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Vital Signs

Spring 2009

Help Available for Women with Pelvic Floor Disorders

Vital Signs Spring 2009 issue: Help Available for Women with Pelvic Floor DisordersToo embarrassed or discouraged to seek medical attention, many women with pelvic floor disorders suffer in silence. But these common disorders are readily treatable.

“This is not something that women have to suffer with,” says Christopher Tarnay, M.D., chief of the Division of Female Pelvic Medicine and Reconstructive Surgery in the Department of Obstetrics and Gynecology.

The pelvic floor consists of the muscles, ligaments and connective tissue that support organs such as the bladder, uterus, vagina, bowel and rectum. While the precise causes are not fully understood, factors such as age, childbirth, weight and certain medical conditions can weaken the pelvic floor, leading to problems such as urinary or fecal incontinence. Women may also experience a condition called pelvic organ prolapse, in which the vagina and the organs that surround it fall from their normal position.

Depending on the condition, treatments can range from learning exercises and making lifestyle changes to surgery, says Larissa Rodriguez, M.D., co-director of the Division of Pelvic Medicine, Incontinence and Reconstructive Surgery in the Department of Urology. In the case of urinary incontinence, for example, biofeedback, in combination with pelvic floor exercises, has been found to be corrective in up to 70 percent of cases without the need for drugs or surgical intervention. However, the therapy must be sustained over the course of the patient’s lifetime to remain effective.

When surgery is required, minimally invasive laparoscopic or vaginal procedures are available, Drs. Tarnay and Rodriguez note. Cure rates approach 90 percent for such procedures as the suburethral sling, in which a hammock-like mesh aids in the closure of the urethral sphincter. For more complex conditions such as prolapse, surgeons can use state-of-the-art techniques like hybrid biosynthetic grafts to correct defects in the pelvis. These techniques can offer a higher success rate than traditional pelvic repair and generally do not require removal of the uterus. Most patients feel a huge sense of relief “once they realize that they are not alone in these conditions and that there are treatments available,” Dr. Tarnay says.

Researchers also are exploring high-tech approaches to dealing with pelvic floor issues. For example, at UCLA there is ongoing research into the potential use of stem cells derived from fat tissue to correct such disorders as stress incontinence and bladder dysfunction. “The work we are doing in the laboratory is very promising,” Dr. Rodriguez says. Botox also is being used clinically for such conditions as overactive bladder, and researchers are further studying the drug’s effects in the laboratory and exploring ways to make it work better.

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