Dr. Sandra Culbertson

Dr. Sandra Culbertson, urogynecologist with the University of Chicago’s Center for Pelvic Health., is a spokeswoman for the Pelvic Floor Disorder Alliance. (Handout)

A: This one is tough. It may be caused by damage to the anal sphincter muscles during childbirth. But you may not have problems until you're older.

Physical therapy may strengthen the muscles. If not, we can implant a sacral nerve stimulator. It works like a cardiac pacemaker, using electrical impulses.

Q: How has treatment of prolapsed organs changed?

A: If pelvic floor strengthening exercises don't work, some patients can use pessaries, which are diaphragm-like devices that help support the organs.

Many women need prolapse surgery, but it has also become much less invasive. It's laparoscopic, so you just have a small incision.

Q: What if the patient's symptom is chronic pelvic pain?

A: Pain is complicated because we have to determine what's causing it. That's the hard part. It can be from many sources like the bladder or bowel or involve other gynecological issues such as endometriosis.

We can use a combination of medications and physical therapy. If the pain originates from the pelvic floor muscles, we can relieve the pain by injecting Botox into the muscle.

Q: What makes a woman predisposed to having a PFD?

A: It can be genetic. In some families, organ prolapse, especially, is more likely to occur. I tell my patients to tell their daughters.

Having vaginal births makes you more likely to have a PFD than women who had C-sections or did not give birth, but you may not have symptoms until you're older. Like all muscles, the pelvic floor muscles weaken with age.

Chronic constipation can contribute to PFDs, too, because you are straining the pelvic floor. Constipation is a side effect for many common medications.

Also, lifestyle risk factors include obesity and smoking. Your occupation makes a difference too. Women who have jobs that require a lot of lifting, like nurses and factory workers, are more likely to have PFDs because they're putting strain on the pelvic floor.

Q: What about men?

A: Men do get PFDs but at a much lesser rate. For treatment, they should see a urologist.

Q: Who treats PFDs for women?

A: Primarily, you see us — the urogynecologists. Also, some urologists just treat women and have done the same fellowships as we have.

For the first time in 2013, urogynecologists will be board-certified. We hope this will attract more doctors to the field. It's not glamorous, but it's challenging. Every pelvis is different, so you have to think on your feet. That's what I like about it.

You may be referred to a physical therapist who specializes in treating women with PFDs.

But your internist or primary-care physician is the one who should get the ball rolling. Part of the alliance's outreach is to educate them, to make sure they recognize PFDs. It's all about creating awareness.