Presentation on theme: "The Secret about “Down There”: Pelvic Floor and Bladder Edition"— Presentation transcript:
1 The Secret about “Down There”: Pelvic Floor and Bladder Edition Harriette M. Scarpero, MD
2 Why is “Down There”a Secret? We don’t learn much about our bodies in schoolNot much attention paid to pelvic health in health related media:Name one American female celebrity whoconquered urinary incontinence….Now name one who has conquered obesity….
3 Are We Really in the Dark about the Pelvis? How many of you know the meaning of ED? (thank you Viagra)How many of you know the meaning of PFD ?
5 What is the Pelvic Floor? It is composed of bony structures:pubic bone- frontsacrum- backischial spines- sides
6 What is the Pelvic Floor? Muscles:PuborectalisPubococcygeusIliococcygeus(Levator Ani)
7 What is the Pelvic Floor? Connective Tissue:Attaches muscles to bone and each otherCarries nerves and blood vessels
8 What is the Pelvic Floor? Pelvic Organs:Uterus, ovaries, vaginaBladder, pelvic uretersRectum
9 Anatomy: BladderThe bladder is a small triangular & muscular organ that is suspended between the abdominal wall and the abdominal cavity.The vagina sits beneath it, the rectum to its left, and the uterus on top of it.The kidneys drain into the bladder continuously via long muscular tubes (ureters).
10 Anatomy:The UrethraThe urethra is a muscular tube and the channel out of which urine leaves the body.A circumferential muscle called the external sphincter sits at the middle of the urethra and helps prevent urine from spilling out.
11 Source: Brubaker L: Pelvic Floor Anatomy in “The Female Pelvic Floor. Urethral SupportConnective tissue surrounds, divides and supports the urethra on its top, bottom and sidesIn the interest of time, I will breifly review some of the interesting aspects of these defects by 1st examining the urethra where anatomy meets function. As depicted in this illistration from Brubakers Pelvic Floor text, one can see the endopelvic fascia attaching laterally to the arcus as the urethropelvic ligament containing the pubocervical and pubourethral fascia.Source: Brubaker L: Pelvic Floor Anatomy in “The Female Pelvic Floor.
12 Function: Bladder has Two Jobs The job of the bladder is to provide a low pressure reservoir to store urine (storage).The bladder must also provide a sufficient muscular contraction to empty urine efficiently (emptying).2 jobs = storage & emptying
13 Continence = Control What gives us control over our bladder is: The brainProperties of the urethra (ligament support, seal of its lining, outer vascular layer compression)Tone of the urethral sphincter muscle (anatomy)
14 Neuro Control of Bladder Function (overly simplified) The brain continuously inhibits the bladderThe lower spinal cord acts as a hub for impulses travelling from the brain to the bladder.Bladder sensation begins in nerve endings in the bladder (stretch/pressure) and can trigger urination.
15 What We Take for Granted Humans cannot see their bladders.Humans do not feel their bladders until a critical volume.The bladder is only partially under our control.A complex nerve pathway is at work to keep us dry and allow us to urinateBad brain = bad bladderSame for SCI or nerve damagevolume of urine stretches the wall and triggers a desire to urinate
16 Who Can’t Take Her Bladder for Granted Who Can’t Take Her Bladder for Granted? Women with bladder fistula, spinal cord injury, occupations like fighter pilot, and those with impaired mobility to name a few. Can you think of others?
18 How big is PFD?number of US women with > 1 pelvic floor disorder will increase from 28.1 million in 2010 to 43.8 million in 2050number with UI will increase 55% from 18.3 million to 28.4 millionnumber with POP will increase 46% from 3.3 to 4.9 millionFor fecal incontinence, the number will increase 59% from 10.6 to 16.8 millionWu, Jennifer M. MD et al, Obstetrics & Gynecology Dec 2009used population projections from the U.S. Census Bureau from 2010 to 2050 and published age-specific prevalence estimates for bothersome, symptomatic pelvic floor disorders (urinary incontinence [UI], fecal incontinence, and pelvic organ prolapse [POP]) from the 2005 National Health and Nutrition Examination Survey.
19 If You Are Experiencing PFD Symptoms… Educate your self on PFDIf seeking a specialist, look for one with additional training in pelvic floor disorders and a practice focus in the specialtyAsk lots of questions- don’t just ask the what, ask the why
20 Take Home MessagePelvic floor disorders are common and becoming more soThey are Quality of Life issues and therefore are important, not the oppositeMuch more needs to be done to educate women about pelvic health