Help For Pelvic Floor Disorders
BY NANCY SOKOLER STEINER
Gail “Goldie” Westheimer had a problem that most women, understandably, don’t like to talk about. But given how treatment from her Providence Saint John’s Health Center physicians changed her life, she wants other women who may be suffering to know that help is available. Westheimer had pelvic organ prolapse—the descending or drooping of the pelvic floor organs. This can occur with weakening of the group of muscles supporting organs including the bladder, rectum and reproductive system.
Heredity, age, childbirth and straining from constipation may contribute to developing pelvic organ prolapse. For Westheimer and many other women suffering silently from pelvic floor problems, the compassionate health professionals at the Women’s Health & Wellness Institute at Providence Saint John’s Health Center have the skills and tools to change lives. Initially, Westheimer experienced a prolapsed cervix—meaning that her cervix had started to fall, and its placement interfered with urination. A retired hospital nurse, Westheimer wanted to avoid surgery and chose to endure the problem. But over time the condition worsened, and her bladder eventually protruded outside her body.
Meanwhile, she developed a prolapse of the rectum. That led to incontinence and a constant feeling of pressure. The condition was also painful. “It got so intrusive in my life,” says Westheimer. “I was spending most of my time in the bathroom. Between taking so long to go to the bathroom and the pain I experienced when I walked, I ended up spending all my time in the house.”
Normally, Westheimer likes to walk a couple of miles a day. The 76-year-old lives in Westport, California, about 200 miles north of San Francisco. She enjoys walking along the coast and enjoying the sight of redwoods, mountains and the ocean. She often visits her children and six grandchildren, who live in San Mateo and Houston. But walking—and certainly travel—were out of the question.AN INNOVATIVE APPROACH Westheimer regularly travels to Los Angeles for her specialty medical services.
When mentioning her problem to her neurologist, the physician referred Westheimer to Lauren A. Cadish, MD, a urogynecologist fellowship-trained in female pelvic medicine and reconstructive surgery. In January 2019, shortly before COVID-19 hit, Dr. Cadish examined Westheimer and discussed her options. Then pandemic restrictions prevented Westheimer from traveling back to Saint John’s for treatment. By the time she was able to return to Dr. Cadish in June 2021, her condition had worsened considerably. Dr. Cadish assessed Westheimer and arranged for her to see Tracey R. Childs, MD, the same day. Board-certified in both general and colorectal surgery, Dr. Childs shares an office with Dr. Cadish, and the two collaborate closely.
“Patients experiencing vaginal prolapse are referred to one type of doctor, while those with rectal prolapse are referred to another,” says Dr. Cadish. “But both types of prolapse stem from the same physiological problem.” For that reason, Dr. Cadish and Dr. Childs have teamed up to address the problem. When Dr. Cadish sees a patient with bladder or vaginal prolapse, she always checks whether they might also be experiencing rectal prolapse. Dr. Childs does the same for her patients with rectal prolapse. When a patient has both types of prolapse, the two physicians collaborate to perform both surgeries in a single operation. That is how they treated Westheimer.
“Ignoring it won’t make the condition go away. This is not only treatable but curable.”
“The procedure involved placing mesh inside to hoist her organs up,” says Dr. Childs. “To do this, we use robotic-assisted surgery and make four small incisions in the abdomen through which we insert small instruments to perform surgery. ”Dr. Cadish performed a sacrocol popexy, using mesh straps to reinforce the front and back walls of the vagina and attaching them to a strong ligament overlying the sacrum, thereby lifting the vagina. With the same incisions and instruments, Dr. Childs performed a ventral mesh rectopexy.
She secured the same mesh to the rectum and sacral ligament, holding the rectum in place. In effect, they created a kind of support to hold up the pelvic organs. This collaboration meant that Westheimer did not have to undergo two separate procedures. “Rectal prolapse used to involve bowel resection or open surgery, which meant a four- to six-day hospital stay and a six-week recovery process,” says Dr. Childs. “With robotics, we can visualize, dissect and sew with better dexterity, all laparoscopically. Patients recover quickly, and there is no disruption to their eating, activity or urination and bowel movements. ”Westheimer stayed in the hospital just one night. “I felt better almost immediately,” she says. Prior to her surgery, there was one thing
Westheimer wanted to do more than anything: attend her grandson Evan’s bar mitzvah. “That involved a 4½ hour car ride, and I just didn’t know if I’d be able to make it,” she says. “It would have broken his heart if I couldn’t go. We’re very close.” Dr. Cadish and Dr. Childs scheduled Westheimer’s operation in sufficient time for her to go to the bar mitzvah.
Westheimer says she was still recovering but was well enough to attend and enjoy the milestone event—even doing a few steps of the hora at the reception. A few weeks after the bar mitzvah, Westheimer needed to see Dr. Cadish for a post-op visit. “Since I still wasn’t allowed to lift anything over 10 pounds and had to travel from Northern California, I took Evan with me,” she says. “We had such a wonderful trip visiting family. No more embarrassing half-hour visits to the bathroom! ”A FIXABLE PROBLEM“ You would not believe how common this is,” Dr. Childs says about pelvic organ prolapse. ]
“As in Gail’s case, many women suffer with the condition, feeling like they can’t go anywhere and can’t do anything.” “Ignoring it won’t make the condition go away,” adds Dr. Cadish. “This is not only treatable but curable. It’s very gratifying for me to be able to fix a problem that may have plagued a patient for years—in a few hours.” As part of Saint John’s Women’s Health & Wellness Institute, Dr. Cadish and Dr. Childs treat a range of pelvic floor disorders in addition to offering multiple types of treatments for pelvic organ prolapse.
These include urinary or anal incontinence, obstructed defecation and pelvic pain. They may refer patients to Saint John’s gastroenterologist Claudia Sanmiguel, MD, for anorectal manometry, a test that measures how well the rectum and anal sphincter are working, as well as for biofeedback training. They hope to identify funding to bring in-house pelvic floor physical therapy—exercises to strengthen muscles for continence. “Philanthropic support would help us maximize the reach of this program,” says Dr. Childs.
She and Dr. Cadish would like to see a nurse navigator brought on board to coordinate care and provide patient education, freeing them up to concentrate on clinical care. “We have a limited ability to see the many patients who have these issues,” says Dr. Cadish, whose appointments are currently booked five months ahead. “Philanthropy could allow us to better meet demand.” That would mean a great deal to people like Goldie Westheimer, who says the two physicians transformed her life. Recently returned from a trip to Houston, she marvels, “I never thought I could be back to normal again, but I am. And others can be too.”