In her own words: A talk with Milena Weinstein, MD, a urogynecologist at Massachusetts General Hospital in Boston, MA.
Much like with her colleague, Samantha Pulliam, MD, I provided the talking points and she took it from there
SMF: Tell me about the typical women that make up your practice:
Dr. Weinstein (DW):
Urinary complaints are by far the most common reasons women come in. Many of these women may have urinary incontinence, but just as many encounter problems with urinary frequency (urinating more often than normal) or urgency (strong need to urinate).
Other significant issues are pelvic organ prolapse, pain (from many pelvic sources), and associated colorectal issues, such as constipation.
SMF: So what do you do? What do you offer for them?
Please understand that there are many different interventions for problems such as urinary frequency, incontinence, and pelvic organ prolapse. I am a big believer in maximizing the conservative approach first. Conservative treatment may include recommending patients do Kegel exercises on their own and to see a women’s health physical therapist for additional treatment. Voiding diaries and general education on bowel and bladder habits and function are a large part of my interactions with patients.
SMF: Yes - education is key!! What do you talk about, specifically?
I often start by explaining to the patient how the bladder works. When treating urinary frequency or urgency, I talk about a concept of “overactive bladder” and explain the problem by saying (in part) that the bladder has stopped listening to the signals from the brain, going on to explain that voiding is reflexive and when they were potty trained as a child, they learned to control their bladder urges and signals. This “mind over matter” approach becomes the basis for bladder retraining and behavioral modifications.
Attempt at bladder retraining - putting the body on a schedule for voiding frequency and fluid consumption - is imperative before going on to more involved treatments like medications, pessaries (a removable device that is placed in the vagina to support the pelvic organs), and surgical options.
SMF: Does this type of information come as a surprise to women? Do you find that they had the right information before you meet with them?
Surprise, yes. Right information, not typically! There are so many different myths and beliefs out there - doing Kegels on the toilet when they void, for example, as a good way to train the pelvic floor muscles. Because of this, I have to clarify what a Kegel really is, how to do these exercises correctly, and when it is appropriate to perform them (NOT during voiding, just in case that wasn’t clear!! smf). In addition, I often need to clarify how the pelvic floor muscles work and that they are, in fact, postural muscles that relax and contract and have roles and responsibilities relative to the rest of the body.
SMF: Great information! So - the million dollar question - where would you like to see women’s healthcare in the coming few years?
Without question, we need greater exposure of women’s (pelvic and perinatal) health issues in the public eye, as well as with government and healthcare (service-providing and educational) institutions.
Sadly, most women still don’t know about women’s health specialists in areas of female pelvic health...and the media and politicians don’t really know about it either. This situation is likely reflective of a big knowledge deficit, as well as our historical level of discomfort to talk about such issues openly and honestly.
The American Urogynecologic Society has been asking the National Institutes of Health to recognize women’s pelvic health (pelvic floor disorders) as a stand-alone topic (not a subset of other health issues or disease classifications), and so I truly hope that this will change in the next few years.