Pelvic Floor Dysfunction… Stephen Interviews a Board Certified Urogynecologist

Stephen Dunn: Alright, hey guys. What’s up? It’s Stephen Dunn here, with CORE Therapy and Pilates. I have a very special guest with me today, it’s my brother, Dr. James Dunn, who’s a urogynecologist out of Northern California area right now. We did one of these discussions, it’s been several months ago and we talked about pelvic floor health and we talked about some of the programs that Dr. Dunn does for his pelvic floor patients. We talked a little bit about the difference between what is urogynecologist and what is the difference between seeing a urogynecologist and a regular OBGYN for the kind of surgeries that he does.

My reference or my discussion, was I like to compare it to a dentist and an oral surgeon. You can get your dentist to pull your wisdom teeth, or you can get an oral surgeon to pull your wisdom teeth. Both of them can do the job, it’s just one of them does a lot more than the other and one of them would be more of an expert of the surgical part and one would be more of an expert of the other things. So I think that’s a real simple way to talk about it. If anyone has any comments, put them below and we’ll be happy to answer and questions.

What I wanted to do is just continue the conversation because something that I find is of importance or that I find is … we’re at a place now where it’s okay for women to have urinary incontinence. There seems to be a push, the message from watching TV, it’s all about medications or it’s all about diapers. Wear diapers, adult diapers, and I think there’s a different way of approaching things other than just spending money on adult diapers. I can’t remember the figure but the amount of money spent on adult diapers-

Dr James Dunn: Billions.

Stephen Dunn: Billions, versus actually trying to get it taken care of, way less, on a yearly basis. With that said, thanks for being here, Dr. Dunn.

Dr James Dunn: Hope you had a wonderful Thanksgiving.

Stephen Dunn: We got to spend some time for Thanksgiving and he’s leaving today, so I took advantage. “Hey, give me 10 minutes and lets go through some stuff.” So my first question to you is, if a woman is having … when is the right time for a woman to come see you?

Dr James Dunn: I get consults all the time, ignore that, with more advance problems, moderate and severe problems in older women. I think the best time is 30’s and 40’s, after childbirth. Definitely start on some kind of pelvic floor therapy on their own if the symptoms progress or don’t respond to simple kegel exercises and pelvic floor training at home, weighted cones, vaginal weights, things like that that you can do on your own, then yeah, physical therapy, more aggressive treatments. I would start right after childbearing.

Stephen Dunn: Basically is it normal to be having any urinary incontinence?

Dr James Dunn: It’s not normal, it’s just-

Stephen Dunn: Common.

Dr James Dunn: It’s common. It’s a common thing, I get that question a lot. It’s just a common consequence of childbirth, and pregnancy is the number one risk. Especially vaginal deliveries. You get some protection from cesarean sections, but pregnancy itself is the number one risk factor.

Stephen Dunn: If someone comes in with urinary incontinence the treatment plan doesn’t start with surgical intervention. It starts with other stuff first, correct?

Dr James Dunn: Very rarely does someone come in, already made up their mind. They’re like, “I want surgery,” ’cause of whatever they’ve heard or read, or, “My friend had surgery and I want that surgery.” Most women come in and say, “Yes, I prefer conservative, non-surgical, medications if there are, therapy.”

Stephen Dunn: Mm-hmm (affirmative). If someone goes through the conservative treatment, they do the kegels, pelvic floor strengthening, they do the possible probes and e-stim training. What’s the numbers of people, the percentage of people, that go through that program and then up needing to have surgery?

Dr James Dunn: We’ll go to the positive, about 70 to 80% improve or significantly get better where they don’t need surgical therapy, or other therapy. That leaves about 15 or 20% of women who need surgery or fail conservative options.

Stephen Dunn: Let me ask you this. You and I have had this conversation, if you watch the TV, you see all these lawyers advertising if you’ve had mesh surgeries, to call them for this and that. I think there’s been some misinformation or some bad information out on these mesh products, where I have people ask me questions about the mesh, because they’ve seen the lawyers advertising.

That’s something that I don’t really understand or know, but you mentioned to me that if you were concerned about the mesh, that no surgeries would be happening. It’s kind of what you talked about, it’s been several months ago, but with the mesh and the fear factor out there of, if you get this incontinence surgery and they’re using this certain mesh, that there’s gonna be a long term problem or lawsuit after.

Tell me a little bit about that.

Dr James Dunn: The mesh surgeries are definitely there. They have mesh surgeries and they have non-mesh surgeries that I offer, and we have that long discussion as far as the consent process. Do you want this with these risk and benefits and this surgery? The main concern with the lawyer ads is based on the pelvic surgery with mesh. It does have a higher complication. I haven’t been doing that mesh surgery. I still do the sling surgeries but with a longer discussion and say, “Yes, every surgery has risk. The mesh surgery has some specific risks, only related to the mesh.” So you have to say, “The risk of 90% plus for successful, and a couple percent chance of this things you see on TV.”

Then you go from there, after that process.

Stephen Dunn: Got it. These are just some questions that I get, questions that I don’t always know the answers to. So while you were here I wanted to go through and ask a few question. We’ve got a few people that have jumped in.

Hey, Jared. What’s happening buddy?

We don’t have any questions that have popped up. So let me finish with this one. If someone goes through this procedure, or they go through the surgical procedure for a sling for example, what kind of recovery is after that? And how long before they’re able to do normal exercise, and when should they start doing kegels?

Dr James Dunn: Probably right after surgery, you start your kegel therapy ’cause that doesn’t complicate the recovery. For after the surgeries, I typically do a combination of pelvic surgery, bladder lifts and sling surgery, so I ask those ladies to go slow for six weeks. Not do nothing, I want them to get their cardiovascular fitness so they can walk and treadmill and swim and do light … I just ask them not to lift anything heavy. Low impact. We made the number up, 20 pounds, don’t lift more than 20 pounds. But we don’t have a study that says yes or no.

I tell them, be moving but be mindful of how much pressure you put on the pelvic floor.

Stephen Dunn: Got it. ‘Cause that’s a question that I get, and usually by the time they’re coming to see me after surgeries, it’s been more than those six weeks. Just based on the whole process. But that’s a question that I’ve gotten, and six weeks is kind of a safe zone for many things in medicine. Bones, fractures heal in six weeks, lot of stuff happens in about six weeks. So that’s typically a safe answer, but I just wanted to get your clarification of that.

Alright guys, so with that said, we are done for the day. Hey Andy, what’s happening buddy? So if you have any questions, if you’re watching it later on the replay, put some questions down below and we’ll be happy to answer them. I got Jamey in town for the rest of the day and I wanted to take advantage of sharing some information that can be useful to our clientele.

So with that said, thanks for your time. Thanks for your time, Jamey, and thanks for your time for watching. We’ll see y’all on the flip side, guys. Now he’s got a Pilates class.

Dr James Dunn: Pilates.

Stephen Dunn: Peace, guys.