Pelvic Health

What is Pelvic Health?

Pelvic health focuses on optimizing the function of pelvic organs (bladder, bowel, and reproductive organs) and pelvic floor (muscles and ligaments that hold everything together). Pelvic health plays an important role in physical, mental, social, and sexual well-being.

What causes impairments in pelvic health?

Pregnancy & Pelvic Health

Pelvic dysfunction is common after pregnancy. For example, a weak pelvic floor due to pregnancy may affect bowel, bladder, and sexual function. Weakness of the anal sphincters due to nerve or muscle stretching or tearing during vaginal delivery may occur. This can often be overlooked in the early post-partum years. As muscles generally weaken over one’s life, fecal incontinence may develop many years after the initial injury. Urine and bowel leakage are common after pregnancy but never normal. For many women, these symptoms will progress and worsen if overlooked. In severe cases of pelvic floor trauma, pelvic organ prolapse or protrusion of the pelvic organs may occur. Pelvic floor dysfunction can also affect sexual function and satisfaction.

Bowel Function & Pelvic Health

For many individuals, bowel dysfunction including chronic constipation, diarrhea, irritable bowel syndrome, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), and abdominal/pelvic surgery may affect pelvic health. Excessive straining due to constipation may lead to pressure and laxity of the pelvic floor muscles. In individuals with diarrhea, multiple trips to the toilet can have a similar effect. In severe cases, incontinence or leakage may occur. In some individuals, constant pressure on the pelvic organs may predispose to prolapse or protrusion of the pelvic organs.

Surgery and Pelvic Health

Pelvic and anorectal surgery is a common reason for poor pelvic health. Pelvic surgeries which may affect one’s pelvic health include gynecologic surgery (e.g. hysterectomy), colorectal surgery (low anterior resection for rectal cancer or J-pouch surgery for colitis or polyposis), urologic surgery (prostate & bladder surgery). These surgeries can affect bowel, urinary, and sexual function. Sexual and urinary dysfunction are common after low anterior resection, J-pouch surgery, and prostate surgery. Alterations in bowel function are common after J-pouch surgery and low anterior resection. In women, constipation and prolapse symptoms may develop after hysterectomy.

Anal surgery including surgery for hemorrhoids, anal fistula, and anal fissure can affect the muscles and ligaments of the anus and pelvic floor. Weakness in the anal muscles may occur due to direct trauma or cutting of the anal sphincters or due to nerve injury. Scar tissue may also cause anal dysfunction and pain.

How do you evaluate pelvic health?

During your initial consultation, Dr Zaghiyan will evaluate your pelvic health starting with a thorough history and physical exam. A rectal and vaginal exam may also be performed during your initial consultation. Based on your symptoms and exam findings, Dr. Zaghiyan may recommend additional tests such as:

• Anal manometry (to test the strength and function of your anal muscles)
• Ultrasound (to evaluate the anatomy of your pelvic and anal muscles)
• Dynamic pelvic MRI to evaluate the anatomy of your pelvic floor organs & muscles during straining for defecation

How do you improve pelvic health?

Treatments to improve pelvic health are multifaceted and depend on your specific symptoms and diagnosis. Treatments can vary from completely non-invasive to surgical.

EMSELLA – EMSELLA is breakthrough, completely non-invasive treatment for a weak pelvic floor. EMSELLA is an office treatment utilizing electromagnetic energy to deliver thousands of supramaximal pelvic floor muscle contractions. EMSELLA can be used to restore the pelvic floor, improve continence and sexual function.

Benefits of EMSELLA

• Zero downtime
• Restores pelvic floor strength & health
• Helps with incontinence & sexual function in women & men
• Cost-effective compared with surgery

Biofeedback & physical therapy – Some individuals benefit from an interactive approach to retrain the pelvic floor. Biofeedback often accompanies physical therapy and uses sensors and video to monitor and retrain your pelvic floor.

Benefits of biofeedback & physical therapy

• Non-invasive compared to surgery
• Can treat a variety of pelvic floor disorders
• Can help break bad habits that interfere with pelvic health

Botox – Botulinum Toxin may help certain pelvic floor disorders that result from tightness or spasming of the pelvic floor including levator spasm, anismus, anal pain and anal fissures. Similar to treatments for the face, Botox can help relax the muscles of the pelvic floor to achieve symptom control in spastic pelvic floor conditions.

Benefits of Botox

• Little down time
• Lasts for up to 6 months
• Non-surgical office treatment
• Ideal for symptoms that won’t improve with medicine

Sacral neuromodulation (Interstim) – When medications, lifestyle changes, and pelvic floor strengthening fail, sacral neurmodulation can offer lasting results for fecal incontinence, fecal urgency, urge urinary incontinence or overactive bladder. Certain individuals with bowel alterations after rectal surgery such as those suffering from low anterior resection syndrome after rectal cancer surgery or J-pouch dysfunction may also benefit.

Benefits of sacral neuromodulation

• Outpatient procedure
• Minimal down time
• Excellent long-term results
• Can simultaneously improve both urinary and bowel incontinence or urgency

Surgery

Surgery is generally reserved for the most severe cases. The type of surgery depends on your specific condition.

Surgery for fecal incontinence – Surgery to repair torn sphincters can sometimes offer significant improvements in quality of life, especially in cases of severe injury and rapid onset of symptoms. While surgery is generally reserved for the most severe cases. Dr. Zaghiyan will review your specific case and have an honest discussion with you to weigh all options prior to recommending a sphincter repair.

Surgery for prolapse – Pelvic organ prolapse can have a significant impact on one’s quality of life. After a detailed workup, Dr Zaghiyan will discuss your specific case and treatment recommendations depending on the type of prolapse. For example, individuals with a simple symptomatic rectocele without other concomitant prolapse may be managed quite differently from someone with multi-organ prolapse. It is often recommended that those individuals with both gynecologic organ (uterine, vaginal) and rectal prolapse have a combined repair with a colorectal surgeon and urogynecologist to optimize outcomes. Surgery is generally performed through a minimally invasive approach with the DaVinci robot to facilitate recovery. Adjunctive treatments discussed above may be recommended to optimize results.