That Little “Shpritz” Could Mean a PFD

By Deborah Myers

If Whoopi Goldberg is talking about it, it must be something big.

Maybe you are experiencing what her portrayal of Cleopatra, Joan of Arc and the Statue of Liberty are experiencing in those Poise commercials—that little “shpritz.” If you are, you have some idea of what a PFD (pelvic floor disorder) is.

This inexplicably downplayed syndrome deserves anything but what it often receives: widespread non-recognition. Nearly 25% of women are diagnosed with PFD within their lifetime, though a number of these cases might have been avoided with a combination of education, precautionary exercises and open conversation with a doctor about the symptoms. Yes, this means mentioning those too-close-for-comfort details we choose to omit from that already agonizing appointment.

But when it comes to fessing up on a doctor visit, urologist Marcella M. Nachmann, DO, FACOS of Delaware Valley Urology encourages, “You gotta be proactive!”
PFD involves a whole lot more than the usual urinary tract infection (UTI). As a matter of fact, “UTIs most often have no known cause and are infrequent or are associated with sexual intercourse,” says OB/GYN David Hulbert, MD, FACOG of Burlington County Obstetrics, adding that symptoms disguised as a UTI could be an indication that something more significant has developed.

First, let’s start with a short anatomy lesson. Our pelvic floor is essentially a supporting wall that sustains six important parts below the belly button: the bladder, urethra, small intestine, rectum, uterus and vagina. Prolapse is when one of the six parts drops down as a result of weakened muscle and tissue, causing discomfort and some dysfunction of the organ and often, surrounding organs. The good news is that pelvic dysfunction can be improved and, in some cases, even repaired!

Symptoms of PFD tend to arise in times of physical exertion. Discomfort in the vagina, difficulty urinating, pain during sex and leakage are primary indicators that you could be suffering from a disorder. If any of this is striking a chord, the first thing to remember is: You do not stand alone.

One out of eleven women will have surgery to repair a PFD, and still the topic can be as unmentioned as last midnight’s Oreo consumption. Urogynecologist Gary S. Mirone, DO of South Jersey Healthcare finds the suppression of the subject to be a disconcerting norm, “It’s what I like to call ‘The Most Common Kept Secret.’ One of the most common situations is when a patient has had symptoms for at least five to ten years and they have a friend or cousin saying ‘It’s just a normal part of aging and there’s nothing they can do about it.’”

Though all women are at risk for acquiring a PFD, those who’ve given birth run the highest. Carrying and delivering those little bundles can come back to haunt you somewhere down the line, says Dr. Mirone. “The most common cause of prolapse among child-bearing women is of vaginal labor and the damage and trauma to the birth canal.”

Another high risk group is smokers. While smoking itself does not cause PFD, those who develop issues due to the practice are in jeopardy of dysfunction emerging as a result of lung and respiratory problems. Says Mirone, “I’ve had patients who have never been pregnant but develop prolapse due to chronic lifting and coughing.” Which brings us to physical laborers. Excess weight puts harmful pressure on the pelvis, so regular heavy lifting can definitely be troublesome.

Finally, with age and menopause come a few disadvantages that can be a real pain-in-the-pelvic floor—namely, weakening of the supporting structure of the pelvis. Why does strength “down there” seem to disintegrate so rapidly once we hit a certain age? It’s as easy as E-S-T: estrogen, that is.

Urogynecologist Timothy McKinney, MD of Kennedy Health System stresses the significance of the hormone, “Estrogenization is very important when a woman is in menopause. There isn’t a single cell in the female body that doesn’t have a receptor for it. Estrogen increases healing ability and decreases inflammation. It also shows a decrease in arthritis and colon and ovarian cancer.”

On the other hand, many MDs will encourage patients who wish to use estrogen supplements to proceed with vigilance, one being Dr. Hulbert, who only uses them to promote healing after surgery. “In fact, a recent study suggests that estrogen supplementation may make urinary incontinence worse. However, there is definitely a time and place to use these medications as long as the patient understands the infrequent but potentially significant risks associated with them.”

Interestingly, supplements in patch and pill form should not be confused with estrogen creams applied on the outside of the vagina, says Dr. Nachmann.  “It can bring back lubrication during intercourse, increase sensitivity and bring back good blood supply.”

Advances of pelvic floor treatment have increased dramatically within the past 15 years, so what was once the discouraging fate of our mothers and grandmothers is no more. Dr. McKinney identifies surgeries as recent as 1995 as “doing more harm than good,” and enthusiastically says “Surgeries now have greater than a 90% success rate and are done in less than half an hour. The complication rates are very, very low.” Rules of this easy six-week recovery phase may ring a bell if you’ve ever given birth to a child. “One: Nothing in the vagina for six weeks; two: No sitting in water (tub, hot tub, so forth) and three: no more than five pounds of lifting for the six week period,” lists Dr. Mirone.

And reconstructive surgery is certainly not the only option. The practice of Kegel exercises holds massive opportunity for improvement of a disorder. Dr. McKinney encourages doing the exercises once or twice daily, but stresses women must be taught to do them properly. “Eighty-five percent of women are doing the exercises incorrectly,” he informs. This is why he promotes the use of biofeedback. “Biofeedback utilizes techniques to help the patient identify the muscles she’s using and can extinguish what she might be doing wrong, which can be detrimental.”

Although pelvic floor exercises can make a world of difference, waiting to practice them until those childbearing years is undoubtedly a mistake. Keeping those muscle fibers strong guarantees you a smoother recovery period, should a disorder occur. “When a girl starts to see a gynecologist, the emphasis should be on doing pelvic exercises!” Dr. Nachmann strongly recommends.

When it comes to maintaining fitness, although it can’t prevent events beyond our control, increasing your stamina is certainly a better option. Dr. Nachmann advises, “I do think that keeping toned is a far better thing that you can do.”  She also states that if rehab should be required, “A woman at a better health level will recover more easily.” And with Kegels and Pilates showing many similarities, when questioned if practicing Pilates is beneficial for prevention, Dr. Nachmann affirms with an immediate, “Yes! Join the nearest Pilates class!”

Exercise, surgery and biofeedback aside, the route to repair starts with disclosure of the problem. Despite how hesitant grandma may have been to tell her doctor about vaginal pain or urinary leakage, current generations are taking action to put a stop to silent suffering. “The attitudes of the Baby Boomer generation are different from the very old, pre-NHS (National Health Service) generation in that they will seek and demand treatment for symptoms that affect their quality of life,” says Dr. Susie Orme, Consultant Physician of the International Continence Society. Dr. Nachmann expands on the subject: “The Baby Boomers are a little bit different. We’re getting to be somewhat of a freer society. We’re a little bit more health conscious and health aggressive.”

Another important factor when seeking treatment is finding a doctor who caters to the specific intricacies of the female body. “You have to find a doctor who specializes in female patients,” emphasizes Dr. Mirone, “and you do not have to live with PFD.” The most common declaration he hears from patients who’ve delayed seeking treatment is, “I don’t know why I waited so long!”

Learn More About It
Marcella M. Nachmann, DO, FACOS

David S. Hulbert, MD, FACOG

Gary S. Mirone, DO of South Jersey Healthcare

Timothy B. McKinney, MD

International Continence Society

Tell them you saw it in Girlfriendz Magazine!

Deborah Myers is a wife, mother and fitness activist with a flair and love for journalism. Her enthusiasm for family and healthy living has lead her to pursue online publishing through Blogger, Hubpages, and Examiner in addition to publications in Real Life Ezine and The Gazette of Gloucester County College.

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Nov/Dec 2013
Volume 6, Issue 6