Treating Pelvic Floor Disorders

Photograph courtesy St. Elizabeth

Meet Caroline Elmer-Lyon, M.D., a urogynecologist who specializes in helping women with pelvic floor disorders like urinary incontinence, prolapse, and pelvic pain. She sees patients at St. Elizabeth Healthcare in Edgewood and Greendale, Indiana.

What is urogynecology, and how can it help women with pelvic floor disorders?

Urogynecology is a subspecialty of obstetrics and gynecology (OB-GYN) or urology that focuses on pelvic floor disorders. Most specialists in this field have an OB-GYN background. This means they have experience handling childbirth-related trauma and pelvic surgeries.

After completing their OB-GYN residency, urogynecologists complete an additional three-year fellowship focusing on pelvic floor disorders. The fellowship allows us to become highly specialized in this niche. We treat conditions such as vaginal prolapse, urinary incontinence, bladder pain syndrome, and bowel issues like fecal incontinence. We manage these conditions, always tailoring our approach to meet the specific needs of the patient.

We take a close look at the pelvic floor to figure out what’s going on—whether it’s prolapse, muscle spasms, or something else. These details matter because there isn’t just one surgery or treatment that works for all prolapse or pelvic floor disorders.

Photograph courtesy St. Elizabeth

How does childbirth affect pelvic floor health?

Pregnancy and childbirth can have lasting impacts on the pelvic floor. The weight of carrying a baby and the strain of delivery—especially vaginal deliveries—can stretch or tear the muscles and connective tissues that support the bladder, uterus, and bowel.

Many women don’t realize that childbirth can be the starting point for pelvic floor disorders. Even minor trauma during delivery can have long-term effects, such as incontinence or prolapse. For some women, these issues appear immediately after childbirth. Others may notice them years later, as muscles and tissues naturally weaken with age.

What is pelvic pain and when is it necessary to seek care?

The bladder, bowel, or pelvic floor muscles can cause pelvic pain. It’s a complex condition, but the pain is treatable. Muscle spasms can cause pain, and doing Kegels in these cases can make it worse. Instead, we focus on pelvic relaxation exercises or refer patients to pelvic physical therapy.

Diet can also affect pelvic pain. Certain foods like caffeine, spicy foods, or artificial sweeteners can make symptoms worse. If you’ve tried lifestyle changes and the pain continues, don’t ignore it. Pelvic pain is real and we’re here to help you find and treat the cause.

What can women expect during their first appointment with a urogynecologist?

During the first visit, you can expect a detailed conversation about your symptoms, a pelvic exam, and possibly some diagnostic tests. We may ask you to keep a bladder or bowel diary beforehand. This helps us identify patterns, such as when leakage happens or how much fluid you drink during the day.

Come prepared for a pelvic exam. The exam is important because that’s how we check if structural issues are causing your symptoms. We use these exams to carefully evaluate the pelvic floor and identify potential problems that contribute to symptoms. We may also collect a urine sample to check for underlying issues, like infection or blood in the urine.

If you’ve had past surgeries, try to bring the operative reports with you. Knowing about those surgeries can help us decide on the best treatment plan. Finding those records can be challenging, so having them ready is very helpful.

What are the most common pelvic floor conditions that might require treatment?

Some of the most common conditions we treat include:

• Stress urinary incontinence – Leaking urine when coughing, laughing, or sneezing.
• Overactive bladder – Feeling a sudden, intense need to urinate and not making it to the toilet in time.
• Pelvic organ prolapse – A bulge or pressure in the vagina that feels like a golf ball or egg sticking out.
• Bowel incontinence – Sudden urges to pass stool that make it difficult to reach the bathroom in time.

Since each condition is different, getting the right diagnosis is important to finding the best treatment. For example, surgery for stress incontinence won’t help someone with an overactive bladder, so the correct diagnosis is key.

How do you decide between pelvic surgery and non-surgical treatments?

The choice between medical therapies and surgery depends on how much the condition affects your daily life and personal goals. Some women want to manage symptoms with pelvic floor exercises or physical therapy, and that’s perfectly fine. Others may have more severe symptoms—like being unable to leave the house without fear of an accident—and they’re ready to explore surgical options.

We also have many non-surgical treatment options, like medicine or vaginal inserts, which work well for some conditions. We tailor treatment plans based on the patient’s preferences and how aggressive they want to be. Ultimately, we make the decision together.

What minimally invasive techniques do you use in pelvic surgery, and how do they help recovery?

Most urogynecologists use several minimally invasive techniques. These can include vaginal, robotic, and laparoscopic surgeries. Vaginal surgery is the least invasive since it avoids abdominal incisions and lets us treat the problem directly. We often use robotic surgery when we need to add mesh for additional support. Mesh can make repairs more durable, but it’s not always necessary. Both approaches reduce recovery times and risks compared to traditional open surgeries.

What does recovery look like after pelvic surgery?

Recovery after surgery usually involves light activity for about six weeks. This doesn’t mean you have to stay in bed. You can walk, use light weights, or go up and down stairs slowly. The key is to avoid heavy lifting.

Proper nutrition, especially getting enough protein, is vital for healing. For older women who may have lost lean body mass, I recommend protein shakes like Ensure or Boost to help with recovery. Once you’ve recovered from surgery, pelvic physical therapy can improve outcomes.

How does pelvic floor treatment improve quality of life?

Treating pelvic floor disorders can be life-changing. Many women tell me they feel like they can finally enjoy life again. Whether that’s going out with friends, playing with their kids or grandkids, or feeling confident.

These conditions don’t just affect physical health; they can impact mental health, too. Many women with urinary or bowel incontinence experience anxiety or depression because they’re afraid to leave the house. Addressing these issues can help restore confidence and improve overall well-being.

Ready to take control of your pelvic health? Schedule an appointment today by calling (859) 757-2132. Learn more about the specialized urogynecology care we offer at St. Elizabeth Healthcare.