♪ ♪ ♪ ♪ WOMEN, ARE YOU AFRAID TO COUGH OR SNEEZE FOR FEAR THAT SOMETHING LIKE THE ALIEN FROM THE MOVIES IS GOING TO POP OUT OF YOU.

IF SO, STAY WITH US AS WE TALK TO PELVIC RECONSTRUCTIVE SURGEON Dr. STACY LENGER ABOUT PELVIC PROLAPSE ON KENTUCKY HEALTH NEXT.

ON TODAY'S SEGMENT, WE WILL BE TALKING ABOUT AND SHOWING PICTURES PERTAINING ON STRUCTURAL PROBLEMS AFFECTING THE PELVIC FLOOR IN FEMALE REPRODUCTIVE ORGANS.

WHILE NOTHING IS GRAPHIC, VIEWER DISCRETION IS ADVISED.

SOME OF US, ESPECIALLY THOSE OF US WHO ARE NOW OLDER THAN BEFORE, ARE ACUTELY AWARE AND CONCERNED ABOUT THE POSSIBILITY OF PASSING A BIT OF GAS.

IN EXTREME CASES, EVEN A SQUIRT OF STOOL OR URINE DURING A HARD COUGH OR SNEEZE.

IF THAT IS NOT BAD ENOUGH, THERE ARE THOSE AMONGST US WHO HAVE THE ADDED CONCERN OF FEELING A BULGING OR SENSE THAT SOMETHING THAT IS NORMALLY ENSCONCED WELL INSIDE OF US POPPING OUT.

WHILE THIS IS NOT USUALLY LIFE THREATENING, IT CAN AND OFTEN DOES HAVE AN IMPACT ON THE QUALITY OF OUR LIVES.

CAUSES ARE MULTIPLE BUT THERE ARE SEVERAL THINGS THAT THEY HAVE IN COMMON.

1: THEY'RE MORE COMMON IN WOMEN.

2: THEY OCCUR MORE FREQUENTLY IN WOMEN WHO HAVE GONE THROUGH VAGINAL DELIVERIES.

3: THEY'RE TOO OFTEN IGNORED OR DOWNPLAYED BY HEALTH PROFESSIONALS AND THAT THE CHANGES ARE NATURAL AND NO TREATMENT IS NEEDED OR AVAILABLE.

TODAY OUR GUEST Dr. LENGER WILL DISCUSS THESE PROBLEMS AND TELL US ABOUT THE AVAILABLE OPTIONS EMPLOYED BY PHYSICIANS LIKE HER.

AFTER GRADUATING FROM THE UNIVERSITY OF MISSOURI SCHOOL OF MEDICINE, Dr. LENGER COMPLETED AN INTERNSHIP AND RESIDENCY IN OBSTETRICS AND GYNECOLOGY AT THE UNIVERSITY OF TENNESSEE FOLLOWED BY BY BY A FELLOWSHIP IN FEMALE PELVIC MEDICINE AND RECONSTRUCTIVE SURGERY.

SHE IS CURRENTLY AN ASSISTANT PROFESSOR IN THE DEPARTMENT OF OBJECT AT THE TIME RICKS GYNECOLOGY AT THE LOUISVILLE SCHOOL OF MEDICINE AND DIVISION DIRECTOR OF FEMALE PELVIC MEDICINE IN RECONSTRUCTIVE SURGERY.

Dr. LENGER, THANK YOU FOR BEING WITH US TODAY.

>> THANK YOU FOR INVITING ME.

>> SEEMS LIKE WE HAVE KNOWN EACH OTHER FOR A WHILE NOW.

>> IT DOES SEEM SO.

>> TELL ME WASHINGTON UNIVERSITY AND ST. LOUIS, THAT'S A NAME THAT HAS STRUCK ME AS ODD BUT ONE OF THE MOST PREEMINENT PROGRAMS I KNOW IN PELL VISION RECONSTRUCTIVE SURGERY IN THE COUNTRY.

>> IT WAS AN HONOR TO TRAIN THERE AND GLAD TO TAKE EVERYTHING I'VE LEARNED THERE AND HELP THE WOMEN OF KENTUCKY.

>> WE ARE GLAD YOU ARE ON THIS PART OF THE LEWIS DIVIDE.

LOUISVILLE.

SO TELL ME, WHAT IS PELL PELVIC FLOOR WEAKNESS.

>> PELVIC FLOOR WEAKNESS IS MORE OF A GENERAL TERM, NOT NECESSARILY ONE THAT WE USE IN OUR OFFICE ON A DAILY BASIS, BUT WHEN YOU TALK ABOUT WEAKNESS, THINK ABOUT STRENGTH, THE OPPOSITE OF IT.

IF IT IS WEAK, YOU HAVE TISSUE WEAKNESS IN THE PELVIC MUSCLES, SOFT TISSUES, NOT NECESSARILY A WEAKNESS OF THE BONY STRUCTURE BUT OF THE OTHER TISSUES THAT CAN, YOU KNOW, BE INJURED IN DAILY LIFE.

>> SO WITH THAT UNDERSTOOD, WHAT IS A PELVIC AND RECOULD BE INSTRUCTIVE SURGE ONAND WHAT EXACTLY ARE YOU DOING?

>> SO AS A PELVIC RECONSTRUCTIVE SURGEON, THE OTHER NAME THAT PATIENTS KNOW US AS IS URI GYNECOLOGIST AND WE SPECIALIZE IN EVERYTHING FROM ABOUT THE PELVIC FLOOR.

INCONTINENCE OF URINARY AND FECAL STUFF.

PELVIC ORGAN PROLAPSE IS ONE OF THE BIGGEST THINGS WE HELP PATIENTS IMPROVE THEIR QUALITY OF LIFE.

>> WHAT DOES PROLAPSE MEAN?

>> IT IS WHEN YOU HAVE A WEAKNESS, LIKE WE JUST TALKED ABOUT IN THE PELVIC FLOOR AND THAT CAN BE IN THE SOFT TISSUES, THE MUSCLES, THE RESULTS OF A TEAR.

YOU CAN THINK OF IT LIKE A HERNIA, RIGHT?

SO YOU HAVE A WEAKNESS THAT GOES OF THE SOMETHING PUSHING INTO THE VAGINA JUST LEAK A HERNIA ON SOMEONE'S ABDOMEN ABDOMEN.

>> THAT IS THE POINT OF EGRESS FOR ALL OF THIS STUFF.

>> IT IS THE ONE THAT CAUSES THE MOST PROBLEMS.

>> EVERY NOW AND THEN THINGS POP OUT IN THE BACK END, TOO YOU KNOW.

>> THAT'S TRUE AND WE WORK COMMONLY WITH COLORECTAL SURGEONS IN THOSE SITUATIONS TO HELP BOTH THE VAGINAL AND RECTAL AREA.

>> THAT DIDN'T TAKE TOO LONG TO GET A PLUG FOR THE COLORECTAL SURGEONS OF THE WORLD.

IS THERE A DIFFERENCE BETWEEN PROLAPSE AND INCONTINENCE AND IF SO, WHAT IS INCONTINENCE ALL ABOUT?

>> PROLAPSE AND INCONTINENCE ARE TWO DIFFERENT THINGS.

BOTH VERY COMMON IN WOMEN BUT SEPARATE ENTITIES.

SO A PATIENT MAY HAVE PROLAPSE BUT THEY COMMONLY COME IN SAYING I'VE HAD LEAKAGE, RIGHT.

THE LEAKAGE COULD BE OF ANY BODILY FLUID.

IT COULD BE URINE, WHERE URINE LEAKING WITH CAUGHEY COUGHING, SNEEZING OR LAUGHING OR LEAKAGE WITH AN URGE, PATIENTS SAY I GOT TO GO, I JUST CAN'T MAKE IT TO THE RESTROOM IN TIME AND THEN YOU HAVE FECAL INCONTINENCE.

SO PATIENTS WHO MIGHT HAVE LOSS OF LIQUID OR SOLID STOOL FROM THEIR RECTUM.

>> DO YOU FIND THE TWO TOGETHER WITH PATIENTS?

>> THEY'RE NOT NECESSARILY-- A PATIENT CAN NECESSARILY HAVE ONE OR THE OTHER.

I HAVE PATIENTS WHO COME INTO MY OFFICE AND HAVE ALL OF THE ABOVE.

AND SO PART OF IT IS WORKING WITH PATIENTS TO DETERMINE WHAT IS BOTHERING AND AFFECTING THEIR QUALITY OF LIFE THE MOST BECAUSE THAT'S REALLY WHAT DRIVES TREATMENT IN OUR FIELD.

>> MOTHERHOOD GETS BLAMED FOR A LOT OF THINGS.

>> IT DOES.

>> AND IT IS THE GIFT THAT KEEPS ON GIVING.

SO TELL ME, WITH DELIVERIES, IS THAT WHERE A LOT OF THE DAMAGE ORIGINAL NATES THAT GIVES-- ON RIDGE NATES THAT GIVES.

>> THE ACT OF BEING PREGNANT AND DELIVERING IS A LARGE FACTOR BUT NOT ONLY TERRIFIC FACTOR.

WE DON'T USE A LOT OF IMAGING TO DIAGNOSE PROLAPSE BUT THERE HAVE BEEN STUDIES AND MRI STUDIES LOOKING AT SOFT TISSUES SO IT'S NOT JUST VAGINAL DELIVERIES THAT CAUSE DAMAGE OF THE PELVIC FLOOR THERE.

WAS A SMALL STUDY PUBLISHED SEVERAL YEARS AGO LOOKING AT MRIS AND THEY HAD THE MOST DAMAGE AFTER A CESAREAN DELIVERY.

THE VERY ACT OF BEING PREGNANT AND CARRYING GESTATION TO DELIVERY ITSELF CAN CAUSE DAMAGE.

>> WHAT ABOUT WOMEN WHO ARE ENGAGED IN STRENUOUS PHYSICAL ACTIVITY.

>> ANY REPETITION MOVEMENT, WHETHER IT'S STRAINING OVER AND OVER WHEN YOU ARE WORKING ON A FACTORY LINE, THAT COULD BE A RISK FACTOR.

STRAINING REGULARLY IF YOU ARE HAVING CONSTIPATION, WE BELIEVE, COULD BE PART OF A RISK FACTOR ESPECIALLY FOR THE POST INTERIOR SIDE OF THE VAGINA AND CHRONIC COUGHS.

I SEE THAT NOW IN KENTUCKY THAN OTHER STATES THAT MAY HAVE A DIFFERENT SMOKING RATE.

AND SO THAT'S, IN ADDITION TO THAT, RIGHT THINGS LIKE SMOKING CAN IMPACT TISSUE QUALITY, RIGHT.

AND GENETICS PLAY A ROLE.

IT'S NOT-- I TELL MY PATIENTS JUST BECAUSE YOUR MOM, YOUR SISTER, AUNT, COUSIN OR SOMEONE YOU KNOW HAD A HYSTERECTOMY DOESN'T MEAN YOU NEED ONE BUT IF YOU HAVE A GENETIC PREDISPOSITION TO WEAKER TISSUES THOUGH, HAVE YOU FAMILY MEMBERS WHO HAVE A LOT OF HERNIAS, YOU WILL PROBABLY BE HIGHER RISK FOR HAVING PELVIC ORGAN PROLAPSE.

>> THE PELVIC FLOOR IS REALLY A MUSCLE?

>> I TALK TO MY PATIENTS ABOUT IT BEING TAYE BOWL, RIGHT?

AND SO YOU HAVE THE FRONT IS THE PUBIC BONE.

AND THEN YOU HAVE YOUR BLADDER AND THE TUBE THAT YOU PEE OUT OF, THE URETHRA GOES THROUGH THE MUSCLES THAT CREATE THE BOTTOM OF THE BOWL AND THEN FOR WOMEN WHO STILL HAVE A UTERUS, THE UTERUS AND CERVIX THAT CONNECT TO THE TOP PART OF THE VAGINA.

THE VAGINA GOES THROUGH THAT BOWL AS WELL AND THEN YOU HAVE THE RECTUM AND THE ANUS.

>> NO WONDER YOU HAVE THESE HERNIATIONS BECAUSE YOU HAVE HOLES IN YOUR...

SO OF COURSE YOU HAVE A LEAK.

>> AND I TELL PATIENTS, IT'S SUPPOSED TO BE MOVEMENT THE PELVIC FLOOR IS NOT CONCRETE, RIGHT?

IF YOU THINK ABOUT DELIVERY, RIGHT, YOU HAVE SOMETHING THAT IS RATHER LARGE HEAD, LARGER IN SOME SITUATIONS THAN OTHERS.

AND IT HAS TO BE DELIVERED SO YOUR TISSUE HAS TO STRETCH.

YOUR TISSUE HAS TO ALLOW FOR THE PASSAGE AND DELIVERY AND IN THOSE SITUATIONS LIKE YOUR TISSUE HAS TO STRETCH TO HAVE A BOWEL MOVEMENT AS WELL.

>> WHAT ABOUT WOMEN WHO HAVE HAD HYSTERECTOMIES?

DOES THE ACT OF TAKING OUT A UTERUS, DOES THAT WEAKEN THE PELVIC FLOOR OR STRUCTURAL ELEMENTS?

WHEN WE TALK ABOUT THE STRUCTURE OF THE VAGINA, THERE ARE THREE LEVELS OF SUPPORT.

YOU HAVE KIND OF THE LOWEST LEVEL WHERE THE PER KNEE PERINEUM AND THE LEVEL ALONG THE SIDE OF THE VAGINA AND THE LEVEL AT THE TOP WHICH IS WHAT WE CALL THE APEX.

IF YOU TAKE OUT THE CERVIX, RIGHT, YOU ARE AFFECTING SOME OF THE SUPPORT.

BUT IT'S NOT THE ONLY THING, RIGHT.

YOU HAVE TISSUES THAT HAVE TO BE TRAN SECTED OR CUT AT THAT POINT.

BUT JUST HAVING A HYSTERECTOMY ALONE IS NOT THE CAUSE.

>> WE ARE GOING TO TALK ABOUT THESE MORE BUT IF YOU CAN, LET'S DIFFERENTIATE BETWEEN UT UTERUS PROLAPSE, RECTAL SEAL.

>> IT CAN BE VERY CONFUSING FOR PEOPLE WHO DON'T UNDERSTAND THE DIFFERENCE.

SO WHEN WE TALK ABOUT IT, WE TALK ABOUT PELVIC ORGAN PROLAPSE AND THINK ABOUT IT IN DIFFERENT COMPARTMENTS.

SO YOU THINK ABOUT THE FRONT COMPARTMENT, ANTERIOR, PROLAPSE OF THE FRONT WALL BETWEEN THE VAGINA AND URETHRA, THE BLADDER.

SO THEN YOU HAVE THE TOP OF THE VAGINA, AND SO THAT'S WHEN WE TALK ABOUT THESE COMPARTMENTS BECAUSE WHAT WE DO FOR TREATMENT I'M SURE WE'LL TALK ABOUT IN A LITTLE BIT TALK ABOUT THE COMPARTMENTS SEPARATELY AND THE POST TEAR POST TEARIER SO WHEN YOU HEAR ERECT UM SEAL, THAT'S PUSH IS INTO THE VAGINA AND THE CSSTO SEAL IS PUSHING INTO THE VAGINA.

I CAN'T TELL IT'S THIS PART OR THIS ORGAN UNTIL WE SAY THINGS LIKE ANTERIOR PROLAPSE OR POSTERIOR.

>> ONE OF THOSE THINGS WHERE IT SEEMS LIKE THAT'S ALL IT WOULD BE.

SO TELL ME, WHAT ARE SOME OF THE-- AND WERE YOU KIND ENOUGH TO BRING A FEW THINGS WITH YOU.

WHAT ARE SOME OF THE TOOLS OF THE TRADE THAT YOU WOULD USE?

FIRST TELL ME, LET'S GET SOME OF THIS OUT OF THE WAY.

MESH.

EVERYONE IS AFRAID OF MESH.

>> MESH, LET ME PULL THIS OUT FOR YOU.

>> LET'S SEE THIS DEMON.

>> THIS IS AN EXAMPLE OF WHAT WE USE FOR SOME OF OUR PROCEDURES.

AND IT IS-- THIS IS ACTUALLY WHAT IS A Y MESH.

SACRAL.

WE ARE USING MESH AND IN IN THAT SITUATION TO TIE UP THE VAGINA.

IT HAS TO DO WITH THE VAGINAL TISSUE TYING IT UP TOWARD THE SACRUM.

AND SO IF YOU THINK ABOUT IT, IF MY HAND IS VAGINAL TISSUE, WE USE MESH ALONG THE FRONT WALL OF THE VAGINA AND THE BACK WALL OF THE VAGINA AND WE FULL IT UP-- PULL IT UP AND ATTACH IT TO THE LIGAMENT THAT IS INSIDE THE SACRUM.

>> AND SO THAT'S JUST PULLING THINGS BACK UP.

WHY HAVE WE BECOME SO RETICENT OR FEARFUL OF MESH?

>> MESH IS A VERY POWERFUL TOOL AND SOMETHING THAT IS GREAT TO HAVE IN OUR TOOLKIT AS SURGEONS BUT IT'S DANGEROUS WHEN IT IS PUT IN THE HANDS OF PEOPLE WHO DON'T USE IT ALL THE TIME.

SO PART OF THE THINGS, THE TV COMMERCIALS AND THINGS YOU HEAR, OH NO, I DON'T WANT TO TALK ABOUT MESH.

IN THOSE SITUATIONS, THAT IS ACTUALLY TALKING ABOUT VAGINAL PROLAPSE MESH PLACED THROUGH THE VAGINA.

>> THROUGH THE VAGINA DURING SURGERY.

AND SO ACTUALLY THE FDA IN 2019 HAS TAKEN ALL OF THOSE KITS OFF THE MARKET.

SO I COULDN'T EVEN GET THOSE KITS TO USE FOR A SURGERY RIGHT NOW IF I WANT TO.

THE COMPANIES DON'T MANUFACTURE THEM ANYMORE OR SELL THEM.

SO IT'S DIFFERENT THAN MESH LIKE THIS, WHICH WE PLACE ABDOMINALLY AND WE ARE USING IT.

SO YOU ATTACH IT AND IT DEPENDS UPON THE LAYER OF THE TISSUE THAT YOU ARE PUTTING IT IN.

>> IT'S SAFE?

>> IT'S SAFE.

YES.

THERE ARE RISKS JUST LIKE ANYTHING, RIGHT?

YOU HAD A RISK DRIVING ANYWHERE YOU WENT IN THE WORLD.

AND SO YOU READ THE BACK OF THE TYLENOL BOTTLE AND IT'S TERRIFYING ACTUALLY.

>> IT IS.

>> BUT THE RISK WITH MESH, IF IT'S PLACED CORRECTLY, IF YOU HAVE GOOD TISSUE, IF YOU ARE A NON-SPOKER, IT'S LESS RISKY.

SMOKING IS A RISK FACTOR FOR MESH COMPLICATIONS.

THOSE TYPES OF THINGS ARE ALL TAKEN INTO CONSIDERATION.

WE THINK ABOUT THINGS LIKE WHEN WE ARE IN SURGERY, ARE WE GOING TO HAVE AN INCISION LINE RIGHT AGAINST IT.

>> WE HEAR IT BUT MOST OF US HAVE NO CLUE WHAT IT IS.

>> I BROUGHT A COUPLE OF EXAMPLES WITH ME TODAY.

SO HERE IS TWO EXAMPLES OF PESTERIES.

THESE ARE, I TALK TO PATIENTS ABOUT THESE.

THESE ARE THINGS THAT ARE USED ARE SILICONE, SO THEY DON'T CAUSE BACTERIA TO GROW IN THEM AT ALL BUT THESE STAY INSIDE OF THE VAGINA AND SO THEY ACTUALLY KIND OF THEY ARE CONSERVATIVE WAY OF MANAGING PROLAPSE.

IT GETS PUSHED INSIDE OF THE VAGINA.

THIS PENDS BEND AND MOVES SO IT FOLDS, IT GOES INSIDE SO IT'S NOT AS SCARY AS IT LOOKS.

THIS ONE IS ONE THAT HAS AN INCONTINENCE KNOB ON IT.

IT CAN HELP PATIENTS WITH PROLAPSE AND INCONTINENCE WITH COUGHING, LAUGHING AND SNEEZING.

IT FOLDS LIKE A TACO.

IT MAKES IT EASIER AND PATIENTS CAN BE TAUGHT IF THEY WANT TO, TO USE THESE ON THEIR OWN.

AND SO THEY CAN TAKE THEM IN AND OUT ON THEIR OWN.

I HAVE SOME PATIENTS WHO MAY JUST WEAR ONE OF THESE WHEN THEY'RE EXERCISING.

THEY DON'T HAVE TO WEAR IT 24 HOURS A DAY SEVEN DAYS A WEEK.

I HAVE OTHER PATIENTS WHO SAY YOU KNOW WHAT Dr. LENGER, I'M NOT EXCITED ABOUT HAVING TO TAKE THIS IN AND OUT ON MY OWN AND THEY MAY LEAVE IT TO ARE THREE MONTHS AND TYPICALLY IN OUR OFFICE, OUR NURSE PRACTITIONER MANAGES... >> THEY CAN STAY IN FOR THREE MONTHS WITHOUT A RISK OF INFECTION.

>> WITHOUT RISK OF INFECTION AND THERE IS ACTUALLY WITH COVID ONE OF THE THINGS THAT CAME OUT OF IT, SOMETIMES CAN IT GO LONGER BUT IN OUR PRACTICE, WE TYPICALLY SAY THREE MONTHS BECAUSE AT THAT POINT, A LOT OF PATIENTS START TO SAY I'M HAVING A LITTLE MORE VAGINAL DISCHARGE AND THEY LIKE TO COME IN AT THE REGULAR INTERVAL.

THESE ARE REGULAR TOOLS BUT IF YOU DO NOT MAINTAIN THEM, THAT'S WHEN THEY BECOME RISKIER, RIGHT?

SO HAVE YOU TO MAKE SURE THEY'RE BEING TAKEN IN AND OUT.

PATIENTS WHO END UP WITH A FISTULA OR SOMETHING BETWEEN THEIR BLADDER AND THE VAGINA, A LOT OF TIMES BECAUSE HAVE YOU SOMETHING LIKE THIS PUSHING AND YOU KNOW, CAUSING A SORE IN AN AREA BECAUSE IT WASN'T TAKEN OUT FOR FIVE YEARS, EIGHT YEARS, SOMING LIKE ALONG THOSE LINES.

THAT'S A BIGGER ISSUE.

>> THE PROBLEM WITH UTERINE PROLAPSE.

WHEN THE UTERUS IS HANGING DOWN.

IS IT ACTUALLY HANGING OUTSIDE OF THE BODY OR IS IT PUSHING THROUGH THE VAGINA AND WHAT DO YOU DO ABOUT THIS?

>> SO WHEN I TALK TO PATIENTS, I USE THE ANALOGY OF A SOCK.

IF YOU THINK ABOUT A SOCK.

WHEN THE TOE OF A SOCK IN ITS NORMAL POSITION, PERFECT SUPPORT, RIGHT?

SO THEN YOU HAVE THE TOE WHEN IT COMES DOWN, SO WHEN THE UTERUS, IF YOU THINK ABOUT THE TOE WHERE THE CERVIX WOULD BE CONNECTED, THE SOCK CAN TURN INSIDE OUT AND SO WHEN A PATIENT COMES IN, THEY SAY I FEEL THIS BULGE AND CAN I FEEL IT WHEN I'M WIPING, USING THE RESTROOM.

THAT'S THE VAGINA AND VAGINAL TISSUE THAT IS ACTUALLY THERE.

BUT YOU CAN HAVE THE UTERUS COME DOWN BEHIND IT SO IT MIGHT FEEL SOMETHING THAT FEELS LIKE A CERVIX.

I TELL PATIENTS IF YOU FEEL RIGHT HERE, THAT'S ABOUT THE CONSISTENCY OF WHAT A CERVIX WOULD FEEL LIKE.

AND SO YOU KNOW, IT CAN BE THE UTERUS, BUT IT DOESN'T-- IT CAN BE THE UTERUS THAT COMES DOWN BEHIND IT BUT DOESN'T MEAN IT HAS TO BE OUT.

IF THE SOCK IS TOTALLY INSIDE OUT, THAT'S LIKE STAGE 14 PROLAPSE.

WE TALK ABOUT PROLAPSE IN STAGES AND GRADES.

WHEN IT COMES RIGHT TO THE OPENING, THAT'S CONSIDERED STAGE TWO.

>> SO WHAT DO DO YOU FOR THAT WHEN A PERSON HAS PROCEED COLLAPSE?

DO YOU PULL IT BACK UP TOWARDS NORMAL POSITION OR WHAT DO YOU DO?

>> THE FIRST QUESTION BEFORE WE SAY WHAT DO WE DO?

WE ASK THEM ARE YOU EMPTIYING YOUR BLADDER?

WE HAVE THEM USE THE RESTROOM, DO A GLADDER SCANNER AND MAKE SURE THEY'RE EMPTY.

YOU DON'T HAVE TO DO ANYTHING IF IT IS NOT AFFECTING YOUR QUALITY OF LIFE.

>> IT HATS TO BE UNCOMFORTABLE.

>> MOST PATIENTS SAY IT IS BUT SOME PATIENTS SAY I WANT TO KNOW I'M SAFE AND NOT DO ANYTHING ABOUT THAT.

WE HONOR THAT.

I JUST ASK THAT THEY COME IN WHETHER IT'S US OR ANOTHER PROVIDER AND GET THEIR BLADDER EMPTY AND CHECKED ONCE A YEAR OR IF THEY START THEY'RE NOT EMPTYING, COME BACK AND TALK TO US.

>> IF YOU DO A REPAIR, DO YOU TAKE THE UTERUS OUT OR SUSPEND IT BACK UP WHERE IT BELONGS.

>> TWO DIFFERENT SCHOOLS OF THOUGHTS.

IF YOU HAVE RISK FACTORS FOR ABNORMALITY OF THE UTERUS OR ABNORMAL PAP SMEARS IN THE PAST, WE WOULD DO A HYSTERECTOMY.

THE UTERUS IS AN INNOCENT BYSTANDER IS HOW I LIKE TO DESCRIBE IT.

THERE ARE SOME PLACES AND OCCASIONALLY WE HAVE PATIENTS WHO ARE PARTIAL AND DON'T WANT TO HAVE THEIR UTERUS TAKEN OUT.

AND WE CAN DO SOMETHING CALLED A HIFT ROW PEXI, AN OLD TERM THAT UNFORTUNATELY RESULTS FROM PEOPLE SAYING THAT WHEN THEY HAD MENSTRUAL CYCLES, IT WAS HIS TERRIA.

HYSTERIA.

I'M NOT GOING THERE.

THAT'S HOW THE ORIGIN OF THE WORD IS.

AND SO-- >> YOU GOT ME SHOOK UP ON THAT.

WHEN WE TALK ABOUT HIFT RECOLLECTED MI, YOU DON'T HAVE TO TAKE IT OUT BUT IF YOU LEAVE THE UTERUS BEHIND, A LOT OF TIMES IF IT'S THE TOP PART, YOU CAN'T GET AS GOOD OF A REPAIR ON THE FRONT WALL OF THE VAGINA.

WE DON'T HAVE DATA REALLY NATIONALLY THAT IS THREE MORE FOUR YEARS.

AND WE DON'T KNOW IF YOU REQUIRE HYSTERECTOMY IN THE FUTURE WHAT THE RISK WOULD BE FROM A STANDARD HYSTERECTOMY.

>> VAGINAL PROLAPSE.

WHAT DOES THIS HAPPEN?

>> IT CAN HAPPEN-- ACTUALLY AT ANY POINT OF SOMEONE'S LIFE.

MOST OF THE TIME, I THINK I WOULD SAY NORMALLY IT'S AFTER CHILD BEARING YEARS, MOST COMMONLY IT'S WOMEN WHO ARE KIND OF IN THE PERRY MENOPAUSAL OR MENOPAUSE RANGE.

THE TISSUE GETS WEAKER AS THE ESTROGEN GOES DOWN.

SO YOU CAN HAVE PROLAPSE ALL THE WAY UP TO, YOU KNOW, END OF LIFE AS WELL.

AND SO, YOU KNOW, THAT'S WHY WE HAVE DIFFERENT TREATMENT OPTIONS.

YOU HAVE, YOU KNOW, LIKE WE STALKED ABOUT THE CONSERVATIVE OPTIONS, WE HAVE SURGICAL OPTIONS THAT RECONSTRUCT THE VAGINA, THE WHOLE PELVIC RECONSTRUCTIVE SURGERY AND WE HAVE TREATMENT OPTIONS FOR WOMEN WHO DON'T DESIRE PENETRATIVE INTERCOURSE OR VAGINAL INTERCOURSE WHERE WE CAN CLOSE OFF THE VAGINA AND THAT'S ONE OF THE MOST SUCCESSFUL SURGERIES IN THE LONG RUN.

AND DOESN'T CHANGE ANYTHING EXTERNALLY.

SO IF THEY WERE TO GO TO ANOTHER DOCTOR THAT DIDN'T HAVE AN INTERNAL VAGINAL EXAM, NO ONE WOULD KNOW.

IT'S JUST, THERE ARE SO MANY DIFFERENT OPTIONS AND THAT'S WHY I THINK IT'S A GREAT FIELD AND I LOVE BEING IN IT.

>> TEND TO OCCUR MORE COMMONLY FOLLOWING SOMEONE WHO HAS HAD THEIR UTERUS REMOVED, HIFT RECOLLECT HYSTERECTOMY.

>> CHILD BEARING AND HYSTERECTOMIES ARE ALL RISK FACTORS.

BUT HAVE I PATIENTS WHO COME IN WHO HAVE COMPLETE STAGE 4 PROLAPSE WHO STILL HAVE THEIR UTERUS.

>> OKAY.

I WAS JUST THINKING AGAIN, USING YOUR SOCK ANALOGY, THIS IS THE ONLY WAY EVERYTHING WOULD HAVE TO BE WEAK UP TOP AS IT TURNS ITSELF OUT.

CY STOCIL IS THAT DIFFERENT FROM A BLADDER PROLAPSE.

>> THAT'S JUST THE MEDICAL TERM FOR THE BLADDER COMING DOWN INTO THE BLADDER AND RECOLLECT OWE SEAL WOULD BE THE RECTUM COMING DOWN.

>> WHAT DO YOU DO FOR EITHER ONE OF THOSE.

>> THAT'S WHEN WE TALK ABOUT IF YOU HAVE A PATIENT WHO DOESN'T DESIRE SURGERY OR DESIRES FUTURE CHILD BEARING WE DON'T HAVE A LOT OF GREAT INFORMATION ABOUT IF YOU DO THESE SURGERIES AND THEN HAVE MORE BABIES, SO WE ENCOURAGE CONSERVATIVE MANAGEMENT WITH THE THINGS UNTIL THEN.

IF YOU DESIRE DEFINITIVE MANAGEMENT, THERE ARE LOTH OF SURGICAL OPTIONS.

WE CAN DO THE RECONSTRUCTIVE SURGERY IF IT IS JUST THE FRONT WALL OF THE VAGINA WHICH IS NOT COMMON BY ITSELF WHICH IS WHY YOU WANT TO ABOUT TO SOMEONE WHO CAN DO SURGERY IN ALL THE COMPARTMENTS OF THE VAGINA.

IF YOU JUST THE FRONT WALL, IT IS AN AN TEAR YAR VAGINAL REPAIR -- ANTERIOR VAGINAL REPAIR.

BUT A LOT OF TIMES THERE ARE STUDIES THAT LOOK AT HOW THE ANTERIOR VAGINA HAS PROLAPSE WHEN THE APEX IS INVOLVED SO A LOT OF TIMES WE DO SURGERIES FOR BOTH COMPARTMENTS AT THE SAME TIME.

SOMETIMES WE HAVE PATIENTS WHO HAVE A LITTLE POCKET OR BULGE TOWARD THE OPENING OF THE VAGINA ON THE BACK SIDE AND THAT'S MORE COMMON IN MY PRACTICE.

I MIGHT DO A RECTUS SEAL REPAIR.

AND SO THAT ONE IS WHEN YOU JUST DO THE BACK WALL OF THE VAGINA.

THERE ARE SURGERIES THAT WE WORK IN ALL THREE COMPARTMENTS.

>> WHAT ARE THE COMPLAINTS THAT A PATIENT COMES IN, AND IS IT USUALLY THE PATIENT, ANOTHER PHYSICIAN MAKING THE REFERRAL OR THE PARTNER OF THE PATIENT?

>> SO TYPICALLY, WHEN WE SEE PATIENTS FOR THIS, THE ONLY THING THAT IS A CONSISTENT COMPLAINT IS THAT THEY HAVE A BULGE, RIGHT AND THAT CAN BE A BULGE THAT THEY SEE OR A BULGE THAT THEY FEEL OR A BULGE THAT THEY SENSE.

AND MOST OF THE TIME THAT SENSATION ACTUALLY OCCURS WHEN IT GETS TOWARD THE OPENING BECAUSE IT'S DIFFERENT HIGHER UP.

WHEN SOMEONE IS MENSTRUATING, RIGHT, IT'S EASIER WAY TO EXPLAIN IT IF SOMEONE IS MENSTRUATING AND USING A TAMPON, RIGHT?

WHEN THE TAMPON IS INSIDE, THEY MIGHT SENSE THAT IT'S THERE BUT DOES NOT HURT, NOT UNCOMFORTABLE, NOT A PRESSURE SENSATION BUT IF IT CLIPS SLIPS AND GO ET CETERA TO THE OPENING WHERE THE OTHER TYPES OF NERVES ARE THERE, THAT'S WHEN IT IS BOTHERSOME FOR PATIENTS.

PATIENTS WILL COME IN AND SAY I HAVE TROUBLE EMPTYING MY BLADDER.

I FEEL LIKE IT'S STILL FULL AND I CAN'T EMPTY IT OR IF YOU HAVE THE BACK WALL ISSUES OF THE VAGINA, I FEEL LIKE I HAVE TO ACTUALLY PRESS AND HOLD TO STRAIGHTEN EVERYTHING OUT TO DEFECATE.

AND SO THOSE ARE THE MORE COMMON THINGS.

OCCASIONALLY SOMETIMES THEY WILL SAY, I CAME IN BECAUSE I CAN'T HOLD A TAMPON IN ANYMORE.

I USE A TAMPON AND IT FALLS OUT OR DURING INTIMACY, SOMETHING IS DIFFERENT, AND THAT MIGHT BE WHERE THEIR PARTNER HAS NOTICED SOMETHING.

OCCASIONALLY WE WILL HAVE PATIENTS WHO COME IN WHO HAD A PELVIC EXAM FOR AN ANNUAL AND SAY THEY TOLD ME WE I HAVE TO SEE YOU.

IS IT BOTHERING YOU?

HOW IS IT AFFECTING YOUR QUALITY OF LIFE?

AND SOMETIMES IT'S NOT AFFECTING THEM THEN BUT THEN IF IT DROPS DOWN A LITTLE FURTHERED TO THE NEW SENSATION POINT, THEY COME BACK IN AND SAY I'M READY FOR THE SURGERY NOW.

>> WHAT ARE SOME OF THE DIAGNOSTIC STUDIES THAT A PERSON CAN EXPECT TO HAVE DONE ON THEM?

>> SO NUMBER ONE IS THE PELVIC EXAMINATION.

SO YOU KNOW, IT SAYS YOU HAVE PROLAPSE ON A CT OR THIS STUDY.

WE DON'T NECESSARILY TREAT JUST BECAUSE OF THAT.

BECAUSE IF WE DO AN EXAM AND WE CAN'T SEE WHERE IT'S AT, YOU DON'T KNOW NECESSARILY WHERE TO GO AND OPERATE DURING SURGERY.

AND SO WE DO THAT.

IF SOMEONE HAS, YOU KNOW, ADVANCED PROLAPSE MEANING PROLAPSE COMING OUT OF THE VAGINAL OPENING WHICH WE CALL STAGE 3 OR STAGE 4, THEN WE AA LOT OF TIMES, IF WE ARE TALKING DOING SURGERY WORKS WE DO ADDITIONAL STUDIES BECAUSE IF IF A PATIENT IS GOING TO UNDERGO THE RISK OF ANESTHESIA AND SURGERY, WE WANT TO MAKE SURE WE ARE DOING EVERYTHING WE CAN TO HELP THEM AT THAT TIME.

>> BECAUSE MULTIPLE THINGS COULD BE GOING ON.

>> RIGHT.

BECAUSE SOMETIMES, YOU KNOW,I THINK OF IT LIKE UNKINKING THE HOSE.

THIS IS THE BLADDER AND THIS IS THE URETHRA, IF IT FALLS OUT AND IT'S LIKE THIS, YOU KINKED OFF THE HOSE LIKE A KID PLAYING IN THE GARDEN.

ONCE IT GOES BACK UP AND YOU PUT EVERYTHING BACK IN ITS SPOT, SOMETIMES THEY MAY NOTICE THAT THEY HAVE LEAKING WITH COUGHING, SNEEZING AND LAUGHING AND THEN IF A PATIENT IS IMPROVING THEIR QUALITY OF LIFE FOR THE BULGE, WE DON'T WANT THEM-- THEY'RE NOT AS HAPPY WHEN THEY COME BACK AND THEY'RE LIKE I'M LEAKING NOW.

>> OKAY.

SO BRIEFLY, THE LAST 30 SECONDS OR SO WE HAVE, IN THIS AGE OF SUPER SPECIALIZATION, WHY DO I SEND A PATIENT TO YOU OPPOSED TO MY STANDARD GYNECOLOGIST OR UROLOGIST?

>> WELL, WE ARE UNIQUELY SITUATED IN THAT WE HAVE BEEN TRAINED IN EVERYTHING.

I HAD FOUR YEARS OF OB/GYN AND THREE YEARS OF JUST PELVIC FLOOR STUFF AND URO GYNECOLOGY.

IF YOU WANT TO MAKE SURE YOU ARE GETTING THE BEST OUTCOMES POSSIBLE AND GETTING SURGERY FROM SOMEONE WHO DOES THIS DAY IN AND DAY OUT.

AND SO THERE ARE OTHER INDIVIDUALS WHO ARE TRAINED AND DO THESE KINDS OF SURGERIES BUT YOU WANT TO MAKE SURE THAT WHOEVER YOU ARE GETTING SURGERY FROM CAN ADDRESS ALL THE COMPARTMENTS.

>> I HAVE TO TELL YOU, AS A SURGEON WHO OPERATED ON THE POSSIBLE TEAR-- POSTERIOR OR BACK END OF THIS, I LOOK FORWARD TO WORKING WITH URO GYNECOLOGISTS BECAUSE IT IS A VERY COMPLEX AREA AND GOOD TO HAVE SOMEONE VERSED IN EVERYTHING.

THANK YOU VERY MUCH FOR BEING WITH US.

>> THANK YOU FOR LETTING ME COME ON THE SHOW.

>> AND THANK YOU FOR BEING WITH US TODAY.

I HOPE THAT YOU HAVE A BETTER UNDERSTANDING OF PELVIC FLOURISHES AND AT VEILABLE TREATMENT OPTIONS AND THE INDICATES TO USE THEM F. YOU WISH TO WATCH THIS SHOW AGAIN OR WATCH AN ARCHIVES VERSION OF PAST SHOWS, PLEASE GO TO WWW.ket.org/HEALTH.

IF YOU HAVE A QUESTION OR A COMMENT ABOUT THIS OR OTHER SHOWS, WE CAN BE REACHED AT KYHEALTH@ket.org.

I LOOK FORWARD TO SEEING YOU ON THE NEXT KENTUCKY HEALTH AND IF YOU HAVE A QUESTION ARE ABOUT PROLAPSE OR YOU ARE NOT CERTAIN WHAT IS GOING ON DOWN THERE, SEE YOUR PHYSICIAN OR GET IN CONTACT WITH SOMEBODY LIKE Dr. LENGER.

THEY WILL BE MORE THAN HAPPY TO EXPLAIN AND MAKE SURE YOU GET TAKEN CARE OF.

I LOOK FORWARD TO SEEING YOU AGAIN FOR THE NEXT KENTUCKY HEALTH.

>> KENTUCKY HEALTH IS FUNDED IN PART BY A GRANT FROM THE FOUNDATIONS FOR A HEALTHY KENTUCKY.