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Your Questions Answered on Pelvic Floor Conditions
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Einstein Healthcare Network
3:37
Join us right here at 1 p.m. on March 22 for the live chat. There will be no audio or video, just answers to your questions. You can post questions beforehand or during the live chat by using the blue box below. We will provide a complete transcript as soon as the chat is over. See you March 22.
*** Thursday, March 22 ***
Einstein Healthcare Network
12:51
Dr. Cohn and Farah Zeises are in the house. We will get started in 10 minutes.
1:00
Welcome to everyone. Glad you could join us today. Let's get started.
Antonio Giordano
1:00
Dear Collegue, I would like to know if it is possible to heal the woman pelvic prolapse by gym or it's always necessaire the surgery
Einstein Healthcare Network
1:00
Dr. Cohn: Dear Antonio--A dedicated pelvic floor physical therapy program with a knowledgeable provider (such as those we have at MossRehab) can absolutely improve the symptoms of prolapse and may even reduce the stage of prolapse when it is more minor. More dramatic stages of prolapse, typically associated with visualization of the vagina passed the opening of the vagina, are less likely to respond to exercises alone. I generally recommend against 'self-derived' exercise programs. The pelvic floor is complicated! A therapist can guide you to an appropriate program that can be practiced at home.
tongue 2
TRACEY
1:01
I HAVE TO GO URINATE FREQUENTLY DURING THE DAY . AS SOON AS I START DRINKING WATER AND TEA IN THE MORNING I HAVE TO GO.  SOMETIMES COMING HOME FROM WORK I CAN'T MAKE IT IN THE HOUSE I START LEAKING URINE, I'M A 50YEAR OLD WOMEN AND THIS IS NO COOL. WHAT CAN I DO ?
cool 1
Einstein Healthcare Network
1:01
Farah , DPT: Dear Tracey, It sounds like you have urge incontinence. Your pelvic floor muscles work to maintain your continence. Seeing a skilled physical therapist can help teach you strategies to maintain your continence and help retrain your muscles.
Guest
1:07
I have had a TVT/sling procedure done twice but still experience stress incontinence at times. Is this normal? I am in very good condition, exercise regularly and have a normal BMI. I was told I did not need to continue doing kegal exercises.
Einstein Healthcare Network
1:08
Dr. Cohn: Dear Guest, incontinence after a sling is a challenging issue to manage. If the incontinence completely resolved at first but has returned, it may be due to an overactive bladder rather than recurrent stress urinary incontinence. It may also be exacerbated by incomplete bladder emptying. I generally would prefer to start with urodynamics testing (pressure/flow bladder testing) to understand  the reason why you are still leaking. The cause may surprise you. Sometimes, however, it is about expectations. If you were leaking 6 pads per day prior to surgery and now requires one pad or a thin pad for security, that may still be bothersome, but the cost of the "final pad" may be urinary retention or the development of overactive bladder symptoms as the bladder works harder to overcome the resistance of the sling. In many cases physical therapy may be the best way to make the last bit of progress towards being completely dry.
Veronica
1:10
Post Labor- I can no longer sneeze, cough, or jump without urinating. Is there a permanent or surgical fix for this? Kegel exercises do not seem to work.
Einstein Healthcare Network
1:10
Farah Zeises, DPT: Hi Veronica: Non-invasive conservative treatment should be considered the first line of treatment. It is important to make sure you are doing the kegel exercises appropriately as well as the right frequency. The proximal hip and core muscles work in conjunction with the pelvic floor, and it is important to also assess how they are functioning. A skilled pelvic floor therapist can assist in teaching you the correct exercises to help improve your symptoms.
Debbie
1:11
Hi...i currently have a second degree uterine prolapse and have recently gotten a ring pessary with support which seems to be working well for me so far. My question is if I opt for the surgery in the future is there a surgery that can be performed to lift my uterus rather then having a hysterectomy?  Thank you.
Einstein Healthcare Network
1:12
Dr. Cohn: Dear Debbie--Prolapse can be surgically repaired without a hysterectomy. The name of the procedure is a "hysteropexy" and vaginally typically involves attachment of the cervix to a pelvic support structure (or 'ligament') to restore it to its anatomic location. This is an excellent option with reasonably comparable (if not completely comparable) results to prolapse repair and hysterectomy. Others have advocated for suspension of the uterus to the sacrum by use of mesh; my personal preference is not to do the mesh hysteropexy as it may make removal of the uterus especially challenging if uterine pathology were to arise later in life.
Doe
1:16
Is there any hope for me?
Einstein Healthcare Network
1:16
Dr. Cohn: Dear Doe--Sometimes it may feel like pelvic floor issues are embarrassing, overwhelming, or that "nothing can be done". The solution is rarely a 'simple fix'--if it were, it may have been done already but one of the providers you had already approached. But with multidisciplinary care, shared motivation, and caring and knowledgeable providers, there is always hope--don't give up!
Chris G
1:17
I was told I have a prolapsed bladder. !st ob gyn said uterus and bladder. 2nd said bladder only. I have trouble going to the bathroom. When I first have to go I feel like that commercial "gotta go gotta go right now" especially if I am upright walking like shopping at a store. Once I get into the bathroom I go but then its like I think I am finished but if I patiently wait I will go more. Its like when I am sitting my bladder doesnt empty completely. When I squat to urinate (when out at a public bathroom) I find I can get it all to come out. Why is this? Is this normal aging or because of the bladder issue. I can literally feel it when I am in the shower. That is what prompted me to ask the OBGYN about it at my appt. Also and this is a little embarrassing but when my better half and I are intimate sometimes I leak a few drops of urine during him masturbating my clitoral area. It is like as he is rubbing the muscles are opening and closing and when they open sometimes a drop or two will leak out. Why is this?
Einstein Healthcare Network
1:17
Farah Zeises, DPT: Hi Chris, the pelvic floor works to maintain your continence during the day and on demand, "I got to go." When you urinate your pelvic floor muscles relax, to empty the bladder. In your case, it appears that we need to retrain your muscles to teach them how to contract and relax appropriately. A skilled pelvic floor therapist. can assist in teaching you the exercises and strategies needed to improve your symptoms.
Guest
1:19
I was treated for prostate cancer by radiation and Lupton injection. I now have ED and inconvenience.
Einstein Healthcare Network
1:19
Dr. Cohn: Dear Guest--there are excellent surgical and medical options available to you for the treatment of erectile dysfunction and incontinence related to prostate cancer treatment. I recommend visiting with a urologist to address these. My partner Dr. Jay Simhan is an expert in post-prostatectomy erectile dysfunction, and we work together to determine the appropriate treatment for urinary incontinence. We would be happy to evaluate you.
1:23
To learn more about Dr. Cohn, read his profile: http://einsteinperspectives.com/expert-female-pelvic-medicine-joins-ei...
Nan
1:23
What causes me to pass gas when I cough?
Einstein Healthcare Network
1:23
Farah Zeises, DPT: Dear Nan, your pelvic floor muscles work together to maintain you from loosing urine, feces, as well as
control your gas. When you cough there is an increase in your intra-abdominal pressure that places increased pressure on the pelvic floor. When the pelvic floor is not working well, the increased pressure can result in symptoms such as leaking urine, and loss of gas. A skilled pelvic floor therapist can retrain and strengthen your pelvic floor muscles to decrease the loss of gas.
1:26
Dr. Cohn: Dear Rachel, I would direct anyone with queries regarding interstitial cystitis to Dr. Chris Payne's lecture at the following website: https://www.urotoday.com/video-lectures/bps-ic/video/788-embedded-medi... approach to interstial cystitis in many guidelines, as thoughtfully described by Dr. Payne, is that it fails to distinguish between the various "types" of bladder pain syndromes (of which true interstitial cystitis is one type, affecting ~10%). Most are related to complex, multifactorial pain syndromes primarily affecting the bladder or global pain syndromes. As a urologist, I attempt to identify bladder pathology through advanced evaluation (urodynamics testing) that is correlated with pain episodes. If bladder spasms are primarily responsible for pain, therapies directed at overactive bladder (such as PTNS, botulinum toxin injection, sacral neuromodulation) may all be of benefit (https://www.ncbi.nlm.nih.gov/pubmed/29336927)
Rachel
1:28
I wanted to ask about IC..Interstitial Cystitis and deep pain in the bladder..Have yo had success with PTNS-percutaneous tibial nerve stimulation?
Einstein Healthcare Network
1:28
Dr. Cohn: Dear Rachel, I would direct anyone with queries regarding interstitial cystitis to Dr. Chris Payne's lecture at the following website: https://www.urotoday.com/video-lectures/bps-ic/video/788-embedded-medi... approach to interstial cystitis in many guidelines, as thoughtfully described by Dr. Payne, is that it fails to distinguish between the various "types" of bladder pain syndromes (of which true interstitial cystitis is one type, affecting ~10%). Most are related to complex, multifactorial pain syndromes primarily affecting the bladder or global pain syndromes. As a urologist, I attempt to identify bladder pathology through advanced evaluation (urodynamics testing) that is correlated with pain episodes. If bladder spasms are primarily responsible for pain, therapies directed at overactive bladder (such as PTNS, botulinum toxin injection, sacral neuromodulation) may all be of benefit (https://www.ncbi.nlm.nih.gov/pubmed/29336927)
Mayj
1:30
I had surgery to cut blood supply from my large fibroids. My symptoms for going through this procedure have only slightly improved. They included painful intercourse, bleeding after intercourse, daysss before my period. I am 41 years old. I was suspected of having endometriosis many years ago, when I was in my early 20s. Because of my symptoms, my sex drive leaves much to be desired. After having 2 babies. I was never consistant with Kegak exercises. My period flow has never been heavy. I do still have cramping, backpain, and headache, and weird color discharge. I worry about cancer. I want a hysterectomy. My husband and doctor thought i wss to young, 3years ago. But I still want it..
Einstein Healthcare Network
1:30
Dr. Cohn: Dear Mayj--I would recommend you address this issue with your gynecologist. It is good to have physicians who are thoughtfully reluctant to intervene, understanding the delicate balance between benefits and harms. But the decision to perform hysterectomy for persistent bleeding after fibroid embolization is not our area of expertise
Debbie Sellman
1:33
Been SUFFERING for 10 years with very low pelvic pain to no avail! Went on Vicodin for 2 years back in 2008 and had every test done and nothing found, so finally had a total hysterectomy in 2010. I am still suffering TODAY. Have tried many different nerve pain Meds, can’t seem to handle the side effects. Tramadol helps but don’t want to be on that all the time. WHY AND WHERE COULD THIS DEBILITATING PAIN BE COMING FROM???  HOPE UPU CAN HELP ME!! Thanks, Deb
Einstein Healthcare Network
1:34
Farah Zeises, DPT. Hi Debbie. It is frustrating when you have chronic pain with no diagnosis and no relief. When we are in pain, our muscles have a tendency to tighten up and fascial  restrictions develop. When these restrictions are not addressed they can progress and become a source of pain. We get stuck in a pain cycle that needs to be broken. A skilled physical therapist can take a closer look at your musculosketal system to see what may be contributing to your pain.  If you haven't done so, I would recommend you see a MD to r/o other sources of pain.
Linda K..
1:34
Female 60 yr. old, post menopausal (surgically) I saw a Urologist  because I have frequent UTI's and spasms of my bladder that caused discomfort most times but especially during intercourse. During my exam she told me I had the most rigid Hard and contracted bladder she has ever felt.  What exactly does this mean and how is it treated.
Einstein Healthcare Network
1:34
Dr. Cohn: Dear Linda K.--I would start with an advanced evaluation of your bladder with x-ray and functional studies of the bladder ("video urodynamics") and cystoscopy. Botulinum toxin injection into the bladder wall, if medications fail, can be beneficial to reduce spasms. There may be other pathology that also needs to be addressed. Infection can cause this, although severe overactive bladder symptoms may be frequently misdiagnosed as infection.
1:39
For more information, to make an appointment or to learn about Einstein Healthcare Network’s urology services, please visit https://www.einstein.edu/urology or call 1-800-EINSTEIN.
Monica Hanssens
1:40
34 y/o mother 2 children 6 & 13. Prolapsed uterus, bladder & rectum. Lost 1 ovary due to multiple cysts that are now returning. Should I request them removing the other ovary while repairing the prolapses? What is the best approach to repair all 3?
Einstein Healthcare Network
1:43
Dr. Cohn: Dear Monica, in the absence of family history of ovarian cancer or an abnormal appearing ovary, it is generally recommended that the ovaries be maintained in a patient as you as you are undergoing hysterectomy. it sounds like there are subtleties to your case that would best be answered by a gynecologist. Via an abdominal approach, the fallopian tube can be removed (while preserving the ovary). I find a robotic assisted transabdominal apical suspension (robotic sacral colpopexy) can in many cases effectively treat anterior (bladder) and apical (uterine/vaginal cuff) prolapse without vaginal surgery. Repair of rectal prolapse will often require a vaginal approach after the vagina is re-suspended. The "best" choice for vaginal versus abdominal approach to apical (vaginal cuff/uterine) suspension is one with which the surgeon is most comfortable and fits with the patient's wishes based upon the relative benefits and drawbacks of each approach.
1:44
To learn more about MossRehab’s urogynecologic and pelvic floor treatment, please visit https://www.mossrehab.com/urogynecologic-and-pelvic-floor-treatment or call 1-800-CALL MOSS.
Asha
1:46
Regarding physical therapy interventions for stress incontinence, is there enough evidence to support transversus abdominus training as an alternative or conjuctive treatment to pelvic floor muscle training? If so, could you direct me to such evidence? Thank you!
Einstein Healthcare Network
1:46
Farah Zeises, DPT: HI, asha. The pelvic floor works together with the transverse abdominus. The pelvic floor provides a sling to assist in holding up the bladder, uterus, and rectum, as well as maintaining continence and allowing for sexual pleasure. If we only treat the TA then we are lacking the key muscles that assist in providing us a good support system. It is important to learn how to contract these muscles in isolation and in conjunction with the traverse abdominus.
Elayne Smith
1:51
I am a 65 yr old active female who had 3 normal vaginal deliveries &1 C-section of a 2 lb preemie. Being diagnosed with Uterine Prolapse, could my 2 yr Post Nasal Allergy cough contribute to my prolapse & weak bladder? Would my cough cause problems if I have hysterectomy? Can taking Myrbetriq help my incontinence or not?
Einstein Healthcare Network
1:51
Dr. Cohn: Dear Elayne, it sounds like your prolapse may have progressed since your initial evaluation. This may be related to your cough, but fixing the cough is unlikely to fix the prolapse (although may improve your symptoms). A hysterectomy in and of itself is not going to treat a prolapsed uterus--this will require re-suspension of the vagina via surgery or a vaginal insert device called a pessary. I prefer to start with a pessary--many women will find it provides excellent relief of prolapse symptoms with minimal downside provided follow-up is good. In addition, there is much to be learned about whether the prolapse is causing your symptoms by reducing it with a pessary. Should you wish to consider surgery to avoid long term pessary use, your response to the pessary guides the risk benefit discussion and can help uncover leakage with coughing or sneezing that may need to be addressed at the same time.
Jenn
1:54
I had transvaginal mesh surgery for prolapse.  The mesh was removed because it protruded through vagina and since then I have not been able to have sex due to horrible pain and bleeding.  I have tried all the expensive vaginal moisturizers to no avail.  It has been 10 years since I have been able to have sex with my husband.  Are there any new medical fixes for this problem?
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