Women's Health Month: Why women suffer in silence from issues 'down there'
May is Women's Health Month, but a lot of young women are suffering in silence with private health issues "down there," like incontinence and pain.
"This is something that happens and people just aren't willing to talk about it," said Ingrid Harm-Ernandes, a physical therapist for nearly 40 years.
Harm-Ernandes became a trailblazer for women's health in the Triangle early in her career at Duke Health when she realized her female patients were embarrassed or hesitant to come forward with their questions.
She said she first noticed the gap when her pregnant patients came to her embarrassed they were leaking urine or suffering from pain during sex. Many hadn't told anyone, and others didn't get a clear solution from their doctors.
Harm-Ernandes was part of Duke's first women's health physical therapy residency program, an in-depth study into pelvic health and the issues women face.
For the last 27 years, she has focused on treating pelvic health issues and advocating for women's health. A published author, she teaches workshops to health care providers on how to make pelvic exams more comfortable for women and when patients could benefit from physical therapy or other treatments beyond medication and surgery.
Harm-Ernandes recalls being told by doctors, "You just blew my mind. I didn't know there was so much you could do for my patient."
As more women are referred to physical therapists, mental health counselors and other health professionals, Harm-Ernandes said it has been exciting to see the changes in women's healthcare in the last 10 years, but there is still progress to be made.
According to Harm-Ernandes, 1 in 4 women in the United States suffer from some kind of pelvic floor issue -- including incontinence and pain.
"That's huge, yet everybody feels like they are alone so they don't step forward and say 'I have this symptom, I have this problem, and can I get help for it?,'" Harm-Ernandes said.
Why isn't this talked about in doctor's offices?
Women are often embarrassed to talk to their doctors about problems like urinary or fecal incontinence or pain during sex. Often they are scared they will be ignored or brushed aside, or they think they are one of only a handful who are suffering and believe limited treatment options are available.
"It becomes a vicious cycle, because if no one talks about it, people don't realize how common these conditions are," Harm-Ernandes said.
What issues are women suffering in silence?
Harm-Ernandes said urinary incontinence is the pelvic issue she sees the most in women, especially in postpartum and postmenopausal patients.
Incontinence
"People are somewhat willing to talk about this one but don't understand the embarrassment or how many women struggle," said Harm-Ernandes, who wants women to know incontinence is common and they can usually be treated without surgery.
"It's sad that this condition is so common yet it often goes untreated," she said.
Another common women's health issue, fecal incontinence, is something people really don't want to talk about, and it impacts younger women as well as seniors, Harm-Ernandes said. While men can also suffer from incontinence, women are more at risk after childbirth.
Harm-Ernandes said the use of forceps or suction during some deliveries can be tied to urinary or fecal incontinence and even prolapse, where the pelvic organs sag. Tears, which are also very common during vaginal delivery, are particularly related to fecal incontinence, she explained.
"Fecal incontinence is much more common after childbirth than people think, but it is very treatable," Harm-Ernandes said.
Incontinence occurs after childbirth because the pelvic muscles are weaker and stretched out, so they don't close as well. This can lead to leaks when women sneeze, cough or exercise.
"That can be hugely embarrassing, but women try to live with it," Harm-Ernandes said.
The fourth trimester
Women generally visit their doctors around six weeks after delivery to make sure they are healing properly. This is also around the time women are told by their doctors they can resume having sex.
But Harm-Ernandes said postpartum and the fourth trimester isn't just the first six weeks after you give birth.
"[Postpartum] can be months, it can be a year, or longer," she said. "When we suffer with conditions like incontinence and pain with sex, all that happens after pregnancy but we're running around taking care of a little one or other children in our family and we put ourselves on the back burner. That's the time women should really get that help and not get ignored."
Most women will suffer from so-called "baby blues" after childbirth and many develop postpartum depression. Combined with lack of sleep and limited support, it can be difficult for women to seek out the medical care they need to feel like themselves again.
Pelvic pain
Another issue Harm-Ernandes sees in women is pelvic pain, which can include pain during sex and even issues like IBS (irritable bowel syndrome).
"Pain with intercourse is something that again women just haven't stepped forward about," Harm-Ernandes said.
Many believe pain during sex or gastrointestinal issues are the new normal after childbirth or menopause, but by visiting a physical therapist or other provider and learning changes to lifestyle, diet, women can be empowered to take treatment into their own hands.
What is pelvic physical therapy?
"A lot of patients who are referred to pelvic physical therapy never go because they are afraid," Harm-Ernandes said.
A visit with a physical therapist for pelvic floor issues is based on the patient's comfort level. It may feature a discussion about symptoms and lifestyle, practice with stretches or movements that can help, and an external or internal exam only if the patient is comfortable. The focus is giving patients knowledge and stretches they can use at home.
Topics discussed could include what patients are drinking and how much, diet, exercise and self care. Women can learn what to do before intercourse to make sex more comfortable. The therapist will look at the strength of muscles, endurance and the pelvic floor's ability to relax.
Pelvic physical therapy is usually covered by insurance, and women can see their therapist anywhere from once a week to once a month. Harm-Ernandes said she sees most patients every two weeks.
The bottom line? There is so much providers can do for their patients, Harm-Ernandes said. Women just need to ask for help, advocate and know they aren't suffering alone.
