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Pelvic floor dysfunction and pregnancy
The Ohio State University Wexner Medical Center is one of the few health care locations in the nation offering collaborative, multidisciplinary care for pregnant and postpartum women with pelvic floor symptoms. In close partnership with the patient’s regular obstetrician, Ohio State Wexner Medical Center can begin specialized treatment prior to the traditional 4 – 6 week postpartum visit, which can significantly improve recovery.
Up to 80% of women suffer some degree of perineal or anal sphincter laceration during vaginal delivery. Because the perineum attaches to the pelvic floor—the muscles that support reproductive organs, bowels and bladder—perineal damage can cause significant and lasting issues, particularly when a patient suffers an advanced tear that extends into or beyond the anal sphincter.
“Our approach provides a new level of care that is extremely focused,” explains Ohio State Wexner Medical Center urogynecologist Lisa Hickman, MD. “This not only ensures an earlier diagnosis of pelvic floor or healing issues, but also enables us to have a patient-centered approach for treatment coordination and rehabilitation.”
In addition to Dr. Hickman’s team, the medical center's multidisciplinary care team may include specialized pelvic floor physical therapists, gastroenterologists and other specialists, each with dedicated training in pelvic floor disorders. The clinic also screens for other common postpartum issues and may bring in experts such as lactation specialists or psychiatrists who treat postpartum depression. The goal of this service line is to work in conjunction with the patient’s obstetric provider to promote optimal healing after delivery.
“There is such a range of issues that can impact new moms, both short- and long-term,” Dr. Hickman says. “We treat bowel and bladder control issues, postpartum urinary retention, healing abnormalities, pain, wound infections, pelvic organ prolapse, obstetric fistulas and more. Each of these issues can significantly affect the health, well-being and confidence of our patients.”
Once treatment is concluded, patient care reverts exclusively to the original referring obstetrician, who is kept abreast of care throughout.
“We also share diagnosis and treatment details with residents or any others who were involved in the delivery,” Dr. Hickman explains. “That way, everyone who has an existing patient relationship can track recovery, and we're able to provide important pelvic floor education and awareness to everyone involved.”
The ultimate goal, Dr. Hickman says, is to provide more immediate, more comprehensive care to such patients.
She’s dedicated much of her career to this type of treatment: She is a founding member and vice chair of the American Urogynecologic Society’s special interest group, Childbirth and Pelvic Floor Disorders, which is committed to nationwide advocacy, education and multicenter research studies. She's also co-author of “Subspecialty care for peripartum pelvic floor disorders,” an article published in the American Journal of Obstetrics and Gynecology.
“There aren’t many multidisciplinary pelvic floor clinics focused on pregnant and postpartum women,” Dr. Hickman says. “I joined with my co-authors to provide a roadmap for others who want to understand what’s needed to start this type of clinic, including the development process, helpful resources and our own perspective and experiences during clinic startup and growth. I believe this type of care is an important opportunity for secondary prevention against the future development of pelvic floor disorders in this at-risk population, which is why bringing this to the women of central Ohio is so exciting.”
