Clinical Update
Center for Women's Pelvic Health
by Dan Gordon
Pelvic floor disorders — including urinary and bowel incontinence, pelvic discomfort, and pelvic organ prolapse — are among the most common health problems facing women, particularly as they age. Yet, despite their substantial impact on quality of life, these conditions tend to be undertreated because of a combination of factors — including patients wrongly assuming nothing can be done for their problem, not bringing it up with their primary care physician out of embarrassment, and not being asked about it by their provider.
The UCLA Center for Women’s Pelvic Health, which opened in 2019, aims to change that narrative. Its multidisciplinary team of urogynecologic experts offer the full spectrum of therapeutic approaches to women with these conditions, delivered in a compassionate, patient-centered setting.
“Any woman suffering with issues such as incontinence, symptoms of pelvic organ prolapse, or accidental bowel leakage needs to know our center is a place where they can receive care specifically designed for them, and that our urogynecologists are best able to meet their needs — whether it’s conservative options, behavioral care, or surgical care when necessary,” says Christopher Tarnay, MD, professor of obstetrics & gynecology and urology, and co-director of the UCLA Center for Women’s Pelvic Health.
To better serve its patients, the center uniquely brings together subspecialists from UCLA’s Department of Obstetrics & Gynecology and Department of Urology, marrying the two disciplines within the field of female pelvic medicine (also referred to as urogynecology) to provide integrated care under one roof. The center’s urogynecologists also work closely with colleagues in gastroenterology and colorectal surgery, as well as a network of ancillary service providers, such physical therapists. In addition to older women, another important patient population includes postpartum mothers who are struggling with pelvic floor issues in the months following delivery.
“By combining the expertise of these two departments in a collaborative, multidisciplinary center, we can ensure that each patient receives optimal care for her condition,” explains Victor Nitti, MD, professor of urology and obstetrics & gynecology and co-director of the center. “Among the center’s seven urogynecologists, we have experts on all of the conditions and treatments patients might need, and we work as partners to individualize therapies, ensuring that patients can choose the best treatment for themselves based on their condition, lifestyle, and goals.”
The spectrum of treatments ranges from conservative, nonsurgical approaches to surgical options that include laparoscopic and robotic minimally invasive procedures, as well as major pelvic reconstructive surgery. Many of the conditions can be managed with behavioral modifications, pelvic floor physical therapy, or medications. Innovative yet simple office treatments for women can include urethral bulking, acupuncture nerve stimulation, or Botox, which can be extremely helpful in improving quality of life. For certain pelvic floor conditions, the center’s urogynecologists offer biofeedback as part of the rehabilitation. Beyond offering state-of-the-art care for women with common problems related to pelvic function, the center’s expert team is equipped to handle rare and challenging reconstructive surgical cases, such as complex fistulas and complications from gynecologic or colorectal cancer treatment.
Traditional therapies for pelvic floor disorders can be highly effective, but new treatments also continue to emerge, giving women a wide array of choices that can be provided by the center’s multidisciplinary team. The center is currently conducting a clinical trial on a small, implantable neuromodulation device that is placed on the tibial nerve as a nonsurgical alternative to medication for women with overactive bladder, as well as a clinical trial using Botox to treat women with pelvic pain. A third study is underway deploying the patient’s own tissues or stem cells to treat stress urinary incontinence, also as a nonsurgical alternative. Regardless of whether patients participate in these clinical trials, Dr. Nitti notes, “We’re always looking to improve patient outcomes, and we use the information and outcomes collected through all of our treatments to ensure that we are providing care to each patient informed by the latest evidence.”
At some point in their lives, approximately one in three women will experience a pelvic floor disorder, with roughly one in nine needing surgery. An important goal of the UCLA Center for Women’s Pelvic Health is to raise awareness that these disorders are both common and treatable, and to provide a space where women feel comfortable discussing sensitive issues. “In the past, older women were told that they would just have to live with it, but that is no longer acceptable,” Dr. Tarnay says. “We are excited to bring experts in urogynecology together in this unique way to manage these disorders and make a difference in the lives of our patients.”
