After five years of delivering babies, Dr. Bernard Taylor, a urogynecologist with Roper St. Francis Physician Partners Urogynecology and Pelvic Surgery, discovered a passion for urogynecology. With more than two decades in the field, today he treats women for various pelvic-floor disorders, including bladder control issues, frequent or strong urges to urinate, urine leaks, loss of bowel control, and prolapse of the uterus, bladder or rectum.
“Pelvic-floor disorders are most commonly associated with the events of natural childbirth,” he explains. “We don’t think of childbirth as traumatic because having a newborn baby is such an exciting milestone and celebrated event. Unfortunately, during delivery, some women sustain injuries to pelvic muscles and nerves that can have long-term impacts on the support and function of the uterus, bladder and rectum. Often the injuries are not apparent and may not become noticeable until after multiple pregnancies or as women age. There is a natural weakening in muscles and connective tissue as women and men get older, so the conditions related to pelvic-floor disorders are more common later in life.”
Pelvic-floor issues can also present in women who lift heavy weights or are constantly straining. “We’re seeing an increasing number of women who do heavy lifting, high-impact training or CrossFit, and running present with concerns of leaks with exercise or vaginal pressure related to prolapse. This is due to the straining that exacerbates or puts strain on the already weakened pelvic floor,” he says. “Other causes are prior radical surgeries for cancers, spinal surgeries that involve nerves, medical conditions, smoking and poor nutrition, or there is a family history or genetics that predispose certain women to develop these conditions. We don’t have a 100% recommendation to prevent these problems, but we can develop a treatment plan based on an individual woman’s activity level, lifestyle, goals and expectations. We use the term quality of life to address our patient care planning because these conditions rarely cause significant medical problems on the scale of hypertension, heart disease or diabetes, but they can be just as debilitating for many who are suffering.”
Dr. Taylor is passionate about his field, partly because so many women struggle with pelvic-floor issues in silence. “The economic impact of incontinence or urine leakage is in the billions of dollars per year nationwide,” he says. “Over half of the briefs, sanitary pads and liners sold are being used for incontinence. Besides that, people with pelvic-floor issues have a much higher rate of depression and anxiety because they can’t engage in activities that once defined them. Some can’t live at home anymore because of incontinence issues, so they need nursing care.”
One of his goals is to normalize conversations around these conditions. “I try to develop a dialogue and educate my patients about how common these conditions are so they don’t feel so isolated,” he says. “Those conversations alone can alleviate anxiety and fear and sometimes allow women to open up about other things I need to know to help them.”
Many patients don’t need surgery to treat their condition. “First, we identify lifestyle elements such as diet, chronic constipation or unnecessary lifting and straining,” he says. “Some may need help with yard work, for example, or they may need to alter their job or learn how to perform tasks better. We also try to determine if there are other medical conditions that contribute to their symptoms; sometimes, we can change medication and talk to their other doctors to make changes in medications that are having negative side effects, such as diuretics that cause increased urination.”
When lifestyle modification isn’t enough, Dr. Taylor discusses moving on to surgery. Before the days of minimally invasive surgery, women spent days in the hospital with weeks of recovery at home. “Now they’re often home the same day and driving themselves back to see me in seven days,” he says. “These procedures aim to minimize symptoms, but sometimes we want to gain or restore function so patients can resume activities that help restore personal identity and self-esteem. One area that is often not emphasized is how intimate relationships can be affected by pelvic-floor issues. It’s very important that we also address how impactful these conditions can be on relationships and families.”
In the past, pelvic-floor surgery required a large incision on the stomach; minimally invasive surgery is done laparoscopically or robotically, resulting in less pain and faster wound healing. “I don’t usually treat life-threatening medical emergencies, so we rarely save lives, but patients often express appreciation for making their lives whole again. After treatment, many patients tell me they’re active with their kids again or finally able to take vacations and enjoy travel without the worry of having accidental leakage. These stories motivate me, and I’m excited about the opportunity to be in Charleston and partnering with Roper St. Francis Healthcare to provide care for the Lowcountry and Charleston community.”
Robin Howard is a freelance writer in Charleston. See more of her work at robinhowardwrites.com.
