By Elizabeth Chorney-Booth | Photography by Jared Sych
The Calgary Pelvic Floor Clinic empowers women to take control of their pelvic floor health by offering specific procedures and support.
Dr. Erin Brennand’s eyes light up when she talks about pelvic floors. Public discourse around pelvic floor health usually involves little more than quips about Kegel exercises or women making increased trips to the bathroom after childbirth, but pelvic floor disorders can be serious health concerns that affect people of various ages.
More than half of women will experience pelvic floor dysfunction as they reach middle age. Despite that prevalence, conditions surrounding pelvic floor health — namely, incontinence and genital discomfort — remain a source of self-consciousness for many. Even at a time when more women have embraced their bodies and discussions around formerly stigmatized topics like menstruation, menopause, and breast cancer screening have become mainstream, the pelvic floor remains out of the conversation.
As the department head for obstetrics and gynecology at the Cummings School of Medicine and Alberta Health Services, and a urogynecologist at the Calgary Pelvic Floor Clinic in the Woman’s Health Centre at the Foothills Medical Centre, Brennand sees too many patients who only seek treatment after years of unnecessary suffering. Brennand wants women to take control of their pelvic floor health instead of suffering in silence.
The first step? Helping them get over their reluctance to talk about their struggles.
“We did a study where we interviewed Calgary women about their journey to receiving treatment at our clinic, and ‘shame’ and ‘stigma’ were the two words we heard the most,” Brennand says. “For many women, there’s really nothing more embarrassing than not having control of your genital tract.”
What is the pelvic floor?
Many people have heard about the pelvic floor but can’t necessarily describe or pinpoint it. It’s a hammock-shaped group of muscles that attach along the base of the pelvis, wrapping around the genital openings. These muscles collectively hold the lower abdominal organs inside the body.
“The pelvic floor muscles provide core stability,” Brennand explains. “It’s what keeps your insides from falling when you stand up. You’d be unable to walk, move, or lift without your pelvic floor.”
People of all genders have a pelvic floor, but issues with the muscles are far more common in women, particularly those who have gone through childbirth, as pregnancy and birthing can cause damage to the pelvic floor muscles and to their attachment to the pelvis. This often results in urinary and fecal incontinence or vaginal prolapse — when the organs within the pelvis slip and protrude outside of the vagina.
Pelvic floor ailments can range from being mildly inconvenient to overwhelmingly debilitating, causing sufferers to abandon sexual relationships, or become housebound to avoid accidents while out in public. The effect on quality of life can be significant and traumatic.
You are not alone
Brennand says women can feel alone with what they’re going through because of a lack of casual chatter around pelvic floor care, but the reality is that these ailments are staggeringly common.
Advertisements for incontinence pads and briefs exist because many people need these products. Brennand says up to three-quarters of women experience urinary leakage by the time they’re 65. About 50 percent of women in Alberta will eventually develop stress incontinence, the phenomenon where bladder release is triggered by things like coughing or laughing.
Prolapse is also far from rare: again, about 50 percent of women in Alberta will develop prolapsed genitals, while 15 to 20 percent will seek surgery to correct severe cases.
This level of occurrence, combined with the stigma and potentially life-altering repercussions, is part of what led Brennand towards specializing in urogynecology, the area of surgery that specializes in pelvic floor disorders.
As a lifelong Albertan, she’s in the right place to do it — after completing her MD at the University of Alberta, Brennand came to the University of Calgary for her obstetrics and gynecology residency and eventually took on a urogynecology fellowship. One of her mentors during the fellowship was Dr. Magali Robert, founder of the Calgary Pelvic Floor Clinic. The Clinic, which was founded in 1999, was a perfect fit for Brennand not only because it was in her home province but also because it was a leading facility in pelvic health treatment and research.
Outside of work, Brennand is the mother of three children, so she intimately understands how pregnancy can affect the body.
“Our pelvic floor clinic in Calgary is groundbreaking — I would say it sets the national standard,” Brennand affirms. “When I speak to leaders at other institutions across Canada, Calgary’s pelvic floor clinic is often spoken of with envy and reverence.”
Goal setting and treatment intertwined
Part of what makes the Calgary clinic revolutionary is its dedication to taking a multidisciplinary approach to care. It addresses many aspects of a patient’s life. After a patient is referred by their family doctor or gynecologist, the team of surgeons and nurses counsel them about their desires and expectations before setting a course of treatment.
Prolapse surgery, for example, is not always recommended if the condition isn’t causing any pain or if the patient has no intention of resuming sexual activity, while mild incontinence can often be kept under control with low-intervention treatments. A patient’s relationships, lifestyle, and emotional needs are always considered when deciding on a course of treatment.
“When patients come into the clinic, we really try to use a goal-oriented approach to understanding which path they should walk,” Brennand says. “Sometimes people know that they are not ready for any type of surgical intervention. They’re looking for lifestyle modifications such as learning how to do pelvic floor exercises or understanding how their activity levels or diet may affect their pelvic floor.”
The Clinic is the only place in the city where women with pelvic floor issues can undergo a cystoscopy, a procedure funded by Calgary Health Foundation that involves inserting a small camera into the urinary tract. The imaging allows for more precise diagnostics and can be used to rule out cancer.
Where stress incontinence is concerned, doctors and patients can choose between vaginal sling surgery (where a sling is created to help close the urethra and bladder neck) or the injection of a bulking agent to strengthen the urethra to combat the condition. When an urgent treatment is needed, Botox is administered to the bladder to decrease the urge to pee.
Significant prolapse cases often require intensive surgery to reconstruct the pelvic floor. In some cases, patients are happy to learn to accept the appearance and sensation of a mild prolapse or use a removable non-surgical device called a pessary to hold the pelvic organs together.
Each therapy plan has different requirements, such as length of hospital stay and recovery time. The clinic team works closely with each patient, so they fully understand the possible options for treatment.
Maintaining pelvic floor health
The other side of the pelvic floor health equation is prevention and education. Women need to know how to keep their pelvic floors healthy and, at the very least, delay surgery so they don’t have to undergo multiple reconstructions. Pregnancy — particularly those that result in a vaginal birth made worse with the use of tools like vacuums and forceps — is the most common cause of pelvic floor disorders. What’s worse: these disorders don’t fully manifest until women near menopause.
Brennand recommends that women be proactive while pregnant. They can do this by maintaining a healthy weight and keeping gestational diabetes in check, both of which can minimize pressure on the pelvic floor.
For patients who are not pregnant, she recommends mitigating measures like avoiding straining during bowel movements, reducing the consumption of bladder irritants such as excess coffee, and working with a specialized physiotherapist, when budget allows, to better strengthen the muscles of the pelvic floor.
While women might not be comfortable discussing their incontinence or vaginal prolapse with friends over brunch just yet, Brennand is optimistic about the advances she sees in pelvic floor health. For example, prolapse surgeries are becoming more common, not because of a higher rate of occurrence, but because women are better informed of their options and more proactive about seeking care. Brennand takes that news as a win.
“It’s so rewarding when a patient comes back and tells you they got their freedom or confidence back and that they’ve been able to step back into intimacy and into their relationships. That’s why I signed up to be a doctor.”
Thanks to donor support, Calgary Health Foundation is also funding two other exciting urogynecological initiatives: a postdoctoral fellow for Women’s Health Hub, a Calgary-based centre which trains future women’s health researchers, and a sacral neuromodulation feasibility study for female patients with urinary and/or fecal incontinence.
