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Your Questions Answered on Pelvic Floor Conditions
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Einstein Healthcare Network
1:54
Farah Zeises, DPT: Hi Jenn, one of the roles of the pelvic floor is to allow us to have sexual pleasure. If the pelvic floor muscles are shortened, restricted and or painful, then penetration to the area can be a further source of pain. Surgery, can lead to scar tissue build up which can also be contributing to restrictions. A skilled pelvic floor therapist can address the pelvic floor muscles, with goal to decrease the restrictions and decrease the pain. We can also teach you the appropriate strategies to minimize your pain.
Concerned
1:56
After a bowel movement, I sometimes leak a clear liquid for a bit afterwards, is this normal?
Einstein Healthcare Network
1:56
Dr. Cohn: Dear Concerned--I would recommend having this evaluated by a gastroenterologist to rule out other causes, however, it may be related diet/loose stools, and/or constipation
Jan
1:58
FYI  kegle  not sure of spelling,  Philadelphia Protestant Home Wellness , Maureen, makes us do Kegles (keg-el)  silver sneakers class to strengthen pelvic floor.  I believe that it works.
Einstein Healthcare Network
1:58
Dr. Cohn: Dear Jan--Right on! Yes they can work, but they have to be done correctly. It's difficult to have the goal of "getting in shape" and walk into a gym and just start exercising. We need trainers! The same is true for the pelvic floor. A guide to help you ensure you are doing the exercise properly is so important
eve
2:00
If you cannot have surgery for prolapse, what other ways can you relieve the discomfort?  (I have a pessary and also take Pyridium pills.)
Einstein Healthcare Network
2:00
Dr Cohn: Dear Eve--A pessary is a great way to relieve symptoms of prolapse without surgical intervention.  Many times reduction of the prolapse with a pessary will result in improvement in pelvic pressure and discomfort and urinary symptoms if they coexist.  Pessaries are helpful, but some women cannot tolerate them due to coexisting pelvic floor discomfort, and about one third of women will develop bothersome discharge.  Nevertheless, I think there are a great way to start in managing discomfort or other symptoms related to prolapse and I support their use strongly.
Nancy
2:00
In 2014 my sister suffered a stroke which caused her to become incontinent. Medications (including Myrbetriq), Botox injections in the bladder, and percutaneous tibial nerve stimulation (PTNS) have not helped.  Are there any other options left for her?
Einstein Healthcare Network
2:05
Dr. Cohn: Dear Nancy--urinary incontinence after stroke is 1 of the more challenging things that I manage in urology.  Many times a stroke will lead to both bladder overactivity resulting in incontinence and incomplete bladder emptying which is a set up for worsening incontinence and potentially infections as well.  Patients lose control over their bladder--it empties when it wants to not when the patient wants it to.  Although it is not necessarily an optimal situation, for the most difficult cases with severe incontinence in a patient who is somewhat debilitated, I may recommend placement of a suprapubic catheter (a catheter placed in the lower belly that goes into the bladder) and Botox injections.  Though far from perfect, this can restore quality of life and avoid major surgery.  It highly motivated patients willing to undergo the risks of major surgery, removal of the bladder with diversion of the urine can be another option for severe refractory urinary
Debra
2:07
I have urinary incontinence (despite a previous bladder mesh) and now fecal incontinence.  How do I tell if it's from neurological issues or just a weak pelvic floor? And does my sexual dysfunction (lack of sensation and low libido) have anything to do with it?
Einstein Healthcare Network
2:08
Dr. Cohn: Dear Debra--I have found that sudden onset urinary incontinence and fecal incontinence can be due to spinal cord pathology as you have suggested may be the case.  I typically referred these individuals to be evaluated by spine surgery (orthopedic surgery or neurologic surgery) to evaluate for a reversible cause of their symptoms.  In the absence of a neurologic cause, sacral neuromodulation ( InterStim) can be a highly effective treatment for both urge associated urinary incontinence and bowel incontinence.  As for sexual dysfunction and low libido, I am not sure that these are definitely related, but it is conceivable that concerns about urinary incontinence can significantly impact sexual desire and function
Debbie Sellman
2:09
Been SUFERING  from low pelvic pain for 10 years and still no Doctor can find anything wrong with me. Started back in 2008 and after two years and lots of Vicodin they gave me a total hysterectomy. I STILL HAVE THE PAIN. Some days, like yesterday it is DIBILLITATING!!! I have had multiple CT Scans, Ultrasounds, Colonoscopies, over these 10 years. Hope you can help?
Einstein Healthcare Network
2:10
Dr. Cohn: Dear Debbie--as a urologist, I start with advanced evaluation to see if the pain you are having is related to the bladder filling and emptying cycle.  If this is the case, than therapies directed at abnormalities in the filling cycle can help with the pain.  Oftentimes, however, this pain is related to a global pain syndrome that requires multidisciplinary care with physical therapy and clinical psychology to help reduce symptoms and improve coping mechanisms. There often is no quick fix--but there is help.
Priscilla Thorpe
2:13
Why with the meds I am on they don't work every 10 to 15 minutes u am going to the restroom font always make it care to go out if I can't go to the restroom  it just run down as I am going trying to make it.
Einstein Healthcare Network
2:13
Dr. Cohn: Dear Priscilla--when medications prescribed by your primary care physician for overactive bladder no longer help, it is time to see a specialist who can evaluate why we have not had an adequate response to therapy and offer options beyond medications.  First-line management of overactive bladder with incontinence includes lifestyle changes such as cutting back on fluid intake and caffeinated beverages and alcohol and weight loss (weight has a profound impact on urinary symptoms--as a consequence, weight loss can have a profound positive impact, with many bariatric surgery studies showing complete resolution of urinary symptoms in many patients following surgery).  Second line therapy includes medications.  Third line therapy includes treatment such as sacral neuromodulation or InterStim or botulinum toxin injection that can provide significant relief to individuals when medications are insufficient.
EHN
2:14
Do physical therapists work with men with pelvic floor issues? What kind of conditions do you treat with them?
2:15
What are some of the pelvic floor conditions that can be treated through physical therapy?
Einstein Healthcare Network
2:15
Dr. Cohn: Pelvic floor physical therapist work with both men and women for variety of conditions including but not limited to: Urinary incontinence, overactive bladder, pain, and discoordinated urination
K in Collegeville
2:16
Is frequent urination in an over 60 woman related to prolapse?
Einstein Healthcare Network
2:18
Dr. Cohn: Dear K--frequent urination may be related to prolapse but also may be related to primary bladder pathology or "overactive bladder".  This can be idiopathic which means there is no known cause but likely has its roots in aging, blood vessel disease, and subtle neurologic disease or can be caused by a host of neurologic conditions.  It may also be caused by fluid or caffeine intake in someone who is especially sensitive
Jean
2:20
At what age do you stop trying to stop or curtail the situation? In other words.......do you just buy one of the many products available at your local drug store when you've reached the age of do nothing and deal with what ever comes up?
Einstein Healthcare Network
2:20
Dr. Cohn: Dear Jean--the options for incontinence and prolapse are very in how involved and invasive they are.  There are options for even relatively frail individuals that can provide significant relief.  Nobody is too old to receive guidance or even many office-based interventions
Robert
2:20
Following prostatectomy, what can a man do.  Kegel's didn't work
Einstein Healthcare Network
2:21
Dr. Cohn: Dear Robert--I recommend evaluation to determine if you might benefit from a male sling or an artificial urinary sphincter
Anne
2:22
I wake up every 2 hours during the night to urinate. It doesn't seem to matter if I drink something close to bedtime or not. What can I do to stop this?
Einstein Healthcare Network
2:23
Dr. Cohn: Dear Anne--nocturia is exceptionally frustrating. It may be caused by bladder overactivity or by making too much urine overnight (or both). I would direct you to the following resource to gain a better understanding https://www.nafc.org/nocturia/
Guest
2:23
My mother had bladder prolapse in her late 70s -early 80s and had a pessary.  Is bladder prolapse hereditary and if so, what can be done to prevent it?
Einstein Healthcare Network
2:25
Dr. Cohn: Dear Guest--there are hereditary risk factors but the strongest risk is related to number of pregnancies and vaginal deliveries (and if there were any complications of those deliveries). General health recommendations--ie nutrition, healthy weight, aerobic exercise, may help prevent prolapse or its symptoms
Guest
2:25
Is erectile dysfunction common in diabetics and is there anything to help this?
Einstein Healthcare Network
2:27
Dr Cohn: Dear Guest--ED is very common in diabetics and heart disease. After having a thorough evaluation with your PCP or cardiologist to determine you do not have a global health issue that needs to be addressed, there are a number of oral and injectable medications as well as surgical procedures to help restore erections
Guest
2:27
54 yr. old female suffering with bowel incontinence. I had a diagnostic test that determined that I had a weak pelvic floor. I was prescribed physical therapy but never had it. This was a few years ago.  Could I still benefit from physical therapy?
Einstein Healthcare Network
2:28
Dr. Cohn: Dear guest--you could benefit from another dedicated pelvic floor PT program. Should that benefit be insufficient, InterStim may be an option for you provided an underlying neurologic cause (such as spine disease) has been ruled out
TEST
2:29
CAN TOTAL URINARY AND FECAL INCONTINENCE BE REVERSED AFTER A SPINAL CORD INJURY?
Einstein Healthcare Network
2:30
Dr. Cohn: Dear Test--this is an area of important study for those of us who care for neurogenic bladder and bowel. Unfortunately, these issues cannot be reversed, but they can be helped. I would recommend evaluation to see why these issues are occurring in you specifically (with advanced testing) and review options to manage these symptoms better
Fearful
2:31
Having Prolapsed Uterus, i can see the buldge protruding when standing or sitting on toilet. I was given info on therapy, Pessary & advised hysterectomy. Should I seek 2 & 3rd opinion? I dont want to have my bladder opening measured again for a catheter (it hurts) can i just bring my records from one doctor to another? Im also embarrassed about this, please help.
Einstein Healthcare Network
2:36
Dr. Cohn: Dear Fearful--you can always bring your records to another physician. Sometimes with severe prolapse the kidneys can be blocked--in this case treatment is not a quality of life issue but a necessity (though a pessary can work for this as well). In all other cases, treatment is based upon the symptoms of bother and individual patient preferences. I'm not alone in this as a reconstructive surgeon--I want my patients to be well-educated, which means they have taken whatever time is needed to understand the potential benefits of surgery against the risks--do what you need to do in order to feel like you are doing the right thing by proceeding with operative intervention. We understand.
Curious
2:36
After 3 vaginal deliveries with stitches, many years ago. I feel the opening to my vagina is too large. Is it possible over the years where i was cut to delivery, has now opened. What can be done to correct this?
Einstein Healthcare Network
2:38
Dr. Cohn: Dear Curious--a widened genital hiatus may be seen in conjunction with a posterior compartment prolapse, or "rectocele". Rebuilding support for the perineal body (the area between the anus and vagina) can treat the rectocele and restore the anatomy, but it is important to have realistic expectations.
2:39
Dr. Cohn: Thank you for all of your excellent questions. I am sorry if there were any I did not have the time to address.
Thanks so much for taking part in our chat! 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. To learn more about MossRehab’s urogynecologic and pelvic floor treatment and to make an appointment, please visit https://www.mossrehab.com/urogynecologic-and-pelvic-floor-treatment or call 1-800-CALL MOSS.

The information contained in this chat is not intended or implied to be a substitute for professional medical advice. Einstein has a talented team of primary physicians and specialists who you can contact or make an appointment to see to discuss your specific medical problems; but most importantly, you must always seek the advice of a physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition. Nothing contained in this chat should be u
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