There's a place in our own bodies where only the brave will go. It's shrouded in taboo, myth, misinformation, and no small measure of bashfulness and red-faced humor. It's hard to locate; to find it requires a headlamp and compass, or better, GPS. It's hard to talk about; euphemisms and evasive descriptions tiptoe around the subject. If there's a malfunction in this area, someone might tend to "spritz" or "leak." There might be "a kink in the garden hose." Some feel that even statements like these are too revealing, preferring to fall back on the conveniently nondescript "I have a problem...you know...down there."
This mystery destination is the pelvic floor—the complex bowl of musculature holding the genitals, organs of elimination, and abdomen in one carefully balanced package. If the area had a job description, it would be the primary foundation for our torso—the diamond-shaped hammock upon which the upper half of our bodies rest. Important? Yes, and also susceptible to health issues that can undermine its vital, supportive functions. In these hinterlands of the flesh, more can go wrong for women than for men. Pregnancy and childbirth can put tremendous pressures on pelvic floor muscles, ligaments, and fascia (connective tissue)—and even for women who never carried babies, the area is vulnerable particularly after the hormone changes of perimenopause. Men are not guaranteed a problem-free pelvic floor either—a host of assaults from cycling to prostate surgery can damage the area. Finding a therapy to help can feel as lucky as spotting a bald eagle. But experts ranging from a physician to a physical therapist and Pilates instructor are coming out of the Hudson Valley woods with surprisingly effective programs designed to restore order in the most unmentionable of places.
Seat of a Problem
Karen James at 64 had a healthy sex life and was entirely continent until a problematic surgery to fix a rectal prolapse left her in terrible pain and constant leakage months after the recovery. "I had pain with intercourse and I was urinating maybe 20 times a day and three or four times at night, so I was up all night, I couldn't sleep," says James (not her real name), of Kingston. "I was crying a lot about it and depressed. My whole life had changed." While the surgeon's office in Albany couldn't do much for her, James found that her OBGYN practice, Mid Hudson Medical Group in Rhinebeck, had a new doctor in the group—a hard-to-find urogynecologist, one of just a handful in the Valley—named Stephen Young, MD. "He was wonderful. I kept telling people there was something wrong, and he was the only one who would listen to me. He said, 'You've got to have some help here.'" During an exam, Young found that James had a bladder prolapse that had gone undetected (the bladder was bulging into a weakened part of the vaginal wall). Although Young could have fixed the problem with another operation, James opted instead to be fitted with a pessary, a device inserted in the vagina to provide structural support. "Almost immediately, I felt better," she says of this first step in her healing journey.
"A huge number of women suffer in silence from urinary incontinence or prolapse [bulges]," says Young, who built a program in urogynecology in Worcester, Massachusetts, for two decades before "retiring" two years ago to the Hudson Valley, where he sees or operates on patients three days a week. "For women 45 and older, the statistic is one in three who have urinary incontinence, prolapse, or both. One in eight has anal incontinence. A family doctor might say, 'It's a normal part of aging and you just have to live with it.' The truth is, it's not normal and you don't have to live with it." Young puts the cure rate for both incontinence and prolapse at about 85 percent. His specialty is vaginal reconstructive surgery—a minimally invasive, natural-orifice surgery that requires no abdominal incision. Unfortunately, there isn't enough training in this kind of medicine, but Young had the opportunity to apprentice in the 1980s at Brown University with a famous physician who had written the textbooks for vaginal surgery. "All I do is fix vaginas," Young says. What he doesn't do is so-called vaginal rejuvenation surgery or other vanity procedures ("You can't get back your 18-year-old vagina," he says). What he does do is repair the structural-related incontinence and prolapses that plague so many women. "I've only been with Mid Hudson since last August, and I'm mobbed."