Women's Pelvic Health Challenges- What Are They?

 Women’s Pelvic Health Challenges- What Are They?

During our weekly  Facebook Live Show, we had the honor and privilege to interview Dr. Andrew Siegel, who is dual board-certified in both urology and female pelvic medicine/reconstructive surgery and who serves as Assistant Clinical Professor of Surgery at Rutgers-New Jersey Medical School.  Dr. Siegel is a Castle Connolly Top Doctor in the New York Metro area and a New Jersey Top Doctor.

Dr. Siegel is passionate about wellness advocacy and educating the community about living a healthy lifestyle.  He has a YouTube channel and has written many books on health and wellness.

Dr. Siegel was able to shed light on some tough questions regarding women’s pelvic health in midlife including urinary tract infections, urinary incontinence, overactive bladder, and pelvic organ prolapse. We all agreed that many women have these issues, but are too embarrassed to seek the right help and treatment.  Many women had shared that they just accept wearing a pad for urinary incontinence as something they have to accept, “my Mom wore a pad and so should I” or “UTIs during midlife are just what happens, so I will deal with it.”

What many women don’t realize is that there are treatments that could improve a women’s pelvic health and most of our discussion centered around those treatments as well as providing women a detailed understanding of these pelvic conditions.

Urinary Tract Infections (UTIs) in Midlife-How serious are they?

Dr. Siegel spoke in depth about the causes of urinary tract infections for women in midlife.  Most women will experience urinary tract infections about 10 years after menopause. He outlined the changes that take place physiologically during midlife that can contribute to the development of UTIs, these included thinning of the lining of the Gastro-Urology (GU) system, low levels of estrogen, and the easy introduction of bacteria from the rectal area.  He explained that the urethra is a short “tube” where bacteria can migrate easily to the bladder and cause a urinary tract infection.    He has seen many midlife women in his practice who return for recurring UTIs which can be annoying and disabling.

Treatment for these women included antibiotic therapy, but he also spoke about preventive treatment, such as taking the supplement Cranberry Extract.  This helps the bacteria from sticking to the lining of the bladder where it can cause infection.   Women can also prevent UTIs by drinking plenty of water.  Some women with recurring UTIs may require low-dose antibiotic preventive therapy.  A small topical dose of Estrogen may also prevent UTIs in women as well.

Urinary tract infections during midlife and beyond can have very serious consequences such as kidney infections and sepsis, a life-threatening infection in the blood.  As people age, they may not exhibit the normal signs of a UTI, which are frequency, urgency, and pain on urination.  The only sign that may occur is a change in mental statuses such as confusion and agitation.   It’s important to be aware of this in the elderly population as these signs are often thought to be dementia and the UTI may go untreated, which can have very serious consequences.

Managing Urinary Incontinence and Overactive Bladder

Many midlife women are plagued by urinary incontinence and will not seek treatment because they are embarrassed to seek the help they need.  The causes of stress urinary incontinence include sneezing, coughing, and exercising. Unfortunately, because exercise may induce incontinence some women shy away from working out, which affects their quality of life.

Urinary urgency and frequency were also addressed by Dr. Siegel.  An overactive bladder is one that contracts involuntarily and gives rise to urgency and frequency. 

What was fascinating was when Dr. Siegel spoke about “triggers”.  Triggers cause a woman to feel an urgency to urinate suddenly.   It can happen when running the water, turning the key into the door when arriving at home, or washing the dishes.  Urinary urgency can be very disruptive to a women’s life by causing her to get up at night to urinate or having to wear pads to avoid accidents.

Dr. Siegel stressed that these issues are manageable and treatable.  His strategy is to start with the simplest interventions first.   There are medications available that can relax an overactive bladder which can eliminate involuntary contractions and enable women to live a better life. He also discussed the use of pelvic floor training and biofeedback for these conditions which are used instead of surgery as a first-line strategy.

The connection between the mind and the body, particularly with urinary urgency is very strong.  Relaxing the mind and taking deep breaths can also assist with the issue of urinary urgency.  Kegel exercises can also be used to strengthen the pelvic muscles to help control urinary urgency.  The beauty of doing Kegel exercises is that they can be done without anyone knowing you are doing them! He encourages women to do them at home, in the car or just about anywhere!

Pelvic Organ Prolapse - Don’t Delay Treatment

The idea of falling organs is not appealing to anyone, particularly for midlife women who are already going through many changes.  Dr. Siegel sees women in his practice that are embarrassed and uncomfortable as they literally feel a bulge coming out of their vagina.  Pelvic organ prolapse also makes sex very uncomfortable and many women shy away from intimacy. Pelvic organ prolapse can be caused by childbirth, aging, and straining with bowel movements. 

Noninvasive treatments are considered first for pelvic organ prolapse, such as Kegel exercises and the placement of a pessary, which can be very effective.  In more severe cases, surgery may be indicated.  The message for midlife women with pelvic organ prolapse was they do not have to suffer from this condition, there are treatments and ways to manage it.

The Importance of a Urologist for Midlife Women

During the interview, it became evident that midlife women do need to have a relationship with a urologist.  Many women often feel if they are seeing a gynecologist, a urologist is not necessary.    For some that may be the case.  However, when a woman has pelvic health issues the gynecologist, and urologist work closely to make sure that women’s pelvic health issues are managed properly.

As health and wellness coaches we reinforced that there is an emotional component to these physical pelvic issues.    Many women identify the pelvic organs with their sexuality and womanliness.  When these organs do not function properly many women are anxious and depressed.  They feel “less than” a woman.  Dr. Siegel agreed with this and supported that women’s pelvic health should be managed holistically, including mind, body, and spirit.  Dr. Siegel’s takeaway for midlife women was to live a healthy lifestyle and seek medical attention early to that less invasive treatments can be used instead of surgery.

Below are links to more specifics that were published in Dr. Siegel's newsletters.

Click here for urinary infections

Click here for incontinence

Click here for overactive bladder

Click here for vaginal prolapse

Watch the replay of our interview with Dr. Siegel here.

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