Childbirth may be natural, but the journey through pregnancy, delivery and the postpartum period is a complicated process that, for many women, has more significant consequences for the mother’s health than our medical system has historically acknowledged.
Urogynecologist Lisa Hickman, MD, who specializes in treating pelvic muscle, bowel and bladder problems in women, was an early pioneer in aggregating treatment of these disorders, establishing one of the first clinics in the country devoted to pelvic floor disorders, while in her fellowship at Cleveland Clinic in 2017.
In 2020, she joined The Ohio State University Wexner Medical Center and now offers her expertise to women in central Ohio and beyond at the Childbirth Pelvic Floor Disorders Clinic in New Albany.
“I see our clinic as an extension of the obstetrics team,” Dr. Hickman says. “We work very closely with providers to take care of their patients, with everything from a severe perineal tear during childbirth, to pelvic organ prolapse, to bowel and bladder control issues that may have developed during pregnancy or after delivery.”
As a result of these injuries, it’s not uncommon for women to experience accidental bowel leakage, fecal urgency, difficulty controlling flatus, urinary urgency or incontinence sooner or later.
Dr. Hickman says that up to 80% of women have an obstetric laceration during vaginal delivery, and between 4-8% of these tears are severe enough to require surgical care beyond the delivery room.
“When a patient has an advanced obstetric laceration, they are automatically referred to our clinic,” she says. “While uncommon, wound infections or wound breakdowns typically occur within the first two weeks following delivery, so the goal is to see a patient in that time frame, evaluate the wound and come up with a plan for healing.
“Women may also rarely develop rectovaginal fistulas from delivery. In such situations, early care is essential,” Dr. Hickman says. “And having a dedicated clinic like ours can make all the difference.”
Proactive Measures
Addressing emergent or other acute issues is just one facet of the clinic. The team also works proactively to avoid problems that can emerge later in life. Sometimes that means working with pelvic floor physical therapists to rehabilitate women who’ve had a difficult childbirth or delivery, muscle weakening and a high risk of prolapse or compromised urinary and bowel function later in life.
Besides laceration repairs, office-based procedures the clinic offers include excising granulation tissue, administering trigger point injections, delivering bladder and pelvic floor Botox or urethral bulking agents, providing posterior tibial nerve stimulation and peripheral nerve evaluations, offering diagnostic cystoscopy and performing vulvar injections for vulvodynia.
“We offer pelvic floor and anal sphincter ultrasound for patients with bowel control issues so we can better evaluate the anatomy of the muscle and direct surgical planning if a secondary repair is indicated,” Dr. Hickman says.
Planning eases tension and supports best outcomes
Planning pelvic floor rehabilitation and approaches to future pregnancies is also a big part of the clinic’s work to enable women to make informed decisions about prenatal interventions to reduce their future risk and about what factors to consider in deciding on delivery methods.
“Most of our patients are first-time mothers and want to have more babies. So, for example, if they had a tear, we discuss why it happened and what could be done to avoid it next time. We talk about both modifiable and nonmodifiable risk factors and prepare them for choices they need to make before pregnancy and as pregnancy progresses,” Dr. Hickman says.
For many women, sequelae from their delivery, like a wound breakdown, a fistula or persistent incontinence increases the chance of developing mood disorders or post-traumatic stress disorder from a traumatic delivery. When this is the case, Dr. Hickman’s clinic draws in specialized counselors to support them in grieving the loss of the childbirth experience they envisioned and their fear of future pregnancies.
“Even if you have physical or mental health concerns unrelated to the pelvic floor conditions we’re treating, we’ll ensure that every aspect of your health is addressed,” Dr. Hickman says.
No more need to “live with it”
Dr. Hickman says that before the creation of these specialized clinics, patients often just lived with burdensome conditions the medical community didn’t necessarily anticipate or think were modifiable.
“I can’t tell you how many times people say, ‘I wish a clinic like this had existed when I had my baby or when my wife had our baby,’” she says. “That doesn’t mean that if my colleagues and I didn’t exist that women wouldn’t get good obstetric care. We’re just trained to think about things differently, and that gives us a more long-term lens to address some of the consequences of childbirth.”