Ep34 Dr Chris Gillespie 

An increase in life expectancy has led to an increased elderly population. In turn, this aging population is more likely to develop health conditions, such as pelvic floor disorders. These disorders are considered as a major global health problem and are classified as urinary incontinence, fecal incontinence, and pelvic organ prolapse.

A number of factors may increase your risk of developing pelvic floor dysfunction issue, and one of them is ‘age’. Although these disorders can occur at any age, it's more common in adults over 65.

What are they… why do they occur…. And most importantly, how can they be treated or prevented.

To help answer these questions we’re joined by Dr. Chris Gillespie. Chris is a specialist colorectal surgeon practising in Brisbane at Mater Private Hospital. He works in both the private and public areas, with special interests in colorectal cancer and functional issues with the bowel including constipation and faecal incontinence. He performs laparoscopic and robotic surgery, and enjoys teaching students and trainee surgeons. He has set up a multidisciplinary service called the Queensland Pelvic Floor Centre in Bowen Hills in Brisbane, an all-under-one-roof centre designed to look after people with troublesome bowel or pelvic floor issues.

QUESTIONS

1. What is the pelvic floor

2. What happens to the pelvic floor as we age

3. What are the main types of Pelvic Floor Dysfunction that are prevalent as we age…. 

4. Are pelvic floor disorders a normal part of aging

5. What causes these and who’s most at risk?

• Nerve damage. People who have long-standing diabetes, multiple sclerosis, or back trauma from injury or surgery may be at risk of fecal incontinence. These conditions can damage nerves that help control defecation.

• Dementia. Fecal incontinence is often present in late-stage Alzheimer's disease and dementia.

• Physical disability. Being physically disabled may make it difficult to reach a toilet in time. An injury that caused a physical disability also may cause rectal nerve damage, leading to fecal incontinence.

1. Is there something we have done or are doing that has caused it - is it possible to get it under control before it advances

2. What is the impact of pelvic floor dysfunction? Physically and emotionally.

• Loss of bladder control is a common symptom of a pelvic floor dysfunction. Some people experience anal incontinence, which means they can't always control the passage of wind (gas) or faeces (poo). Weak pelvic floor muscles can also cause sexual difficulties such as reduced vaginal sensation.

1. Are there also psychological reasons for pelvic floor dysfunction?

• The psychological characteristics of the pelvic floor disorders are very well described, suggesting that the impact of social factors, such as sexual abuse for example and psychological distress, on the expression of pelvic floor symptoms should be taken into account.

• Stress and anxiety can lead to tightening of the pelvic floor muscles, which can result in pain or high-tone pelvic floor dysfunction.

1. What makes pelvic floor dysfunction worse?

• A: Common causes of a weakened pelvic floor include childbirth, obesity, heavy lifting and the associated straining of chronic constipation. Childbirth is one of the main causes of pelvic floor disorders. A woman's risk tends to increase the more times she has given birth.

1. 10.What does a weak pelvic floor feel like

2. 11.How do we know we have a pelvic floor disorder

3. 12.Can you strengthen a weak pelvic floor after 50 (what can we daily with regards to diet and lifestyle) 

4. 13.What can be done (non-invasive) 

• Pelvic floor dysfunction can be debilitating, which is why patients may want to consider treatment to experience relief from their symptoms. Treatment for pelvic floor dysfunction often includes a combination of techniques such as self-care, medication, physical therapy, or minimally invasive surgery.

14.At what point does surgery become the only option

MYTH or FACT

Myth #1: Pelvic floor problems are inevitable with age

Myth #2: Pelvic floor dysfunction only happens in women

Myth #3: Kegels are always the cure for pelvic floor problems

Myth #4: Kegel exercise is useless

Myth #5: You should stop the flow of urine to properly do Kegel exerciseMyth #6: All pelvic health concerns are related to weakness in the pelvic floor