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Scott Webb (Host): Chronic pelvic health issues can be painful and frustrating for women. And joining me today in this panel discussion to explain the various pelvic health issues and discuss treatment options, including physical therapy are Dr. Megan Cesta, she's an OB GYN specializing in improving pelvic health and treating pelvic disorders and Physical Therapist Amy Senn. Both of whom are with Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So thanks for being on today. And we're talking about common pelvic health issues for women they may experience. And Dr. Cesta, what are some of the most common pelvic health issues for women?

What are some of the most common pelvic health issues for women?

Dr. Cesta: Most common pelvic health issues that women we see often have in their lives. They have endometriosis which can cause painful periods, pelvic pain. It can have implications such as subfertility. They can have fibroid uterus, which is when these kinds of benign smooth muscle tumors can grow in the uterus and cause abnormal bleeding, can cause pelvic pain. As well as patients can have chronic pelvic pain from a myriad of causes, meaning muscles and nerves and things that kind of acquire as they age. And then many of them can also have additional things like pelvic organ prolapse or incontinence, and that can also kind of complicate their health.

Host: Definitely. And I want to go through some of these individually, so we'll just take these one by one and we can go through and maybe talk about causes, symptoms, risk factors, that kind of thing. So let's start with CPPS or chronic pelvic pain syndrome. What are some of the causes symptoms and risk factors for women?

What is chronic pelvic pain syndrome (CPPS)?

Dr. Cesta: And that's a very tricky question to answer because chronic pelvic pain is very challenging. It's very complex. Every single patient has a different pain experience and it can have many causes and it can also be multifactorial. So we first try to narrow it down to the organ system. So things that can cause chronic pelvic pain are not necessarily only gynecologic organs, meaning the uterus, the fallopian tubes, the ovaries, the cervix, they can also come from the bow or the gastrointestinal system or the urinary system, the kidneys, the ureters, the bladder. We often know that chronic pelvic pain is not solely attributable to a mental health disorder like anxiety, depression, bipolar. However, those can contribute significantly to the cycle that feeds into chronic pelvic pain. So at Summa, we try to treat all of those different factors. Many times it has a musculoskeletal in origin, just like we would get shoulder pain or leg pain, the pelvic floor, or the muscles that hold our bodies up. And those muscles can become painful as well as the nerves that feed into that area.

Host: Yeah. We're going to talk later and speak specifically with Amy about some of the pelvic floor disorders and how they're treated, but it really interesting to know that there's such a myriad of variety of causes and symptoms, and thankfully women have experts like you to try to help diagnose this and treat this properly. And when we talk about endometriosis, do we know what actually causes it? Cause I don't think we do. And also I'd like to ask you, why is it so painful for women? What are some of the long-term complications?

What is endometriosis?

Dr. Cesta: So, endometriosis is a disease that we're learning more and more about every single day, the basic kind of physiology of endometriosis is the glands that grow inside the uterus, implant elsewhere in the pelvis. So they implant on this surface called the peritoneum, which is a glistening layer that covers all of our internal organs. They can actually grow into things like the bowel or the bladder. You can get big cysts on the ovaries, which contain these glands called endometrioses. And they can actually grow in areas that can cause things like painful intercourse and they can grow in areas like between the vagina and the rectum. So these glands somehow get there. And there are a couple of different theories, whether or not when you have your period, if they reflux through the fallopian tubes, there's another theory where maybe these cells are already in your body and they're predetermined to become what they become. It causes pain and the number of ways, these glands implant on the areas in the pelvis. And they actually cause inflammatory factors around them. And then those implants actually develop their own kind of chemical irritants and they grow their own innervation. And so it can cause that pain just by infecting inflammation and irritation. Additionally, when you get so much scarring, it can immobilize organs that are kind of normally mobile and you can get pain from that as well. And the long-term effects from those become the neurologic pain and the musculoskeletal pain that we often.

Host: Okay. So when we talk about fibroids, what are they exactly? Cause they're a little bit confusing I think. And what causes them and how would women know if they have fibroids?

What are fibroids?

Dr. Cesta: Fibroids oftentimes are discovered accidentally or incidentally during an exam. Some symptoms that fibroids can have can cause heavy bleeding or patients may come in with a pelvic fullness or feeling like you either have a soft ball sitting in your pelvis or a basketball, even in your belly. They're what we call benign muscle tumors. So the uterus is a muscle that eventually is evolutionary made to squeeze out a baby and those muscle cells can kind of go awry and they can replicate and duplicate. And this one muscle cell will duplicate so much that it builds into a ball of muscle of hard tissue. And those are what we called fibroids they're by and large benign, very, very rarely may they be a cancerous or something like a sarcoma and they can cause all of those different symptoms because they're just kind of these heavy masses that can sit in the pelvis and they can be located on the inside or the outside of the uterus. And that kind of differentiates whether they cause heavy bleeding or a significant amount of pelvic pain. Sometimes if they're in the correct or incorrect, depending on how you look at it location, they can even affect a woman's fertility.

Host: Yeah, definitely. And is that how women would know whether or not to seek advice or counsel or see a specialist? Is it the discomfort? Is it the pain? Those things aren't normal, right? So if women are experiencing that, you know, as you say, basketball or softball effect or actual pain is that when it's time to see a specialist?

When should you see a specialist?

Dr. Cesta: Any of those symptoms can be, you know, kind of alerting symptoms or alarming symptoms, and that will require consultation with your obstetrics and gynecologist’s specialist or provider. You can also discuss those things. If you have the opportunity at your annual exam, if you've been experiencing new symptoms. So if there's any change in your menstrual cycle, if your bleeding is heavier, if it's less, if it goes away completely, if you're having more pain than normal, that will be another kind of, you know, alerting symptom to discuss with your provider. So any of those things can kind of allude to that there may be fibroids or any other kind of pelvic process going on that your OB GYN should be able to help you out with or investigate what the cause is.

Host: Yeah, for sure. And just as a side note here during COVID-19, have you found that you're seeing less patients, are women more sort of suffering in silence perhaps afraid, you know, to go into the office or see a specialist? Is that been an issue for you?

COVID-19's effect on women's health

Dr. Cesta: I think certainly at the beginning of COVID-19 we slim down our office processes. I think kind of nationally the trend was to really only see emergent visits or complaints because as the virus kind of played out epidemiologically, we needed to know if it was safe to have patients in the office. And so there was probably a portion of time where patients weren't seeking care immediately because a lot of our visits were virtual visits and it's oftentimes very limiting to have a virtual visit because the exam and obstetrics and gynecology is really a key factor in diagnosis and treatment. And so we were real limited on our exams and our imaging, but hopefully I do think that we are on the upswing and we're safely practicing seeing patients in the office now. So I would encourage patients to call their providers, see what their local providers are having kind of as their method in the office of seeing patients or whatever their current practice is and see if they can get in and speak about these issues because COVID affects us mentally. And if it starts to affect us physically, then that's a double whammy. So we certainly need to be addressing all of that for the patient.

Host: Yeah, absolutely. And good to know that you've been doing telehealth, but as you say, you know, these types of exams and imaging are things that unfortunately really have to be done in person. So I'm sure it's a combination of things, but specifically these types of exams, you know, we want people to, especially if there are emergent or alerting conditions, we want them to, you know, to see the doctor to go in. So Amy, I don't want to forget about you. I know you're still there. I want to talk to you about this. Let's talk about pelvic floor disorders. What are they exactly? What are the range of disorders that can exist for women? And are they only related to pregnancy?

What are pelvic floor disorders? Are they only related to pregnancy?

Amy Senn: They are not only related to pregnancy. Currently, they are talking about the fact that one in three women has some type of pelvic floor disorder. That disorder can include anything from, as Dr. Cesta mentioned a bladder concern, a pain concern, a postpartum concern, a pregnancy concern, or even bowel concerns. And you had mentioned earlier about the slim down during COVID, but I do find that a lot of times women are just afraid to mention some of these issues to their doctors. And so it's important to be vocal about that. We are experts on our own bodies and if something doesn't feel right, it's really important to bring it up to your doctor. It is not a normal part of aging or normal postpartum to have issues with pain or to have issues with bladder leakage. And so those are definitely issues to be addressed. Physical therapy can step in then because we don't want to forget that the pelvic floor really is just a bowl of muscles. It's the same type of muscles that make up your arms, make up your legs. It's just another grouping of muscles, and equally important to the body because those muscles provide a lot of support to the bottom of our core. They have bladder function, bowel function, and sexual function. And so similar to how you can have an issue with a shoulder or a knee, you can absolutely have an issue effecting the muscles within your pelvic.

Host: Yeah, definitely. And we want women to advocate for themselves, as you say, they are experts in their own bodies and they know when something's not right. And we just want them to do something about that. And I know that you all work as a team, the doctors and the physical therapists, you all work as a team, which is a great approach for patients. So when we talk about ways to manage or relieve pelvic issues, maybe you can take listeners through that process of what are the options and how do they ultimately end up, you know, with physical therapy?

What are the treatment options for pelvic floor disorder?

Amy Senn: So, they can be referred by their doctors. We do need a physician order to come to therapy that can come from their OB GYN, or that can come from a specialist like Dr. Cesta. And then once they come into therapy what we want them to know, it is a very comfortable experience for them. Many times, nobody has heard of pelvic floor physical therapy. So we get a lot of patients that are very skeptical to come, or unfortunately are afraid to come see, but you are seen in a private room in a one on one setting with the physical therapist. And every part of the examination is only done to patient comfort level. We take a very extensive history to learn what is bringing them into therapy. And we take a look at all the parts of the body. We want to take a screen of their low back hip position, look at hip strength, muscle function. And then when it's comfortable for them, we will do a pelvic examination. It's a little bit different than a gynecological examination because we are really more just looking at the muscle function within those pelvic floor muscles. Are there any areas specifically of soreness or tenderness, how their muscles are moving and coordinating. And again, that is often not even done at the first visit. It's just done to patient comfort level when they're ready for that part of the examination.

Host: And so, what is Summa Health doing specifically in the area of pelvic health that you'd like listeners to know?

What is Summa Health doing in the area of pelvic health?

Amy Senn: Well, we've expanded our practice. We now have three different locations with our pelvic floor, physical therapists. We're in Akron, we're in Hudson and we're in Wadsworth. We have, you know, reached out to the community to help other physicians know that we are available and here to help service the patients. And we're just helping to bring that education and awareness and knowledge to help empower women to take care of some of these issues before it becomes a longer standing more chronic problem.

Host: That's a great word empower. I love that. And that definitely, you know, as the goal here of this podcast today is to help women to understand, you know, that they have to advocate for themselves and really to help them empower themselves. Dr. Cesta, as we wrap up here today, I'd like to give you the last word about, you know, the common pelvic health issues for women and when women should see their doctors, whether they're primary or OB GYNs, just what's the final word on this?

A final word for women from Dr. Megan Cesta and Amy Senn

Dr. Cesta: The final word I think I would agree with Amy is we just want to empower and encourage women to be vocal about these issues with their providers, to be able to have an open discussion. And you're, you may be able to see your primary care physician. And if you know that discussion, isn't very fruitful. You may be able to see an OB GYN. And if that does discussion, isn't fruitful, please continue to seek out a provider that will take your concern. Seriously. We have many different options to treat chronic pelvic pain, endometriosis, fibroids, and these treatments range from the most conservative techniques ranging from mindfulness and meditation all the way up to the most invasive, most cutting edge surgical techniques in terms of, you know, taking out the pathology out of the abdomen, cutting out the endometriosis, cutting out the fibroids. So we have kind of a wide range of therapies that we can match to the patient, to their desires and to their lifestyle. So it's not one size fits all. And every patient, we treat them very individualized and come up with a plan of care that will best suit the patient and the patient's life. So I would just encourage them to speak up, find a provider, find someone that's knowledgeable in the arena, learn about your options and then figure out what's best for you.

Host: That's great advice and a great place to end. So awesome having you both on today. I think really helpful, insightful, just a great way for women, you know, to click play on this podcast and get as many answers as possible. And then as you say, we hope that it empowers them and we hope that they reach out. And if they're not happy along the way, keep pushing, keep empowering themselves, advocating for themselves and get the answers and treatment that they need. So thank you both for being on. I really appreciate it. And you both stay well. For more information, visit Summahealth.org/pelvic. And if you found this podcast helpful and informative, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Healthy Vitals, a podcast from Summa Health I'm Scott Webb, stay well. And we'll talk again next time.