New Program for Pelvic Floor Disorders

August 3, 2015

WMC_pelvic_floorIt was in an unusual setting where Pamela Lambert, of East Providence, first learned she needed a colonoscopy – at a routine eye exam back in the summer of 2012. Little dark spots could be seen on her retina – an indicator of colon cancer. Just one week and one day later she had a colonoscopy – and less than one week after that she learned that a tiny polyp removed during her colonoscopy was malignant and it would be difficult for doctors to stage her cancer.

On September 26, 2012, Lambert had an ileostomy (surgery in which a piece of the ileum, the third portion of the small intestine, is diverted to an artificial opening in the abdominal wall). A portion of her colon and 14 lymph nodes, two of which tested positive for cancer, were also removed. Subsequent chemotherapy and painful radiation treatments attacked her cancer, but left Lambert, a local stage and film actress and active volunteer, with symptoms ranging from neuropathy to intercourse pain and severe pelvic muscle damage that made her practically housebound from decreased bowel control. But a new program at the Women’s Medicine Collaborative changed all that.

“This is a triumph,” says Lambert, a Miriam Hospital volunteer, recounting a recent restaurant dining experience. “I just ate, and I’m fine.”

“I couldn’t have done that before,” adds Lambert, who would often avoid eating to avoid loss of bowel control. “I used to have to sit in my back yard and read. Now I can leave my house.”

The Program for Pelvic Floor Disorders, part of the Center for Women’s Gastrointestinal Medicine at the Women’s Medicine Collaborative, offers patients a multidisciplinary team of clinicians with expertise in pelvic floor disorders such as incontinence, constipation and pelvic pain.

Almost 20 percent of the general population and up to 50 percent of seniors are affected by stool accidents and at least one in four women experience significant discomfort and diminished quality of life as a result of a pelvic floor disorder. Symptoms can extend beyond incontinence, constipation and pelvic pain to organ prolapse – the dropping down of an organ. Yet only a small fraction of these patients bring the problem to a health care provider’s attention, and many providers do not routinely ask, according to Leslie Roth, MD, FACS, FASCRS, a colorectal surgeon and co-director of the Program for Pelvic Floor Disorders.

“Many women suffer in silence,” says Roth. “Often they believe symptoms such as pelvic pain, stool accidents (fecal incontinence) and chronic constipation are a normal part of aging. They are not, and they are treatable.”

“For example,” she adds, “many women with fecal incontinence are told there is nothing left to be done, when in fact they may have a correctable pelvic floor disorder.”

Pelvic floor disorders occur only in women. They include a dropping down of the bladder, urethra, small intestine, rectum, uterus, or vagina due to weakness or an injury to the ligaments, connective tissue, and muscles of the pelvis. Women may feel pressure or fullness in the pelvis, or have problems with urination or bowel movements.

While it is true that fecal incontinence, constipation, and other pelvic floor disorders are not a normal consequence of childbirth or aging, they do become more common as a woman ages.

In addition to childbirth (vaginal delivery in particular), other common causes for pelvic floor disorders are:

  • Obesity;
  • Hysterectomy;
  • Aging; and
  • Frequent activities that increase pressure on the abdomen, such as straining during bowel movements or lifting heavy items.

The Program for Pelvic Floor Disorders features a multidisciplinary clinician team who works collaboratively to meet patients’ needs and improve their quality of life. Staff includes a gastroenterologist, gynecologists, a colorectal surgeon, a clinical dietitian, behavioral medicine professionals and physical therapists who communicate with referring providers throughout treatment to ensure continuity of care. Each team member has specific expertise in pelvic floor disorders, offering patients a wide range of treatments and therapies.

In addition to fecal incontinence, chronic constipation, and pelvic pain, other conditions treated through the Program for Pelvic Floor Disorders are:

  • Hemorrhoids;
  • Irritable Bowel Syndrome (IBS);
  • Pelvic organ prolapse;
  • Postpartum pelvic floor issues;
  • Rectal prolapse and fistulas (abnormal connection between an organ, vessel, or intestine and another structure); and
  • Anal fistulas and anal fissures (tear(s) in the lining of the lower rectum)

A patient’s individualized plan of care may include biofeedback; bladder retraining; electrical stimulation; exercises; lifestyle modification; manual therapy; medication; colon motility testing; relaxation techniques; urinary control devices; and surgery. During her lifetime, about one in 11 women need surgery for a pelvic floor disorder.

“Our goal is to offer treatment options that meet our patient’s distinct needs and more importantly, change their quality of life for the better,” says gastroenterologist Amanda Pressman, MD, co-director of the Program for Pelvic Floor Disorders.

“If we don’t ask,” adds Pressman, “patients won’t tell, and we want our patients to know they are not alone.”

“I wish I had known about The Program for Pelvic Floor Disorders two years earlier,” says Lambert, who still goes for bi-weekly physical therapy at the Women’s Medicine Collaborative. “It has been so invaluable for me – it has changed my life in such amazing ways.”

For more information about pelvic floor disorders or The Program for Pelvic Floor Disorders at the Women’s Medicine Collaborative, please call 401-793-7080.

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