Center erasing the stigma surrounding incontinence

OPEN  DIALOGUE: Dr. Leslie Roth of the Women's Medicine Collaborative works with patient Pamela Lambert. Roth said many women
OPEN DIALOGUE: Dr. Leslie Roth of the Women's Medicine Collaborative works with patient Pamela Lambert. Roth said many women "suffer in silence" with pelvic-floor disorders. / PBN PHOTO/ RUPERT WHITELEY

After receiving surgery for stage 3 rectal cancer three years ago, Pamela Lambert’s oncologist asked her if she could go to the bathroom without issues and she lied.

“When he first asked me, I would outright lie to him because I didn’t want to have that discussion,” Lambert said.

Truthfully, Lambert was having trouble with her bowel movements, but was too embarrassed to discuss it with anyone else because she felt like society had taught her that there are things in life “you keep quiet about and deal with.

“But that just doesn’t have to be the case,” she added.

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The stigma surrounding incontinence, or the inability to control the evacuative functions of urination or defecation, and other similar conditions, is what Providence-based Women’s Medicine Collaborative, a Lifespan company, is trying to eradicate with its recently established pelvic-floor-disorders program.

Pelvic-floor disorders are conditions that affect the muscles, ligaments and connective tissue in the lowest part of the pelvis, including the bowel, bladder, uterus, vagina and rectum. It affects roughly 20 percent of the general population and up to 50 percent of seniors, according to the collaborative.

If you haven’t previously heard of pelvic-floor disorders, it’s likely because those affected are often “suffering in silence,” according to Dr. Leslie Roth.

“It’s really the last frontier of medicine that people don’t talk about,” Roth told Providence Business News. “It’s very embarrassing, patients won’t talk with their physicians about it or if they do they won’t say much.”

Roth was the first female colorectal surgeon in Rhode Island and is now co-director of the program. When she first started practicing, she says patients would wait up to six months to see her because they wouldn’t talk about these issues with their male doctors. While pelvic-floor disorders can also happen to men in some instances, the collaborative says it affects at least one in four women, which causes significant discomfort and diminished quality of life.

“Quality of life decreases” for those affected by these conditions, Roth said. “A lot of elderly people would rather die than go out.”

Conditions include a dropping down of the bladder, urethra, small intestine, rectum, uterus or vagina, according to the center. Common causes for pelvic- floor disorders are childbirth, obesity, hysterectomy, aging and putting frequent pressure on the abdomen, such as constipation or lifting heavy items.

Roth and her team of multidisciplinary clinicians, with backgrounds in constipation, pelvic pain and incontinence, begin treating patients with basic approaches, such as shifting dietary and bowel habits, and gradually work toward other forms of care, such as physical therapy and surgery.

Surgery is typically the last option considered, according to Roth.

Dr. Peg Miller, medical director of the collaborative, says the program is already yielding results and she expects demand to grow dramatically in the next five to 10 years as baby boomers move into their geriatric years at a greater rate, increasing the volume of people likely to be affected by these conditions.

The program is a part of the Women’s Gastrointestinal Center at the collaborative. The collaborative bills itself as Rhode Island’s largest multispecialty center dedicated to women’s health at all stages of life. The new program, Miller says, enhances the reputation of the collaborative.

“These women don’t come to receive care until their uteruses are hanging out of them and they’re suffering for a long, long time,” Miller said. “They can get the treatment they need without having to suffer through these conditions.”

The collaborative also provides services that include obstetric medicine, women’s primary care, women’s behavioral medicine, cancer services and specialty services.

Roth says the program recently received a donation given specifically to help raise awareness about pelvic-floor disorders. She thinks society is just at the beginning stages of making this a topic that can be talked about.

“The demand is definitely there, it’s all about whether people will talk about it, seek help and feel comfortable about it,” Roth said.

Lambert said her quality of life “has improved 100 percent.” She said prior to receiving treatment, she wouldn’t dare leave the house after eating. But she can now go out to restaurants, eat and not have to worry about not being in control of her own body.

She urges anyone else who might be suffering from pelvic-floor disorders to talk with a health care provider they feel comfortable talking with because there’s treatment available.

“It’s been a life-changing experience,” she said. •

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