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New Pelvic Health Assessment

New Pelvic Health Assessment

St. Luke's is First in the Country to Offer Women a Comprehensive Assessment to Protect Pelvic Floor Health Following Childbirth

St. Luke's is first in the country to offer a comprehensive program to evaluate pelvic floor health following childbirth. The program focuses on prompt assessment and effective intervention to address current pelvic floor disorders and/or prevent pelvic floor disorders in the future. A multidisciplinary team, including obstetricians, midwives and nurses directly involved with labor and delivery at St. Luke's are participating in this program, the only one of its kind in the country.

The initiative was initially developed and piloted at St. Luke's last year by urogynecologist Heather vanRaalte, MD of the Institute for Female Pelvic Medicine & Reconstructive Surgery and associate Stephanie Molden, MD, also of the Institute.

“The program is certainly innovative; it allows us to be proactive and make assessments early on to enhance the long-term pelvic health and well-being of our patients following childbirth,” says Joseph Merola, MD, Chief, Obstetrics & Gynecology, St. Luke's Hospital & Health Network, who fully supports the initiative. “The numbers behind the effort are compelling; it is estimated that 40 percent of women who give birth vaginally will go on to develop one or more of the problems collectively known as pelvic floor disorders.”

During pregnancy and childbirth, pelvic floor muscle weakness can result from the weight of the baby on the muscles and the stretching of the muscles during delivery. The muscles making up the floor provide support for the pelvic organs and help maintain continence of both bladder and bowel, so it's essential to keep them healthy, according to Drs. vanRaalte and Molden.

Certain risk factors increase a woman's chances of developing a pelvic floor disorder, including age during pregnancy, a larger baby, multiple vaginal births, episiotomy, the use of forceps or vacuum-assisted delivery as well as 'pushing' for an extended time during second-stage labor. Tobacco use and a high body mass index during pregnancy also increase one's chance of developing a problem.

Signs that a pelvic floor disorder may be present include leakage of urine with cough, sneeze or exercise; difficulty making it to the bathroom in time; difficulty pushing out a bowel movement or loss of stool; pain or cause lack of sensation during intercourse; or the feeling that something is dropping or bulging in the vaginal area.

Sometimes women believe pelvic floor disorder symptoms are just a normal consequence of childbirth or a normal part of aging, according to Vincent Lucente, MD, the Institute's founder and Medical Director, St. Luke's Center for Pelvic Health. “Often women are too embarrassed to mention the problem to their doctor,” he says. “The truth is pelvic floor disorder symptoms, although common, are never a normal part of childbirth or aging.”

Damaged pelvic floor muscles can lead to incontinence and pelvic organ prolapse later in life, according to Dr. Lucente. “As practitioners we need to identify what can be done differently to minimize the chance of pelvic trauma, and if a patient is at an increased risk for pelvic trauma, what can be done to maximize their recovery before the onset of symptoms,” he says.

A woman's initial evaluation following childbirth may indicate no further treatment is required or demonstrate a need for physical therapy or a physician consultation followed by further medical and/or surgical management, according to Dr. vanRaalte, who has developed a special scoring system to evaluate patient risk. Known as Obstetrical Pelvic Trauma Assessment or OPTA, this tool takes all of the known risk factors that can limit pelvic health into account. “By creating this scoring system to determine individual patient risk, patients carrying a significant number of risk factors for the development of pelvic floor disorders will be easily identified and offered appropriate counseling, follow-up care and possible intervention,” she says.

It is important to realize certain factors can be controlled by the patient, according to Dr. vanRaalte. “Women shouldn't feel they there is nothing they can do to treat a current problem or prevent a problem from occurring,” says the physician. “Decreasing risk begins early, by maintaining a healthy pregnancy weight and not smoking.”