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Below the Belt
Uncovering women’s pelvic health issues By Shana Liebman
M
ore than 50 million women suffer from pelvic floor dysfunction in the United States, a number that is projected to nearly double by 2050. These “below the belt” issues, such as incontinence and prolapse, are commonly the result of a weakened pelvic floor—and they usually begin during or after pregnancy. Unfortunately these problems can dominate a woman’s physical and emotional life, and often lead to anxiety, inactivity, and diminished intimacy. We spoke to Sovrin Shah, M.D., a Mount Sinai Health System urologist specializing in female pelvic medicine and surgery who is now seeing patients at Richmond University Medical Center, to understand these afflictions and what women can do about them.
Pelvic Floor Issues in Women
A woman’s pelvis includes her bladder, uterus and cervix, vagina, and rectum. The pelvic floor is a group of muscles that support these organs. “The two main complications associated with problems with the pelvic floor are urinary incontinence and pelvic organ prolapse,” Dr. Shah explains, noting that pelvic organ prolapse is when the bladder, uterus, or rectum protrudes into the vaginal opening and is sometimes visible outside of the vagina. Pelvic floor issues usually begin in pregnancy because of hormonal fluctuations, as well as the weight of the uterus and the baby. “During pregnancy, all those forces are working to loosen the pelvic floor, to get ready for delivery because that tissue has to 30 August 2021 • siparent.com
be able to stretch to allow the head of the baby through,” Dr. Shah says. “But the problem is that after that’s all done, all that stuff has to kind of regain its form.” One of the ways women can regain those muscles is through Kegel’s exercises, named after a gynecologist who developed it. It is an exercise where you intentionally contract and then release the muscles of the pelvic floor to strengthen them. “The whole idea of Kegel’s exercises is to gain awareness of where these muscles are and how to contract them. Also knowing how to relax them is very important,” Dr. Shah says. But while Kegels can help, many women do not fully regain strength in their pelvic floor, which can lead to incontinence. “Stress incontinence is leakage caused by pressure on the belly— as opposed to urge incontinence, which is a sudden desire to pee that you just cannot hold off on,” Dr. Shah explains. (Urge incontinence can also be caused by a dropped bladder, certain medications—especially those for diabetes, as well as consuming diuretics like caffeine or alcohol.) The majority of Dr. Shah’s patients suffer from an overactive bladder—which afflicts about 15 percent of Americans, and means they frequently have to pee, feel the urgency to pee, and wake in the night to pee. (Though, women who wake up in the middle of the night to urinate do not necessarily have an overactive bladder.) “About a third of the women who have overactive bladder symptoms have urge incontinence, because they didn’t get to the
