Pelvic medicine clinic offers new help for women

2014-04-23T05:30:00Z Pelvic medicine clinic offers new help for womenDAVID WAHLBERG | Wisconsin State Journal | dwahlberg@madison.com | 608-252-6125 madison.com

It started nearly 10 years ago, after Gillian Eccles had her first child. She’d cough, sneeze, laugh, run or play soccer, and urine would leak.

Physical therapy and a supportive device provided limited help. In January, she tried surgery — and now is happy to be leak-free.

“I can run now without thinking about it,” said Eccles, 46, of Madison, whose sons are 9 and 7.

Women with urinary incontinence, accidental bowel leakage or pelvic organ prolapse can now go to a UW Health clinic that focuses on a newly recognized medical subspecialty: female pelvic medicine and reconstructive surgery, also known as urogynecology.

Many women develop the conditions after childbirth or from aging, said Dr. Heidi Brown, one of four surgeons at the new Women’s Pelvic Wellness Clinic, open two days a month at UW Hospital.

“As we get older and our muscles get weaker and everything sags a bit, the same thing happens to our pelvic floor,” Brown said.

Many of the women live with the conditions for years, wearing liners or pads, said Dr. Sarah McAchran, another one of the surgeons.

“Women are very adaptable,” McAchran said. “A lot of these are quality of life issues. They’re not life-threatening.”

But surgery and other treatments, such as injections and nerve stimulation, are increasingly becoming available, McAchran said. The Accreditation Council for Graduate Medical Education recognized female pelvic medicine and reconstructive surgery as a subspecialty just two years ago, so it’s likely more doctors will be focusing on the area, she said.

“You’re going to see more and more of this nationwide,” McAchran said.

Stress incontinence, triggered by coughing, sneezing and other movements, can be alleviated through pelvic floor exercises or by wearing a supportive device called a pessary, Brown said. Surgeries can lift the bladder or urethra back into position.

Urge incontinence — a sudden, strong need to urinate — can be treated with medication, physical therapy, biofeedback, nerve stimulation or Botox injections to relax the bladder, Brown said.

Accidental bowel leakage, also known as fecal incontinence, can be improved through diet, exercise, medication and other treatments. Bulking injections or surgery are sometimes done to control bowel movements.

In pelvic organ prolapse, the walls of the vagina weaken, allowing organs such as the bladder to drop from their normal position and cause bulging. Or, as Brown put it, “the insides start to come outside.”

Exercises, a pessary or surgery can help, she said.

Georgann Mortensen, 78, of Palmyra, had vaginal vault prolapse. It became difficult for her to urinate until her bladder got so full she would lose control and go suddenly, resulting in accidents.

“I blame it on Bobby,” she said with a laugh.

Bob Mortensen, the youngest of Mortensen’s children, weighed 10 pounds when he was born nearly 50 years ago. She later had a hysterectomy, which also may have contributed to her prolapse, she said.

After Mortensen had a significant accident while out with friends last year, she decided to have surgery. McAchran did a colpocleisis, sewing Mortensen’s vagina shut in a procedure typically done only on women who say they no longer plan to be sexually active.

The surgery resolved the urinary problems, Mortensen said.

“Everything is back as if I was a young woman,” she said. “It gave me independence and freedom.”

Eccles, a regular runner who also plays soccer, said she put up with her stress incontinence for years until it finally wore her down.

At UW Hospital, Brown surgically tightened up her vaginal tissue and put in a mesh sling to support her urethra.

Now, Eccles can run, cough or laugh without worry.

“After crossing my legs for so many years, it’s almost hard to get used to not having to do it anymore,” she said.

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