases the procedure is covered by insurance.

“I’m glad I didn’t let it get too far along so it didn’t impact my life too much,” Letitia said. “I’d recommend it right away. Don’t wait.”

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And why are they more common during the summertime? Blame swimming pools, wet bathing suits, sweaty clothing and dehydration.

Here are three more things you may not know about UTIs.

UTIs can cause mood and behavioral swings

Children and adults are all susceptible to UTIs at any age. What can be different among these groups though, are UTI symptoms. For example, in very young children, symptoms may include fever and irritability. Older children and teens, as well as adults, likely will show the more well-known signs of a UTI, like urgent, painful or frequent urination.

Older adults also may experience behavioral changes from a UTI in addition to the more common symptoms. Behavioral changes may include restlessness, hallucination, agitation and confusion.

These are just some symptoms of UTI, which can vary from person to person, regardless of factors like age.

Certain conditions such as pregnancy, menopause and diabetes can put you at higher risk for a UTI.

Home remedies for UTI? Mixed results

It seems like everyone has a home remedy for UTIs: cranberry juice, garlic, essential oils, probiotics and more. Researchers have gotten mixed and inconclusive results in many cases when studying the effectiveness of home remedies.

However, there are other forms of treatment alternatives undergoing studies that could be promising for the future of UTI treatments. These include immunotherapies and vaccines that   prevent UTIs, as well as biologic treatments that work to restore the ability of the body’s immune system to fight infection.

“Always see a primary care provider if you have fever, acute (new) back pain, nausea or vomiting,” said Crystal D. Narcisse, M.D., internal medicine physician and pediatrician with Norton Community Medical Associates – Hurstbourne. “This may indicate that the infection is not just in the bladder or urethra but involves the kidneys, which is called pyelonephritis. Pyelonephritis may require IV antibiotics and additional testing to be properly treated.”

Frequent UTIs? See a specialist — treatment may help

Some women may experience recurrent UTIs or bladder infections (a type of UTI). When these infections happen frequently, such as two or more times in a six-month period, your primary care provider may recommend that you see a specialist, such as a urologist or urogynecologist, to determine the underlying cause and whether treatment can help.

Some possible causes of frequent UTIs may include kidney or bladder stones, bacteria entering the urethra during sexual intercourse, hormonal changes during menopause, abnormalities in shape or function of the urinary tract, or a predisposed risk for developing UTIs.

According to Dr. Narcisse, there are also things women can do to help prevent UTIs.

“In women, it is a good idea to urinate after sexual intercourse,” Dr. Narcisse said. “Reviewing proper hygiene techniques also may be beneficial. For example, women and girls should wipe from front to back in order to keep stool from the away from the urinary tract.”

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Myth or Truth: Does Cranberry Juice or a Cranberry Supplement Treat or Prevent UTIs?

The truth is, the answer isn’t very clear. The outcomes of research studies are conflicting. Studies have found that taking cranberry supplements and/or drinking cranberry juice can help prevent UTIs in women at risk for recurring infections, but other studies show that cranberry doesn’t work for everyone. Additionally, cranberry juice doesn’t seem to help treat a UTI that you already have.

It was once believed that cranberry juice/supplements protected against UTIs by making urine more acidic. However, it’s been shown that  a substance in cranberries, A-type proanthocyanidins (PACs), can prevent bacteria from sticking to the walls of the urinary tract. However, many studies show that cranberry juice and supplements don’t have enough of the active ingredient to be effective with prevention of UTIs. Additionally, supplements aren’t regulated by the Food and Drug Administration, so there is no labeling that shows the level of PACs in a product.

At the end of the day, cranberry may be worth trying if you experience frequent UTIs. However, if you take blood-thinning medications, you should avoid cranberry products as they can cause an adverse reaction. Cranberry juice is high in salts called oxalates that can raise the risk of kidney stones, especially if you are prone to kidney stones. If you have a condition, such as diabetes, that requires you to take medications, it’s best to talk to your doctor before starting to take any supplements.

Can Cranberry Help Incontinence and Bladder Control?

Women of all ages can experience incontinence and issues with bladder control. If cranberry can help with UTIs, can it help with other urinary issues as well?

Unfortunately, certain foods and drink can cause symptoms of urinary frequency, urge incontinence, bladder pain and urgency. Because of its acidic pH, cranberry juice can make urge incontinence symptoms worse.

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Urinary Incontinence — Bladder Control Issues More Common Than You Think

One in four women over age 18 experience episodes of incontinence, according to the National Association for Continence. In addition to physical discomfort, women experience emotional pain, isolation and fear of ridicule that often prevents them from seeking treatment. On average, a woman will live with incontinence for more than six years before seeking medical advice, due to embarrassment or believing myths such as “incontinence is just a part of aging or being a woman” or “it’s brought on from sexual activity or drinking too much water.”

A woman’s pelvic floor is like a trampoline –– sometimes a bladder can become displaced through a lifetime of activity, including heavy lifting, coughing, constipation and childbirth.

Chances increase with subsequent pregnancies, and there’s also evidence of a genetic predisposition to incontinence issues. Other risk factors for stress incontinence include obesity and previous gynecologic surgery such as hysterectomy.

Treating the Most Common Bladder Control Issues — Stress Incontinence and Urge Incontinence

The two most common types of bladder control issues that lead to urinary incontinence are:

• Urinary stress incontinence: This type includes an involuntary loss of urine when a woman coughs, sneezes or laughs. This is the most common type and is often a symptom of a weakened pelvic floor.
• Urge incontinence: In this type, the bladder contracts when it shouldn’t, and urine leaks through the sphincter muscles that hold the bladder closed. It is sometimes called overactive bladder.

A common treatment for both types is Kegel exercises to strengthen the pelvic floor. A woman can find the muscles by stopping and starting the urine stream. Regular exercises to strengthen these muscles can improve bladder control symptoms. A urogynecologist or pelvic floor physical therapist can evaluate if the patient is doing the exercises effectively.

A urogynecologist can help a patient evaluate the full range of treatments available and offer a customized solution. Whether that is medication, surgical procedures, internal or external devices, physical therapy, behavior modification, injections or a combination of treatment options, a urogynecologist can help the patient reach her treatment goals.

The Norton Women’s Care Pelvic Health Program specializes in caring for women with pelvic conditions. A full range of specialists, therapists and health care professionals are available to ensure you get back to the life you were meant to live — full of joy, activity, intimacy and strength.

The post Bladder control: Don’t hide urinary incontinence symptoms appeared first on Norton Healthcare.

After the birth of her first child, Donna Gomez began to experience the beginning symptoms of urinary stress incontinence, or the involuntary loss or leakage of urine. She had gained weight during her pregnancy, and carrying a 10-pound, six-ounce baby put a lot of pressure on her bladder. The combination caused occasional post-delivery bladder leakage that was bothersome but manageable.

However, Donna’s loss of bladder control worsened after the birth of her second child in 2006.

“Every time I would cough, sneeze, jump or laugh — which I do often — I would have an accident,” said Donna. She feared this condition would be her new reality.

Millions of women experience urinary stress incontinence from any movement that puts pressure on the bladder, including exercising and routine motions. Many assume this condition is part of aging or menopause, but this is not the case. Loss of bladder control and an overactive bladder can be treated, managed or eliminated with a proper diagnosis.

Movement is part of Donna’s daily job as an emergency room nurse, and urinary incontinence became a burden in her day-to-day life. The simple motion of raising her arms to hang IV fluids or set monitors for patients caused her to have an accident.

“It was embarrassing,” Donna said. “I felt like I always had to wear a pad during my shift or carry a change of clothes with me at all times.”

When her issues interfered with her job and daily lifestyle, her gynecologist recommended a visit with Marjorie Pilkinton, M.D., urogynecologist with Norton Urogynecology Center.

Urogynecologists complete four years of residency training in obstetrics and gynecology, followed by a fellowship in urogynecology and pelvic reconstructive surgery. This specialized training prepares them for treating women with pelvic floor disorders such as urinary stress incontinence.

“Dr. Pilkinton was amazing,” Donna said. “She was straight to the point, discussed various procedure options and their success rates, evaluated me for other issues that could be the source of my issues and made referrals as needed.”

In June 2017, Donna chose to undergo a minimally-invasive procedure called tension-free vaginal taping with cystoscopy. Tension-free taping, or the midurethral sling system, is designed to stabilize the urethra during physical activity to prevent leakage known as stress incontinence. According to Dr. Pilkinton, the procedure takes 30 to 45 minutes, and the midurethral sling procedures have cure rates between 80 to 95 percent in various studies.

“The goal is to improve bladder control, allowing you to return to the activities you enjoy without the constant worry of leakage,” Dr. Pilkinton said. “Most women see results right after the procedure with return to full activity within four weeks in most cases.”

While Donna experienced a little discomfort and discharge the first couple of days following the procedure, she was able to return to work in about five weeks. She believes she could have resumed work earlier, but due to the physical challenges that come with a job in nursing, she was cautious.

The procedure was put to the test when Donna came down with a virus recently. A 24-hour stomach bug caused her to get sick, and despite vomiting, Donna experienced no urinary leakage — a feat that wouldn’t have happened without the surgery, and one she referred to as an “amazing moment.”

Today, Donna is healthy and grateful for the procedure.

“I am so glad I had this procedure,” Donna said. “Now I can actually move and reposition and hop and jump without fear of leakage.”

There are many treatment options for stress incontinence, besides surgery. Consultation with a gynecologist or urogynecologist will allow you to make the best decision for treatment. Don’t assume that being unable to hold your bladder is natural or normal. Like Donna, you can experience relief and resume your life without worry.

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For Jonathan H. Reinstine, M.D., becoming a surgeon was in the cards almost from the start. Coming from a family that included pediatric and general surgeons, he knew that’s what he wanted to do. What he didn’t know was the specialty.

“I was going to be a pediatric surgeon originally,” said Dr. Reinstine, an OB/GYN  with Associates in Obstetrics and Gynecology, a Part of Norton Women’s Care. “But during medical school I worked with some gynecological oncologists and was attracted to the art of surgery for pelvic issues. It was a way I could make more of a difference for people.”

During his residency, he discovered even more.

“I really enjoyed the perfect mix of medicine and surgery,” he said. “I also really liked that I could have lifelong relationships with my patients. Obstetrics was also an unexpected joy as I was able to watch families grow.”

Minimally invasive gynecologic surgery

Dr. Reinstine was a pioneer in bringing new surgical techniques to patients in Louisville and Southern Indiana. He performed some of the earliest laparoscopic hysterectomies in 1991. He was at the leading edge in developing laparoscopic surgery and hysteroscopy to treat fibroids, endometriosis and bleeding issues with less pain and recovery time.

He was also instrumental in Norton Women’s & Children’s Hospital becoming a Center of Excellence in Minimally Invasive Gynecology^TM (COEMIG) recognized by the American Association of Gynecologic Laparoscopists (AAGL) as well as a Center of Excellence in Robotic Surgery ^TM (COERS).

The COEMIG and COERS programs are focused on improving the safety and quality of gynecologic patient care and are designed to expand access to minimally invasive gynecologic procedures performed by surgeons.

Treating complex pelvic issues

“An estimated 25 to 30 percent of women live with pelvic health issues,” Dr. Reinstine said. “The key to treating them is examining other functions of the body and bringing multiple specialists and services together.”

While many patients have been with him for years, Dr. Reinstine and the rest of the pelvic health team also help women who have not been able to find answers elsewhere.

“Sometimes we also need to start from scratch and take fresh looks at everything if a woman is not getting relief,” Dr. Reinstine said. “The main goal is finding an answer.”

Sometimes that can include new treatments for endometriosis and fibroids.

The pelvic health team

The Norton Women’s Care Pelvic Health Program includes specialists in gynecology; urogynecology; pediatric and adolescent gynecology; urology; allergy; colorectal surgery; interventional radiology; anesthesiology; physical therapy and mental health.

Their goal is to bring together expertise not always found elsewhere to help women with often complex conditions. This can include women who have large fibroids, women who have already had multiple procedures or surgeries that can make treatment more complex, and those wishing for less invasive options.

Minimally invasive procedures for pelvic health include:

• Laparoscopic, robotic-assisted and hysteroscopic myomectomy along with uterine artery embolization as an alternative to hysterectomy for uterine fibroids
• Laparoscopic or robotic-assisted procedures for uterine prolapse, including sacral colpopexy and native tissue repairs
• Vaginal and laparoscopic options to abdominal hysterectomy
• Laparoscopic and robotic-assisted conservative resections for endometriosis

Other Norton Women’s Care Pelvic Health Program physicians include David L. Doering, M.D.; Sarah M. Kane, M.D.; Marjorie L. Pilkinton, M.D. and Dwight D. Pridham, M.D.

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