Dr Chin Yong and Caroline Chaplin meet to discuss the issues surrounding a women’s pelvic floor after pregnancy, and dive into what often happens after pregnancy to the pelvic floor, the common complications, the treatment options available and the role GPs play in treatment.
A link to the URCHOICE calculator can be found here.
‘Conversations’ is a new format from PodMD, focused on more relaxed and informal discussions surrounding important issues that specialists and GPs see in the community.
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Caroline: Alright, well welcome to the PodMD studio Chin, how’s your morning?
Chin: Oh so far so good. Thank you for having me Caroline.
Caroline: Yeah, we’re very, very grateful to have you here today. And today, our focus, as we’ve talked about in preparing the podcast, is really about the effects of pregnancy and childbirth on pelvic floor. And I guess our goal is to really inform the GP’s regarding pelvic floor issues, so there’s no better place to start Chin than what are the issues and how common are these?
Chin: It’s interesting because this is a fairly common problem and I see this, I see the women with pelvic floor issues on daily basis and then mainly related to a few issues, bladder can be in the form of leakage, bowel leakage. Prolapse, which is a herniation of the pelvic organ or rarely sexual dysfunction. And it is a common problem that people don’t talk about. My general advice is to speak to the reliable healthcare providers that you trust and they normally will be able to guide you an more way to go, from there.
Caroline: I think you’re right. I think it’s an issue that women don’t talk about too much. I know a few of my friends will whisper to each other about this and that, but it is something that is a little bit still taboo, so it’s great we’re doing this podcast. What are the other issues?
Chin: So, so so mainly the the urinary incontinence as I mentioned before they are affecting up to 40% of the women even up to 12 years after the initial childbirth and prolapse affecting up to 50% of the women, faecal incontinence, about 10 to 20% at some stage of their life and they can significantly impact the quality of life. They’re not life-threatening conditions.
I think the key thing here is what to do and what we can do to identify this group of women and how we can deal with the problems. We’re focusing so much on treatment or what I’m trying to educate most of our colleague is about the prevention, how we can make things better for women in general. And prevention is better than cure of course.
Caroline: Ohh, absolutely preventative techniques and actions are definitely what GP’s are going to want to know. So what are the preventions that that you know of what can we do?
Chin: Yeah so when we talk about prevention, we first need to identify the risk factors. So there are modifiable and non-modifiable risk factors. So in the community, the GP can focus on the lifestyle modifications, maintaining the patients weight in the healthy range, normal BMI. Just healthy lifestyle, healthy diet, preventing constipation. Managing or limiting the caffeine intake to minimise the risk of bladder leakage. Yeah, those things in general and certainly if they are doing a lot of you know high impact activities or for occupational reason then those are the things that we cannot modify. Yeah. So definitely.
Caroline: f you were talking about caffeine, is there a guideline for the GPs, couple of cups a day or?
Chin: There’s no fast or hard rule about caffeine intake to be honest. It’s pretty much depending on how much the patient is willing to give in and to trade off the symptoms now.
Caroline: No one wants to say goodbye to their coffee!
Chin: No, no, especially we’re in Melbourne.
Caroline: Yeah, absolutely, absolutely. What about diet as well? I’m interested is diet just as it’s related to being potentially being obese or is it actually nutrient choices?
Chin: It’s probably the combination of both. You want to have and healthy diet so you’re maintaining a healthy weight and also more importantly to prevent constipation. So the bladder, bowel and the pelvic organs are all interrelated. So if one has a problem then you’re more likely to cause a problem.
Caroline: Yeah, not under pressure. Mm-hmm. OK. Any other lifestyle choices that we can we can change or improve?
Chin: Smoking, smoking on its own is a risk factor. For a lot of health issues and it can affect the tissue quality in general. Chronic cough that actually increases the pressure of the on the pelvic floor. So those are the simple stuff we can do. And in in terms of the stuff that we cannot change, obviously the genetic familial problems, so those are the things that we were unable to change. Then we just have to identify that as the problem and manage it as accordingly.
Caroline: Yeah, it’s moving forward. I can see though, the role of the GP, they play a big role in this because somebody thinking about starting a family, there’s lots of things that GP can advise on.
Chin: Yes, yes, yes, GP normally is the first point of contact for patients. I think once the GP identified those risk factors and then we try to work accordingly. And certainly if the GP identified any existing pelvic floor issues like some of them have, childhood bladder leakage, bladder issues, then they can be referred on to be managed before they started the family and more of providing information how the cause of the symptoms would change as opposed to stopping the problem completely and more information for patient as well, like whether this is going to get worse during pregnancy or remain the same that sort or thing.
Caroline: Oh absolutely. So in relation to the GP. They’ve tried the lifestyle factors, someone’s had a baby and now they’ve got some of these issues occurring. Where to from here?
Chin: So I think involving their obstetricians for when they’re pregnant is essentially is very crucial and make sure that they can optimise the or minimising the risk factors during pregnancies, maintaining their healthy weight gain during pregnancy and making sure that the baby is growing healthily and not being overly large or overweight and the same principle because that will have an added pressure on the pelvic floor speaking to a pelvic floor expert or urogynaecologist during pregnancy just to get that advice and how we can prevent things from getting worse. And more importantly, what can be done if they have issues after childbirth, or if they completed their family?
Caroline: OK, so if someone’s coming in and they’ve got certain symptoms for a GP. Let’s say I’m imagining a lot of people would come in and they’ve got minor bladder leakage occasionally, maybe after coughing or sneezing compared to sort of more serious or intense symptoms, how can the GP direct traffic in relation to that?
Chin: Yes, yes, I would advise the GP to work with their local pelvic floor physiotherapists and most of the GP will have their friendly physio in their neighbourhood that they can rely on. That will be the first point of contact and most of the time the symptoms will settle with Physio. Even it doesn’t completely resolve the problem. You will at least control the symptom to some extent, because when the patient is pregnant, we would expect things will get worse and more importantly is to help the patient to cope with the symptoms during the pregnancy and what can be done after.
Caroline: Absolutely. And lack of sleep and everything else on top that we all experienced before.
We have heard a little bit about an acronym, URCHOICE. Would you tell us a little bit about that
Chin: Yes, yes, this is a a calculator just like any other screening tools. This is a screening calculator to predict the risk of pelvic floor disorders following the childbirth and this tool was actually developed by the UK, New Zealand and the Swedish Group, and they have this risk calculator stratifying the risk of pelvic floor disorders, 12 years and 20 years after childbirth, and they just, so URCHOICE is an acronym is an acronym with all the Risk factors, and obviously in a nutshell, if you have, if you are older, having more childbirth and having pre-existing problem, that risk will increases further.
And this is more of a tool to counsel our patient in terms of their risk and to guide them on the, the pregnancy and the subsequent mode of delivery and the size of family depending on their desires. It is not 100% preventative tool, it is more of providing information and counselling and that will help our patient to make decision on the on the public floor issues and the size of family they wish to have.
Caroline: I think it’s a terrific tool for GP’s where patients can go home to and and think through whether it’s pre pregnancy or or during or whatever and make some better choices.
Chin: Yes, yes. And and I think a lot of GP is still not aware of the the availability of this tool. We don’t expect the GP to run the whole console and counselling on the prevention, but it’s more important making patients aware that there are options they can explore and then the patient can bring this to their obstetrician attention or some experts they that that they can truly rely on to help with them.
Caroline: Absolutely. Well, I’ll put the link to the calculator on the notes for this podcast. A question I had is how long if surgery is inevitable and surgery is required, how long after a baby’s born can surgery be looked at?
Chin: That’s $1,000,000 questions Caroline, there’s no fast or hard rule. As we all know, we love the word the bespoke. We love bespoke service. So again, this goes back to the patient, what works for them socially and whether they’re psychologically prepared to move on to the next step and we have to see whether they have explored any form of treatment. The most important the basic principle is that we never offer surgical management for patients who hasn’t completed family. Just partly because if we do a surgery, there’s a potential chance that they can undo the surgery with a subsequent pregnancy.
So the focus is conservative management if they have not completed the family or if they are still fully breastfeeding the baby because the tissue quality can change again once they stop breastfeeding. So general management would be pelvic floor, physio, rehab and the use of vaginal pessaries for pelvic organ prolapse and lifestyle modifications. Surgery is only considered once the family is completed or when the patient is ready to move on to the next step.
Caroline: Absolutely. OK. Well, I think that we’ve really covered a lot in relation to pelvic floor issues and particularly today we’re focused on the effect of pelvic floor issues after childbirth. I think there’s so many more topics we could cover here. You’d be more than welcome to come back and record another one with us Chin because I know pelvic floors are huge area.
Chin: Yes, definitely this is a is an ongoing debate and research surrounding this field, and certainly we want to do something more for the women’s because it’s such a common problem and more than happy to provide more education and information for the future.
Caroline: Absolutely. So to finish up for today, our listeners are always keen to get their CPD points and what they have to do there is they have to say the three take home messages and submit that to the college. So just in summary today, if you could sum up for us three main messages.
Chin: OK, so three main messages are prevention is better than cure. But some of those problems are inevitable that we cannot control. So as the GP in the community ,do your best with hat you can do to help your patient and guide them to the proper health expert to give them the more accurate advice and management and also know your local friendly pelvic floor physiotherapists because they can make a huge difference, particularly in the younger group of women or when they’re pregnant and that will change their pelvic floor symptoms to some extent at least.
Caroline: Excellent. Well, thanks once again for coming in today.
Chin: You’re welcome.