The Secret about “Down There”: Pelvic Floor and Bladder Edition Harriette M. Scarpero, MD

Why is “Down There”a Secret? We don’t learn much about our bodies in school Not much attention paid to pelvic health in health related media: Name one American female celebrity who conquered urinary incontinence…. Now name one who has conquered obesity….

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 ?

PFD = pelvic floor disorders

What is the Pelvic Floor? It is composed of bony structures: pubic bone- front sacrum- back ischial spines- sides

What is the Pelvic Floor? Muscles: Puborectalis Pubococcygeus Iliococcygeus (Levator Ani)

What is the Pelvic Floor? Connective Tissue: Attaches muscles to bone and each other Carries nerves and blood vessels

What is the Pelvic Floor? Pelvic Organs: Uterus, ovaries, vagina Bladder, pelvic ureters Rectum

Anatomy: Bladder The 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).

Anatomy:The Urethra The 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.

Source: Brubaker L: Pelvic Floor Anatomy in “The Female Pelvic Floor. Urethral Support Connective tissue surrounds, divides and supports the urethra on its top, bottom and sides In 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.

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

Continence = Control What gives us control over our bladder is: The brain Properties of the urethra (ligament support, seal of its lining, outer vascular layer compression) Tone of the urethral sphincter muscle (anatomy)

Neuro Control of Bladder Function (overly simplified) The brain continuously inhibits the bladder The 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.

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 urinate Bad brain = bad bladder Same for SCI or nerve damage volume of urine stretches the wall and triggers a desire to urinate

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?

PFD = Pelvic Floor Disorders Urinary incontinence Pelvic Organ Prolapse Fecal incontinence Sexual dysfunction

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 2050 number with UI will increase 55% from 18.3 million to 28.4 million number with POP will increase 46% from 3.3 to 4.9 million For fecal incontinence, the number will increase 59% from 10.6 to 16.8 million Wu, Jennifer M. MD et al, Obstetrics & Gynecology Dec 2009 used 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.

If You Are Experiencing PFD Symptoms… Educate your self on PFD If seeking a specialist, look for one with additional training in pelvic floor disorders and a practice focus in the specialty Ask lots of questions- don’t just ask the what, ask the why

Take Home Message Pelvic floor disorders are common and becoming more so They are Quality of Life issues and therefore are important, not the opposite Much more needs to be done to educate women about pelvic health