Originally published in Chester County Life magazine
People with an impaired pelvic floor—the network of muscles, nerves and ligaments that support the bladder, intestines, rectum, and (for women) the uterus—often suffer in silence. That’s because many are too embarrassed to discuss their symptoms, such as bowel or bladder incontinence, or assume these problems can’t be treated or are a normal part of aging. Instead of seeking help, they endure countless inconveniences that affect their quality of life.
Susan Kidder of Chester Springs had been living with fecal incontinence, a common type of pelvic floor disorder (PFD), for 15 years before consulting a doctor. At the time she and her family resided in Wisconsin.
“When I finally talked to my OB/GYN, the condition had completely taken over my life,” the 57-year-old wife and mother of two recalled. “I was constantly thinking about it and what to do in case of an ‘accident.’ I was very embarrassed and depressed.”
PFDs result when the pelvic floor is weakened or injured. Pregnancy, childbirth, menopause, and obesity are the main causes. Other factors that can increase the risk include weak muscles, having pelvic surgery or radiation, repeated heavy lifting, and genetics.
Susan’s doctor referred her to a specialist who tried a number of treatments. Unfortunately, these made little or no difference.
By the time Susan moved to Chester County, she was simply dealing with the condition by curtailing any activities outside her home including work and exercise.
“I had reached the point of resigning myself to a colostomy bag as the only option available,” she said.
Fortunately, Susan’s new primary care physician knew PFDs were not something any woman needed to live with. Susan was referred to Marc Toglia, MD, Main Line HealthCare urogynecologist and Main Line Health System Chief of the Division of Female Pelvic Medicine. Dr. Toglia was among the initial group of physicians to achieve board certification in Female Pelvic Medicine and Reconstructive Surgery in 2013, the first year the exam was offered. Currently only 750 physicians nationwide are credentialed in this specialty.
“Due to unsuccessful treatments in the past, I was a bit hesitant to see yet another doctor for this,” said Susan. “However, after meeting with Dr. Toglia, I knew I was in good hands. He saw me as a person. He listened, asked questions, and gave me hope."
Dr. Toglia was not surprised Susan had lived with her condition for so long. “It’s an uncomfortable topic for many, so instead of seeking help, people like Susan will try to manage them on their own,” he noted. “Another reason for a delay in treatment is many feel the symptoms arise as a natural effect of aging. Although age can be a factor, symptoms can occur at any time.”
After a thorough exam and further testing, Dr. Toglia developed a personalized treatment approach for Susan which included a promising and innovative therapy called InterStim®.
Prior to securing FDA approval as a bowel incontinence therapy in 2011, InterStim has been a go-to treatment for urinary incontinence and overactive bladder since 1997. The device uses a small, implantable stimulator that emits a continuous, mild electrical pulse through a wire into the nerves that control the pelvic floor muscles. In turn, the muscles are strengthened and better controlled.
“Loss of bowel function can be devastating,” added Dr. Toglia, who was the first surgeon at Paoli Hospital and Main Line Health to perform this procedure for bowel incontinence. “I am thrilled that as a community hospital, we are at the forefront of treatments and able to help women in similar situations regain their health, confidence and quality of life.”
After the surgery, Susan felt the effects immediately. “It’s fantastic. I don’t even know the device is there. It’s given me my life back.”
The American Urogynecologic Society estimates one in three women suffer from a PFD such as bowel incontinence; overactive bladder resulting in urinary urgency, frequency, and leakage; stress urinary incontinence involving the involuntary loss of urine during physical activity including coughing or laughing; and pelvic organ prolapse, which is bulging, pressure or heavy sensation in the vagina that worsens by the end of the day or during bowel movements. Although the condition is more common in women, men and children can have pelvic floor disorders, too.
“Despite its prevalence, only a minority of those affected with a PFD consult their doctor and even fewer receive effective treatment,” said Paoli Hospital and Lankenau Medical Center fellowship-trained urogynecologist Matthew Fagan, MD, who also earned board certification in Female Pelvic Medicine and Reconstructive Surgery in 2013. “By increasing awareness about the pelvic floor and its proper function, we can help more people understand and address these conditions. Once it’s out in the open; treatment can begin.”
According to Dr. Fagan, a variety of non-surgical and surgical therapies are available depending on the type and severity of the condition and the patient's general health.
Non-surgical options include: medications, targeted physical therapy and/or exercise such as Kegels, behavioral and lifestyle modifications, non-invasive pelvic support devices, biofeedback and electric stimulation.
“If surgery is recommended, minimally-invasive options are available,” said Dr. Fagan. “This approach can help reduce discomfort and recovery time for many.” Some examples of surgical procedures performed include the repair of damaged muscle and connective tissue to support the pelvic floor and the placement of slings for urinary leakage.
“Treatment is often multi-faceted, for example, biofeedback in combination with pelvic floor exercises for urinary incontinence,” Dr. Toglia said. “However, the goal is always the same; to return each person to a full and active life.”
Today, Susan can walk her dogs, shop, and enjoy time with family and friends without the self-conscious fear of embarrassment and humiliation.
“I had been living with incontinence for a long time and it has taken a while to realize that I am ‘normal’ again,” Susan elated. “It took me far too long to find the right resolution, but now my incontinence is a thing of the past.”
According to Drs. Toglia and Fagan, most patients feel a huge sense of relief once they realize they are not alone and that, in most cases, great improvements and even cure of their symptoms are possible. However, long-term outcomes may require some life-style changes and common sense. For example, cutting down on caffeine, citrus and spicy foods can help calm an overactive bladder. Increasing fiber and water intake can help accidental bowel leakage. Learning exercises to strengthen the pelvic floor muscles can help with urinary incontinence as well as pelvic organ prolapse.
“When a PFD is suspected, don’t hesitate like I did to learn more about potential treatment options,” Susan concluded. “If a doctor doesn’t treat these issues regularly, seek an expert who can help you understand your condition and guide you to the best possible resolution with dignity, respect, and compassion.”
Urogynecology is a subspecialty of obstetrics and gynecology that is dedicated to the study and treatment of female pelvic disorders. To schedule an appointment with a urogynecologist, call 1.866.CALL.MLH