Author: womenpss

Our Postpartum Pelvic Floor Clinic

Women’s Pelvic Surgery Specialists is thrilled to announce we are now scheduling patients at our innovative, multidisciplinary program: The Body After Baby Pelvic Floor Clinic.

Are you recovering from childbirth, or have you experienced an injury or change in pelvic floor function?  If you were running the Chicago marathon, you’d have a detailed and thoughtful plan for pre-race preparation, and post-race recovery.  The reality is, childbirth is mother nature’s marathon:  perhaps the biggest stress your body will ever face. Don’t ignore the challenge, and the importance this will have in terms of your future comfort and control relating to your most basic bodily functions and even sexual function. With just a bit of attention you can be prepared, be informed, prevent problems and maximize your recovery.    

Our Body After Baby clinic provides evaluation, advanced pelvic imaging, and treatments for pelvic floor problems that commonly occur even after what may seem to have been a ‘normal’ and uneventful childbirth.  

Common postpartum conditions we evaluate and treat:

• Episiotomy repairs and other injuries to the perineum, vagina, anal sphincter 
• Pelvic muscle injury: Occult (hidden) injuries to the pelvic floor muscles may occur in up to 80% of women, especially after prolonged or instrumented vaginal birth.  These injuries can be clearly diagnosed using a quick 3D pelvic floor ultrasound in the office. 
• Bladder control problems
• Bowel control problems
• Constipation, and difficulty completing bowel movements
• Change in sexual function
• Pre-delivery pelvic floor counseling:  whether you’re looking ahead to your first delivery, or have already had a baby and planning ahead for a more informed next one, we are happy to meet and provide expert advice.  

Women eager to get an early and accurate diagnosis and to maximize their ability to get their body back after baby are encouraged to contact us.

Convenient office hours and locations

The Body After Baby Clinic is offered at our Skokie and Highland Park locations.

Appointments are available during Mom-friendly Saturday hours! Leave the kid(s) with your spouse or sitter, and take care of your post-childbirth body.

Early recognition and management of pelvic floor injuries and symptoms is the key to long-term quality of life when it comes to your pelvic health.  

Please contact us for an appointment, and take the first steps to your best Body after Baby!

As part of their coverage on postpartum urinary incontinence, the authors of “Your Guide to Urinary Incontinence After Childbirth” looked to Dr. Goldberg to share his expertise on Parents.com, a leading parenting site.

“Even a seemingly uneventful pregnancy and delivery can change urinary control for up to 50 percent of women.”

Roger Goldberg, M.D.

The article by Suzanne Schlosberg and Tracey Zemitis features explanations on the common types of postpartum urinary incontinence and includes a range of treatment options.

Read the full article.

Did you know that between 30-50% of moms report some loss of bladder control by age 40, and 65% notice it for the first time either during or after childbirth?

Or that 25% of women notice some change in sexual function persisting beyond 6-months postpartum? 

Or that, over time, they can lead to major surgery for at least 11% of women?

These are problems that can diminish quality of life at home, in the bedroom, or at work. 

Time to take control of your body. Start with a better understanding of what’s going on down there as you age or give birth.  

Pelvic Floor

The pelvic floor is a group of supportive muscles and connective tissues that keeps your pelvic organs (uterus, bladder, bowels) in their proper positions. It spans like a supportive shelf from your pubic bone to tailbone, and side-to-side across the bottom of your pelvis.  

A strong and healthy pelvic floor helps you maintain control over your bladder and bowels, and helps you to feel normal tone in the vagina.

Your pelvic floor muscles are in a hidden part of your body, but play a critical role by:

• contracting when you cough, sneeze or strain, helping to prevent the accidental leakage of urine. 
• helping to hold the pelvic organs (including bladder) in the right position.
• helping in the control of passing of urine, gas and bowel motions.
• playing a role in sexual function during intercourse.

Like any other muscle throughout your body, the pelvic floor muscles need the right exercise, on a regular basis, to be strong and fit!  

Pelvic Floor During & After Childbirth

Even during a ‘normal’ pregnancy and delivery, the pelvic floor muscles, connective tissues, organs and nerves undergo tremendous strain and become stretched and weakened.  

Even when external signs of injury aren’t present, it’s been shown that the vast majority of women have injury to the deeper muscles. After childbirth, it’s important to rehabilitate your pelvic floor.  

What Happens When the Pelvic Floor is Injured or Weak?

Pelvic Organ Prolapse

The vagina is like a horizontal tube with strong upper and lower walls, with the upper wall providing major support underneath the urethra and bladder, and the lower wall helping to keep the rectum in its proper position. Several ligaments that attach to the bones of the pelvis support the uterus, cervix and upper apex of the vagina.

Under normal conditions, the strength within the vaginal walls, and their attachments to the pelvis, play essential roles in keeping the nearby organs (uterus, bladder, rectum and bowel) where they’re supposed to be.

When prolapse occurs months, years or even decades after childbirth, support might have been lost around one or all of these areas. Different types of prolapse often cause their own distinct symptoms and call for different treatments.   

Learn more about how we treat pelvic organ prolapse.

Cystocele:  The ‘Dropped Bladder’

A cystocele forms when the upper vaginal wall loses its support, allowing the bladder to drop, sometimes causing a vaginal bulge and/or difficulty emptying the bladder.

Rectocele:  The ‘Bulging Rectum’

A rectocele results from bulging of the rectum into a weakened lower vaginal wall, sometimes leading to vaginal bulging and/or difficulty having bowel movements. Some women with rectoceles feel that stools feel like they’re getting ‘stuck’ in the lower part of the rectum.

Uterine Prolapse

This occurs when the uterus and cervix drop down toward the opening of the vagina after the ligaments supporting them have weakened. It may cause pressure sensations in the vagina, rectum or even lower back.  

Perineal Injury

The perineum is the skin and muscle spanning between the vaginal and anal openings. It has a lot of nerve endings and plays an important role in helping you feel normal tone in the vagina and during intercourse.

The perineum very often injured during vaginal childbirth, due to natural stretching and/or episiotomy.  After these injuries, some women complain of feeling ‘too loose’ and others complain of pain or tenderness.     

Stress Urinary Incontinence

Stress incontinence (“SUI”) is leakage that occurs at the moment of a cough, sneeze, exercise or other physical stress. 

Studies have found that for women between ages 30-45, vaginal childbirth carries a two- to five-times higher risk of having SUI.  

If you’ve developed SUI during or after childbirth, one particular anatomical change is the most common culprit:  weakening of the vaginal wall that lies beneath the urethra and provides its main support. This is called urethral hypermobility.  

If you have stress incontinence after childbirth, you like worry it be permanent. In many cases, the problem will resolve as the tissues naturally heal; but one study found that if SUI is still present 3 months after delivery, there are 94% odds that it will not spontaneously resolve.  

But don’t worry! With pelvic strengthening many cases improve; and if not, there are simple ways (for instance: the sling procedure) to completely eliminate SUI for over 90% of women. 

Overactive Bladder (OAB)

Do you map the next bathroom when you’re out of the house, anticipating the next sudden urge?  If so, you may have OAB. 

This condition causes strong urges to urinate, frequent trips to the bathroom during the day and sometimes night, and sometimes leakage before reaching the bathroom

Around 30% of childbearing women have this condition, and one study estimated that 80% of affected individuals are not receiving treatment.   Research done right here at Women’s Pelvic Surgery Specialists has proven that OAB symptoms become more common after each pregnancy and childbirth.  The condition is very treatable with changes to your diet and bladder behavior, as well as medications and other non-surgical options.  

Anal Incontinence & Bowel Problems

Diminished control over the bowels (whether stool or gas) is one of the most distressing and embarrassing problems faced by post-reproductive women. By age 45, it’s 8 times more prevalent in women than men, occurring in around 25% of women who have had a previous vaginal delivery. Sometimes this is due to injury to the anal sphincter muscles.  

An article from 1993, in The New England Journal of Medicine showed that hidden injury to the sphincter occurs in up to 34% of ‘normal’ appearing deliveries, and up to 44% in women after 2 or more vaginal births.   

The good news? We find the majority of cases will be controlled with changes to diet and fiber, over-the-counter supplements and other non-surgical strategies.  

Sexual Dysfunction

Sexual disorders have been reported in approximately 14% of women after routine vaginal delivery, and the risk is thought to be even higher after a forceps or difficult delivery.

This may include a simple change in sexual energy or desire (libido), a diminished physical response (arousal), an inability to reach orgasm (anorgasmia), or perhaps even physical pain during intercourse (dyspareunia).  

As a new mom, if you’re experiencing problems and you think they’re not just due to the exhaustion and new pressures that can impact your sex life, you should consider having a physical assessment of your perineal and pelvic floor healing. 

Common post-childbirth issues may include:

• A sore or incompletely healed perineum
• Lack of estrogen leading to dryness and pain. Sometimes this lack of estrogen is the result of breastfeeding, which has strong hormonal effects.
• Body image concerns as some body changes after childbirth are short-term, and others may be long-term.  

Diastasis (Injury to the Abdominal Muscles) and Cosmetic Issues

Although physical changes in the pelvic and vaginal area are best addressed by urogynecologists, other specialists are available to address changes to ‘body after baby’ changes that occur outside the pelvic floor.

Diastasis (separation of the abdominal muscles) occasionally occurs after childbirth and can cause significant discomfort and dysfunction. The symptoms associated with this condition sometime improve with the help of a physical therapist, and in other cases will not improve without surgery. 

Women’s Pelvic Surgery Specialists is available for consultation for diastasis or any other cosmetic issues of significant concern.  

5 Questions to Decide Whether You Need Help

After learning more about the pelvic floor, and common concerns women have about their pelvic floor health, you may be wondering if you could benefit from the expertise we offer at Women’s Pelvic Surgery Specialists.

Start with our quick five question assessment.

1. Can you strongly contract your pelvic muscles for 10 seconds?
2. Do you have pain in the pelvis, bladder, rectum or vagina?
3. Have you experienced a loss of bladder function?
4. Have you experienced a loss of bowel function, or constipation?
5. Have you noticed a change “down there” that impacts your self confidence, comfort or control?

Then, contact us to see how we can help.

Adapted from “Ever Since I Had My Baby” by Roger Goldberg; Penguin Random House https://www.penguinrandomhouse.com/books/61217/ever-since-i-had-my-baby-by-roger-goldberg-md-mph/

In 2006, I was invited to organize and lead a surgical mission in western Nepal, the country’s poorest and most remote region. 

A Maoist coup had uprooted the region just 18 months prior to our visit, and delayed our surgical mission for a year. Once there, we met heroic local women’s health advocates trying their best to improve the dignity and healthcare for local women, at definite risk to themselves due to brutal and violent political forces in the region.  

Heavy lifting, malnutrition and traumatic childbirth mean Women as young as 14 years old in this area suffer an epidemic of pelvic organ prolapse. This treatable condition leads to severe stigma and social isolation

An epidemic of pelvic organ prolapse

Prolapse in Nepal occurs on a truly epidemic scale. While I had heard this claim from the few reports I’d read, quite honestly, I didn’t fully believe the claim until I witnessed the region first hand.  

Due to a combination of malnutrition, heavy physical labor and often difficult and prolonged childbirth, women in western Nepal routinely experience a profound loss of pelvic support and disabling symptoms.  

From a young age, physical labor such as fetching and hauling the water supply into the village and home each day begins a ‘wear and tear’ process, similar to the development of a hernia, leading to a severity of pelvic prolapse unlike anything we witness in our surgical practice here at home. 

Sadly, girls and women in western Nepal are required to handle the vast majority of heavy physical work, eventually compounded by the physical strain of childbirth—an incredible overall physical burden that eventually takes a dramatic toll.

This burden takes a social tool, too. Woman in western Nepal are often socially outcast from her family and community, in many cases forced to sleep in a different physical space such as a dirty barn with the animals.

After two flights and a two-day jeep ride along mud-slicked mountainside roads subject to frequent landslides, we reached the remote village of Dailekh, Nepal.

We triaged over 400 women who had, in many cases, traveled by foot for up to 4 days for just a chance at receiving care.  Our surgical clinic had been broadcast over the radio stations on western Nepal, generating perhaps a bit too much excitement, as we were facing more women than we could possibly care for. 

It was sad and overwhelming to see the sheer demand for our services, and disheartening to realize that we’d be able to serve only a small fraction of the women seeking help. I distinctly recall one woman who had been carried on the back of her son, for a 2-day day hike over the hills from a different village in the region.  

The tribal clothing and piercings worn by the women visiting us were so vivid and colorful, and such a contrast against the backdrop of the immense poverty of this area, the muddy and cold conditions. 

Many of us on the team were getting sick, unaccustomed to living and sleeping in cold and dirty conditions with no plumbing or heat, and minimal electricity.  Just a few days into the challenge of living in Dailekh and our entire group was physically and emotionally exhausted; yet, all of us were acutely aware that for the locals this was their permanent reality.   

Where health care meets culture

For women in Nepal, the uterus often has important symbolic meaning relating to sense of femininity, and as a result removing the uterus (hysterectomy) for many women is a nonstarter.  

Many Nepalese women felt hysterectomy would leave them ‘empty’, less valuable, potentially even shunned by a spouse. For a visiting brigade of U.S. docs, these cultural norms can be difficult to quietly accept. But we understood our role wasn’t to change every social norm we disagreed with, but rather, to do our best to safely deliver care that met the real-time needs of these female patients within their own cultural realities.  

The good news? Our team is particularly skilled in uterine-preserving surgical techniques (hysteropexy). In fact these methods were developed at our center and are a popular surgical choice among my patients back in the Chicago area. As a result, we were able to offer non-hysterectomy prolapse repairs, or uterine suspensions to many of our Nepalese patients, which met their cultural needs and could also be performed relatively quickly without expensive technology.  

We met and partnered with heroic local women’s health advocates who were trying their best to improve the dignity and healthcare for local women, at definite risk to themselves due to brutal and violent political forces in the region.

Operating in very challenging conditions

During our visit we performed nearly 50 major surgical procedures under the most basic conditions imaginable, and during frequent power outages in the operating room I felt grateful for the REI biking headlamps I had purchased just before heading to O’Hare airport a week earlier, as these provided our only light during those episodes.   We encountered young women with severe pelvic organ prolapse, in fact I distinctly recall one of our nurses helping to counsel a 14-year-old girl with a severe prolapse condition, an unspeakable situation that we would never encounter back at home.  We educated many patients on the use of pessaries, and performed surgery on women who we felt would be most likely to succeed and reap the most benefits.

The surgical challenges in Nepal were immense — not only because these women had far more severe degrees of prolapse than we typically encounter here at home, and malnutrition that would certainly have a negative impact on healing and surgical strength, but also because of the difficult daily realities of their lives.  For instance, unlike here at home where women tend to avoid heavy physical exertion during their surgical healing period, in Nepal we had little faith that our patients would be allowed to postpone heavy lifting and physical labor for very long.   Women simply don’t have a powerful enough voice, and it became obvious to our team that without addressing gender rights issues, the epidemic of prolapse in western Nepal would not disappear anytime soon.  

What we learned

Sadly, we needed to send many patients home with no care at all, because we had simply exceeded our capacity and equipment supply. The patients we did treat were so appreciative, and yet also so hardened and weathered by their incredibly tough reality which was the only life they had ever known and might ever know; we were told that the vast majority of these women would never even make it to Kathmandu, the capital city of Nepal.

Leaving Nepal, our team felt we had done our best to provide safe care to a number of desperate within an incredibly challenging environment. We utilized our surgical skills in pelvic floor surgery, and non-surgical care such as pessary training, to hopefully give some of these women a chance to restore their dignity and confidence.

And perhaps, we planted the seeds of an idea in this far away, turbulent part of the world that women deserve recognition and treatment of these life-changing problems.

But mostly, we were deeply saddened to realize the layers of difficulty that extend so far beyond pelvic health for these women, that without addressing the issues of deep poverty and women’s rights, the epidemic of prolapse in this area of Nepal will remain for some time.

Everyone in the group left with a heavy heart, feeling that while each of us had a return trip back to Chicago, the locals in the hills of remote Dailekh and western Nepal would live and die their full lives in the unspeakably tough conditions in those hills.

International medical missions can open your heart and break it at the same time. I consider this type of work to be an amazing privilege, something that delivers professional and personal life lessons that helps shape my compassion and perspective as a surgeon and human being.

Update from the field

We are happy to see that the International Urogynecology Association (IUGA) recently launched a program partnering with an academic center in eastern Nepal to promote education and surgical training, and we look forward to participating in the future.

Our trip to Nepal was partially sponsored by Women’s Health Foundation, and was featured in a short film produced by Academy and Emmy nominee Danny Alpert of Kindling productions. Click here to watch the film on YouTube.