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Changing Attitudes on Pelvic Floor Disorders

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Jennifer Anger, MD, MPH

More than one-third of women in the U.S. may have a weakened or damaged pelvic floor, a sling-like group of muscles and tissues that supports the reproductive, bowel and urinary organs in the pelvis. Many of these women don't know their condition has a medical name — pelvic floor disorder — and often can be treated.

What they do know is how their symptoms, which can include leaking urine or stool, make them feel. Ashamed. Embarrassed. Too mortified to tell a soul, particularly a physician.

Jennifer Anger, MD, MPH, associate professor in the Cedars-Sinai Department of Surgery, believes a sea change in attitudes toward pelvic floor disorders is long overdue.  "We really need to remove shame from the equation," she said. "Many women with these disorders find it very difficult to talk about any problems in the pelvic area, and that difficulty creates a barrier to accessing care."

Anger shared her observations and research findings on pelvic floor disorders at a lecture in a bimonthly series sponsored by the Barbra Streisand Women's Heart Center at the Cedars-Sinai Heart Institute, the Faculty Development Office and the Department of Obstetrics and Gynecology. The series, "Sex & Gender Medicine Lunch & Learn," was launched to increase awareness that biological and behavioral differences between men and women require gender-specific approaches to diagnosing and treating diseases.

In women, the pelvic floor supports organs that include the bladder, cervix, rectum, urethra, uterus and vagina. Its structure can be weakened or damaged through childbirth or routine heavy lifting as well as by obesity, aging or other conditions.

The shame that many sufferers feel stems from the resulting symptoms, which can include:

  • Bladder issues: A sudden, urgent need to urinate; urine leakage triggered by coughing, laughing or sneezing; painful urination; or incomplete emptying of the bladder.
  • Bowel incontinence: Leaking of liquid or solid stool.
  • Pelvic organ prolapse: If weakened pelvic muscles and tissues give way, one or more pelvic organs may descend into the vagina or press against the vaginal wall. The most common prolapse occurs when an unsupported bladder bulges into the vagina or through the vaginal opening.

"Prolapse is particularly confusing because women don't know what's happening when they feel a vaginal bulge," Anger said.

In 2016, Anger helped direct a multicenter study of women with pelvic organ prolapse. Patients in focus groups expressed fear, depression and shame, she said. Some patients mistook their symptoms for cancer, stopped socializing or said they felt like "freaks."

Educating women about pelvic floor disorder symptoms and available treatments — which include physical therapy, medication and surgery — may improve patients' ability to discuss their disorder and seek medical advice, Anger suggested.

Sarah Kilpatrick, MD, PhD, chair of the Cedars-Sinai Department of Obstetrics and Gynecology and associate dean for Faculty Development, who moderated the session, said physicians have a key role to play in this effort.

"There needs to be better education of primary care and OB-GYN physicians so they understand that asking about these conditions should be a normal part of taking a medical history," said Kilpatrick, a professor of Obstetrics and Gynecology. "If the practitioner is comfortable, then it's easier for the patient."