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| The UK Urogynecology and Reconstructive Pelvic Surgery division is (from left) Dr. Gerardo Heredia Melero; Briana Bell, advanced-practice provider; and Dr. Johnnie Wright Jr. (UK photo by Carter Skaggs) |
University of Kentucky
A woman's pelvic floor, whether she realizes it or not, is constantly under stress. Pregnancy, obesity and physically demanding jobs can strain the pelvic-floor muscles, which are the network of tissues that support the intestines, bladder, urethra, rectum, cervix, uterus and vagina.
Those muscles are responsible for a number of functions, including controlling urination and bowel movements, as well as supporting the organs within the pelvis. A weak or dysfunctional pelvic floor can lead to a host of symptoms, ranging from occasional urinary incontinence to pelvic organ prolapse, which occurs when an organ in the pelvis slips down from its normal position.
UK HealthCare has a new subspecialty program to treat pelvic floor disorders called the Urognecology and Reconstructive Pelvic Surgery program. The providers are Dr. Gerardo Heredia Melero and Dr. Johnnie Wright Jr. and advance-practice provider Briana Bell.
This team of experts in pelvic medicine and reconstructive surgery work with patients to develop a treatment plan; those treatments can be as simple as exercises or medications or as complex as robotic surgery.
“At UK HealthCare, we are among the few providers in Kentucky equipped to diagnose and treat common conditions that frequently go undiagnosed,” said Wright. He said the program offers "comprehensive and tailored treatments to women."
“At UK HealthCare, we are among the few providers in Kentucky equipped to diagnose and treat common conditions that frequently go undiagnosed,” said Wright. He said the program offers "comprehensive and tailored treatments to women."
He said time is a factor because these disorders need to be addressed early before they are beyond the help of surgical intervention. “The majority of patients come to see us for the management of pelvic floor prolapse,” said Wright. “Probably 40 percent of them experience some degree of urinary dysfunction – either urgency, frequency or urge incontinence.”
Wright and Heredia identified a need for comprehensive care for patients who experienced complications during or after childbirth, both after delivery and years after the fact.
Many women experience urinary incontinence and other symptoms after having children but dismiss them as a normal aftereffect of pregnancy. Other risk factors, such as obesity and occupational hazards such as heavy lifting, can contribute pelvic floor stress. Over time, a weakened pelvic floor could lead to pelvic organ prolapse, which can involve a vaginal hernia.
Other common symptoms of pelvic floor dysfunction include:
The first and arguably most important step in diagnosing and treating pelvic floor disorders is helping patients understand urinary incontinence is not normal, and that a better quality of life is possible, Wright said
“The greatest impact we can have is with education,” he said. “There’s a small subset, both in patients and referring providers, who believe that if there’s no pain and it’s not cancer, then there’s no reason to worry.”
Urogynecology has been a board-certified subspecialty for 11 years, but many providers have not had the opportunity to participate in a subspeciality fellowship or training. Additionally, Wright and Heredia say a number of patients they see have already had pelvic reconstruction surgery performed with materials and techniques that are no longer standard practice.
Wright and Heredia are working with referring providers throughout the state, spreading awareness of not just the specialized program at UK HealthCare, but about pelvic floor health in general. Surgery should be the last resort, Wright said; physical therapy, relaxation techniques, medication and targeted therapies can offer lasting relief.
“I call it ‘pelvic floor empowerment,’” said Wright. “We welcome anyone who is experiencing incontinence, discomfort or pain.”
- A heavy dragging feeling in the vagina or lower back
- Feeling of a lump in the vagina or outside the vagina
- Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency, urgency and urinary stress incontinence
- Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly
- Pain or discomfort during sexual intercourse
The first and arguably most important step in diagnosing and treating pelvic floor disorders is helping patients understand urinary incontinence is not normal, and that a better quality of life is possible, Wright said
“The greatest impact we can have is with education,” he said. “There’s a small subset, both in patients and referring providers, who believe that if there’s no pain and it’s not cancer, then there’s no reason to worry.”
Urogynecology has been a board-certified subspecialty for 11 years, but many providers have not had the opportunity to participate in a subspeciality fellowship or training. Additionally, Wright and Heredia say a number of patients they see have already had pelvic reconstruction surgery performed with materials and techniques that are no longer standard practice.
Wright and Heredia are working with referring providers throughout the state, spreading awareness of not just the specialized program at UK HealthCare, but about pelvic floor health in general. Surgery should be the last resort, Wright said; physical therapy, relaxation techniques, medication and targeted therapies can offer lasting relief.
“I call it ‘pelvic floor empowerment,’” said Wright. “We welcome anyone who is experiencing incontinence, discomfort or pain.”
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