The Get Healthy Tampa Bay Podcast

E89: Pelvic Floor Recovery After Childbirth: Insights from Urogynecologist Dr. Nabila Noor

• Kerry Reller

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Welcome to the Get Healthy Tampa Bay Podcast with Dr. Kerry Reller! This week, I am joined by Dr. Nabila Noor, a board-certified urogynecologist and pelvic reconstructive surgeon. In this episode, we dive into the often-overlooked topic of pelvic health after childbirth. Dr. Noor discusses the impact of pregnancy and childbirth on the pelvic floor, common issues like prolapse and incontinence, and the importance of postpartum recovery. We also explore treatment options, from pelvic floor exercises to surgery, and ways to empower women to seek help and not suffer in silence. Tune in for expert advice and practical tips on maintaining pelvic health for the long term!

Dr. Nabila Noor is a board certified, and fellowship trained Urogynecologist and
Reconstructive Pelvic Surgeon. In her practice, Dr. Noor takes care of women with a variety of pelvic floor disorders such as urinary incontinence, pelvic organ prolapse, fecal incontinence, fistulas to name just a few which can significantly affect a women’s quality of life. She is passionate about education and practicing evidence-based medicine and offering the most cutting edge minimally invasive surgical techniques to her patients to help them recover faster and get back their quality of life.

She pursued her undergraduate studies at Smith College, which is an all-women’s
college that first sparked her interest in women’s health. She then continued her educational journey at Duke University School of Medicine, where she honed her clinical skills and knowledge. Following medical school, she completed her residency in Obstetrics and Gynecology at the Icahn School of Medicine at Mount Sinai. To further specialize in Urogynecology, she completed her fellowship at Beth Israel Deaconess Medical Center/Mount Auburn Hospital affiliated with Harvard University, equipping her with advanced minimally invasive surgical techniques and patient management skills.

Dr. Noor currently practices in Allentown PA where she has a busy and thriving practice.

0:00 - Introduction
0:28 - Welcome Dr. Nabila Noor
0:57 - Dr. Noor's Background and Specialization
2:23 - What is the Pelvic Floor?
5:39 - Common Post-Childbirth Pelvic Health Issues
8:20 - Impact of Breastfeeding on Pelvic Health
10:27 - Female Anatomy and Pelvic Health
13:46 - Risk Factors During Childbirth
15:17 - Pelvic Floor Recovery Strategies
17:43 - Correct Techniques for Kegel Exercises
22:32 - When to Consider Surgical Options
30:11 - Addressing Concerns about Pelvic Mesh Use
39:56 - Conclusion and Contact Information

Connect with Dr. Nabila Noor
Website: https://www.drnabilanoor.com/
Youtube: https://www.youtube.com/@UCXWBttgJliEYxy9QB9wyn0g 
Facebook: https://www.facebook.com/profile.php?id=61557585516981
Instagram: https://www.instagram.com/drnabilanoor/
LinkedIn: https://www.linkedin.com/in/dr-nabila-noor-9b5b2930/

Connect with Dr. Kerry Reller
Podcast website: https://gethealthytbpodcast.buzzsprou... 
My linktree: linktr.ee/kerryrellermd
Facebook: https://www.facebook.com/ClearwaterFamilyMedicine
Instagram: https://www.instagram.com/clearwaterfamilymedicine/
Clearwater Family Medicine and Allergy website: https://sites.google.com/view/clearwa...
Podcast: https://gethealthytbpodcast.buzzsprou...

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Kerry:

Hi, everybody. Welcome back to the Get Healthy Tampa Bay podcast. I'm your host, Dr. Kerry Reller. And today we have a very special guest, Dr. Nabilia Noor. Nice to have you on the podcast. Thank you so much for joining us.

Nabila:

Yes, no, the pleasure is all mine. I'm excited to be here and share our conversation with your guests.

Kerry:

Yeah. So you have a little bit of a niche within OBGYN and I would love for you to I tell your story of how you kind of got into what you do and tell us who you are

Nabila:

yeah, absolutely. So, my name is Dr. Nabila Noor. I'm a board certified and fellowship trained urogynecologist and pelvic reconstructive surgeon. But as you mentioned, my background is in obstetrics and gynecology. After medical school, I did my residency in obstetrics and gynecology, and then realized that I wanted to focus, or specialize, in taking care of women, with pelvic floor disorders. So that's when I did a fellowship in urogynecology. My practice right now is a hundred percent urogynecology, where I take care of women suffering from a whole host of pelvic floor issues, which can include things like urinary leakage, bowel leakage, pelvic organ prolapse, childbirth related injuries, which we're going to talk about today. And of course, a whole host of other things both medical as well as surgical. So it kind of gives me a good combination of things that I can take care of. And especially having that OBGYN background really enables me to understand things from a female perspective, because I've taken care of women with pregnancy, postpartum, and pretty much all decades of their lives.

Kerry:

Yeah. I mean, that's encompassing so much. And I think definitely our listeners are going to be very curious of what you have to say. So what I wanted to kind of focus on was basically childbirth and the impact of that on pelvic health and basically long term recovery strategies. Can you explain kind of what happens with the pelvic floor during childbirth and why it can lead to some issues like prolapse and incontinence and?

Nabila:

Yeah,

Kerry:

it.

Nabila:

So I think, you know, before I answer that question, let's talk about what is the pelvic floor, because it's a very common question. We hear about pelvic floor, but a lot of the times patients don't even know what we mean by that. So the pelvic floor is essentially a combination of muscles and connective tissue, which forms the base of our body. It's the base of our torso, and it's helping support all our pelvic organs, which can be the uterus, the bladder, the rectum, the intestines. So the pelvic floor is very important to support those organs. So when we talk about pelvic floor issues or pelvic floor dysfunction or injuries to the pelvic floor, as a result of childbirth, essentially what we're talking about is either injuries or damage to those muscles or ligaments, and as a result, it can affect the organs it's supporting. So with regards to pregnancy, there's a whole host of reasons why women develop pelvic floor issues. So if you break it down, for example, if you start with pregnancy, the act of pregnancy, carrying a baby for nine months, puts a lot of pressure on the pelvic floor over an extended period of time, especially in the third trimester, right? So as the baby gains weight, you know, as the mom's belly, kind of increases in size, that constant pressure on the pelvic floor muscles can cause some damage to the nerves, to those muscles. Then we have the process of delivery. Now depending on what kind of delivery you had, whether it was a vaginal delivery, whether you were laboring for a long period of time, whether you needed assistance to get the baby out, for example, things like a forceps delivery or a vacuum assistant delivery, Or you had an episiotomy, which is an artificial surgical cut that we, or the OB GYN sometimes have to make to enable the baby to come out. Again, all things that can cause damage to the pelvic floor. And then of course you have the postpartum period because there's so much hormonal changes that's going through your body, especially for women who are breastfeeding. So immediately postpartum, our body is in a state of what we called hypoestrogenic state, meaning the estrogen level drops. So as a result, our vaginal tissue There are lots of anatomical changes, a lot of physiological changes to the vaginal tissue, to the walls of the bladder, to the walls of the urethra, and essentially women can have symptoms which mimic as if they were in menopause. So a lot of vaginal dryness, a lot of urinary urgency, frequency, irritation, pain with intercourse just pelvic pain in general, and of course if you've had some trouble to that area from laceration or repair, You have stitches over there which can also cause a lot of discomfort. So there are lots of different aspects. I know I kind of brushed through everything, but of course we can talk in more details. But that's kind of why you see a lot of these changes to the pelvic floor during pregnancy, at the time of delivery, and of course postpartum.

Kerry:

Yeah, that was a great overview. Basically, what is the pelvic floor, what is it doing for us, and then what can happen when you have you know, childbirth delivery and even just pregnancy. So there's a lot of changes going on. And I hadn't really thought about how it is the low estrogen state because I remember going after my deliveries, having like those same symptoms that people have during menopause, even hot flashes, you know, I think were occurring for me, but so those are very, very important. So what are the most common pelvic health problems that women experienced after childbirth?

Nabila:

Yeah, it varies from woman to woman, right? I mean, the obvious ones being if you've had a traumatic delivery where maybe you had a bad laceration. So when we talk about lacerations, lacerations are tears that can happen at the time of vaginal delivery. Now, most women, especially if it's your first delivery, you can have what would be called a first degree or a second degree laceration, which essentially is trauma to the vaginal epithelium, which is the first surface layer of the vagina. And maybe a little bit of the muscles underneath. Those are very common. We can repair it at the time of delivery and patients do very, very well. The more complicated lacerations are the third degree and fourth degree lacerations. That's where you can have injury to the anal sphincter muscles. And of course, the sphincter muscles are very important for women to be able to control their stool. So again, if somebody has had a traumatic delivery where they've had a third degree laceration or fourth degree laceration where there was significant amount of damage done to the anal sphincter, women can have issues with bowel movement and not being able to control the stool. So that's one. Urinary symptoms, right? So urinary symptoms could be urinary urgency, which is the feeling like you gotta go, gotta go, going a lot of the times, not being able to control it. So that's leakage associated with that urgency. And again, a lot of that is caused by that low estrogen state that I was referring to, especially if you're breastfeeding your body doesn't have a lot of estrogen still. So you may notice a lot of these symptoms. And of course, if there was damage done to the nerves, to the bladder again from the process of delivery, that also can cause symptoms like urgency and frequency with urination. If there is damage done to the bladder sphincter or to the urethral sphincter muscles or the support of the urethra, which is the pipe through which urine comes out, women may have leakage with laughing, coughing, sneezing, something that we call stress incontinence. So those are the big things that you see about. The other thing women talk about is feeling feelings of vaginal laxity where everything just feels loose or they feel like something is coming out through the vagina. It feels like there's a ball hanging out. That's known as pelvic organ prolapse. And that happens when the support structures that was supposed to hold your uterus and your bowels and your and bladder in place inside the abdomen are not working the right way. And as a result, those organs are trying to push through the vaginal wall, almost like a vaginal hernia. So those are some common things we talk about and we see. And then, of course, pain with intercourse is a big one, especially if, you know, women haven't healed very well from their previous repairs and there may be stitches or there was maybe some scar tissue from the repair they had. Maybe the swelling there, maybe there was some damage down to the pelvic floor muscles, so that can have some longstanding effect as well.

Kerry:

Could you explain why breastfeeding makes some of these like risk factors worse, I guess.

Nabila:

And that's a great question because we don't think about it. So when you're breastfeeding, you have a high level of a hormone called prolactin, which is basically, you know, we call it the bonding hormone. That's what allows us to bond with our babies. That's what allows women to be able to produce milk necessary for lactation. But what prolactin does, unfortunately, is suppresses estrogen. That's basically nature's way of telling us, like, look, you already have a little one to take care of. Don't get pregnant again, but the issue is estrogen is what's responsible for a lot of our problems. You know, a lot of improvement of our pelvic health and whether it's the anatomy as well as the physiology. So when you have a lack of estrogen or when the estrogen level drops, there are changes that we notice anatomically at the vaginal level. So women have a lot of vaginal dryness, a lot of irritation, so that's why they have a lot of the pain with intercourse. Even putting a tampon can be really uncomfortable, especially, when you're breastfeeding because your tissue is so raw. And then also estrogen receptors are also present at the base of the bladder as well as the urethra. So that's why you can also see some urinary symptoms. Estrogen is really, really important for a lot of our vaginal health. So even though we're very familiar with the term genitourinary syndrome of menopause, which is basically all these symptoms, but in menopausal women, we have this new term which is known as genitourinary syndrome of lactation, which is basically women who are breastfeeding who are also having a lot of these same symptoms. We're very good at treating menopausal women with estrogen, But sometimes we hesitate for young women because in our mind as physicians we think, oh, they have estrogen already. They do, but it's at a very low state. So for my patients, for example, when they come with complaints like this, I would often prescribe them vaginal estrogen, even though they're not menopausal because it could significantly improve their quality of life.

Kerry:

Yeah. I remember before I knew any of this, one of my friends was like prescribed that and I was very curious, but now learning everything at all makes sense. Could you also explain a little bit that I don't know if everybody knows the anatomy as much. So you said like a urethral laceration could, you know, have some of these symptoms as well. And some people don't know exactly where the urethra is in that

Nabila:

And you're, you're absolutely, you're absolutely right. Because a female anatomy, it's not a lot of external structures, because most of it is inside the body, right? So with regards to just the basic, you know, what is your female organs, you have the uterus, which is basically the organ that holds our baby. And then coming out from the head of the uterus, like these two horns, you have the fallopian tube. And then at the At the end of the tube, we have the two ovaries. Now, the ovaries is what's responsible for producing hormones. And then every month when we're ovulating, the ovary releases an egg that travels through the tube into the uterus. And if there's intercourse, if there's a sperm inside the uterus, with copulation, then the two can fuse, and then essentially you have a pregnancy that gets embedded in your uterus. Now The uterus, the tip of the uterus is what's called the cervix, and of course, the bottom of the cervix is the vagina. Now this is all the female GYN organs. I always tell my patients, when you're looking at the vagina from outside, there are three holes in there, and patients are always confused like what I'm talking about. So there's the urethra, which is where urine comes out from. There's the vagina, where the baby comes out of And then there's the anal, which is the anal opening through which stool comes out. And there are three very different openings. So the vagina, like I said, is where the baby comes out, but right above that is the urethral opening. So the urethra is the pipe that's connected to our bladder. And bladder is what holds our urine. And then underneath the vagina is where you have the rectum that collects stool. And then the stool comes out through the anal opening. So yeah, it's much easier to see it in pictures, but that's kind of my overview with words.

Kerry:

No, that's helpful because I've definitely had several patients come to me not knowing their anatomy and surprise what is this extra hole there? Right? So the urethra is sometimes missed and it's just interesting that they're not even aware. So when you're delivering, or when the baby is coming vaginally you're just saying there is at risk of urethra being encompassing in, like, injury and having problems afterwards. Correct?

Nabila:

What happens is, you know, of course, majority of the times the injury is on the vaginal wall, right? Which is the bottom wall. And so the rectum is close by, which is where the stool collects. So when you have a tear on the vaginal wall, If the tear is going all the way down to the rectum, you can basically have that injury to that anal sphincter, but the urethra, like you mentioned, is right above, so it's not far away. Sometimes, especially when you have a big baby that's coming out, or maybe we had to use some instruments like a forceps to assist the delivery or maybe a vacuum. And then, you know, there was a lot of trauma as we were trying to get the baby out. But the urethra, which is a very soft and a very sensitive organ because you know, there's not much to it. It's not uncommon for it to have injury, you know, especially the, the muscles underneath the urethra, which is the sphincter muscles can be injured. Or, you know, if you're unlucky, you could have tear that can basically, you know cause a false track forming between the vagina and the urethra. Thankfully it's not as common. So I don't want the audience to feel like, Oh my God, like I could not have a vaginal delivery because all these things can happen. Thankfully majority of the patients do great, but again, if you are a patient who maybe have a bigger baby and you know, you're noticing some problems already, these are times to kind of bring these up with your OBGYN to have a conversation so you can go into this whole birthing experience knowing what are some possibilities and so you're not shocked when, God forbid, something happens.

Kerry:

You kind of already, like answered my next question, which was. What other factors during childbirth and pregnancy can increase the risk? And what you said, forceps, larger baby, vacuum delivery what else was there?

Nabila:

I think, you know, another thing that I tell patients, like vaginal delivery, if you can have it, that's the best option because it's natural, right? You're not having a surgery, so there's no risk of surgery. But for example, if you've been laboring for a long time and things are not progressing those are again some cues for your OBGYN to be like, you know what, maybe I need to think about some alternative options. I think it's always a conversation, right? I think as long as you're in communication with your physician, you trust them, you trust their judgment. It's a relationship. So there's no right or wrong answer. We all have our own conception or perception of how we want our delivery to be. But guess what? The babies have their own mind, even before they're born. So they want to do what they want to do. And at the end of the day having a safe baby while the mother is being safe without causing a lot of damage to her anatomically, physiologically, and should be told emotionally because a lot of the things we talk about can have a lot of longstanding emotional repercussions. So that's also something that I want our audience to know that, you don't want to do something just because you think that you want a certain way to deliver a baby that can have negative consequences that can affect you much later in life.

Kerry:

Yeah, that's a really good point as well. So, I mean, we're talking about like after childbirth now. So what are some of the first steps women could take to ensure that their pelvic health is on track?

Nabila:

Yeah, absolutely. I think, you know, one of the things that you know, women can do even while they're pregnant, as long as there's no concerns or any complications that they're having is pelvic floor exercises. There are lots of options available online. I mean, especially now, there are lots of physical therapy online who do like amazing exercises that patients can see and learn about. A lot of the times we kind of equate pelvic floor exercises to Kegel exercises, which is a lot of it. And sometimes, patients will tell me that they've been doing Kegels all their life. But the important thing to understand is you have to do it the right way, isolating the right muscles. And sometimes that can be difficult because your pelvic floor muscles is not something that you can see like your abs or your biceps. It's not external. It's internal. So I think the most important thing to understand is if you're going to be doing the Kegel exercises by yourself, make sure you're doing it the right way. And also money is in the repetition. It's just like any other exercises, just doing it once or twice is not going to help you, but you have to keep at it. So you can even start doing some exercises while you're pregnant again, focusing a lot on your body posture, Especially in the third trimester, as the baby gets bigger, it could affect our posture very badly. And again, anything that can affect your lower back can cause issues with your urinary symptoms, bowel symptoms, because all the nerves that's controlling those organs are coming from your lower back. So focusing on your posture is very important. And even so, immediately after delivery. I'm a big proponent of doing this pelvic floor exercises after delivery, whether or not you feel you have pelvic floor issues or whether or not you are suffering from some of the symptoms we're talking about, because again, the focus should always be on prevention, right? So that's how you can prevent these from happening. And so if you're not sure if you're doing it right, then That's when it's helpful to work with a pelvic floor physical therapist. So these are trained physical therapists who are very familiar with women that we're talking about, and they can focus on your pelvic floor muscles, strengthening your pelvic floor muscles, helping you with body postures, alignment, Because immediately postpartum, there's a lot of changes that happens to our movements. I mean, think about you're carrying a baby all the time when you're breastfeeding, right? Those baby carriers, those are heavy, right? So if you're doing that multiple times of the day and you don't have the right postures, or when you're picking your baby up from the floor, if you're not focusing on how your body postures is, how your body mechanics is, again, all this can have long standing effects.

Kerry:

How can someone know if they're doing the Kegels correctly?

Nabila:

That's a little bit more difficult, right? Especially when I evaluate patients in the office, what I do is I usually put two fingers in the patient's vaginal canal and I have them squeeze, give me their best kegel exercises. So essentially the trick is not to use your abdominal muscles, Or use your hip muscles. Because a lot of the times when we think we're tightening our pelvic floor muscles, what we're really doing is tightening your ab muscles. So putting a hand on your belly can show you or make you understand whether or not you're tightening your abdominal muscles. Because if you're tightening your abdominal muscles, then you're not doing it the right way. Same thing if you're using your hips to lift up from the bottom of the bed, then again, you're using your hip muscles. So without using your abdominal muscles, without using your hip muscles, if you can feel the tightness around your finger, then that's the right thing. So if patients are comfortable doing it themselves, they can always lay down in bed, put one hand on your abdominal muscles, and then two fingers from the other hand in the vagina, and you should feel that tightness as you're squeezing. If you're not feeling it the right way, if you're not feeling that pressure on your fingers, that you're probably not doing it right or those muscles are very weak and that we need to work on them.

Kerry:

I often tell people, I mean, I'm not an expert or anything, but some people say like, oh, it's like stopping your urine. But I also say, well, you should also be holding in a fart because it's going to incorporate more of the lower pelvic floor muscles than just trying to stop the urine, if that makes any

Nabila:

Yeah, absolutely. And I think that's another good analogy as well. It's like that feeling when you're really trying to hold a urine and they're not trying to go. The one other thing that I will say while we're talking about Kegels is, you know, Kegels, we always talk about strengthening our pelvic floor muscles, and that is one component. But equally important is learning how to relax those muscles, right? So I always tell my patients that it's a three step process. You basically suck it in. So you contract, you hold, and then you relax. And the relaxation is just as important as the contraction. Because if you're not relaxing, what ends up happening is over time, as you're just contracting those muscles, just contracting those muscles, those pelvic floor muscles develop soreness and pain and just basically become painful, short, tight muscles. And the patients end up with something pain. called myofascial pain syndrome, where now those muscles are just so tight and painful that they're not functional at all. And so as you can imagine, if those muscles cannot function properly, it can again, number one, cause pain with intercourse. Number two, cause problems when you're trying to urinate because urination or during urination, you need to relax your pelvic floor muscles. And same thing with bowel movement, right? If you're not relaxing the Relaxing your pelvic floor muscles adequately when you're trying to have a bowel movement, that stool is not going to come out. So just as important as learning how to strengthen those muscles is to know how to relax those muscles as well.

Kerry:

Yeah, that's a really good point. I think that Often when we're just coaching people on constipation things, that's learning how to relax the floor as well. Yeah,

Nabila:

Yeah. And it's actually something that I see very commonly with my young patients and patients that you won't, you won't think about. It's the people who are, you know, has the perfect body, works out all the time, but sometimes That's exactly the problem is because they're focusing so much on just tightening their core, or just like, you know, tightening their pelvic floor muscles they forget that relaxation is another big component. And then over time, you know, a lot of these women who have been doing, like strength exercises, core exercises for many, many years and by the time they come see me and they're like, I can barely have sex because it's so painful. And then the second I try to do an exam, I'm like, Oh my God, that you have your pelvic floor muscles are so tight. And, you know, the first look at me like, wait, what, what do I have to do? Because the treatment is really to learn how to relax those muscles. And they think I'm just like bluffing, but I'm like, no, believe me, just learning how to relax those muscles is really going to help your symptoms.

Kerry:

yeah. It's not like you can go and stretch them out and get

Nabila:

No, or it's not like I can operate on them either because operating, cutting into those muscles is going to cause even more trauma and cause even more scar tissue and actually exacerbate their symptoms.

Kerry:

Yeah. I think that's a great role for pelvic floor physical therapy. Like the therapist can get in there and help with that myofascial release and

Nabila:

Yeah, and I think that's why, too, like, you know, a lot of the times, the good PT, they will know, right? If you have a a physical therapist who's only telling you to do Kegel exercises without doing an assessment of what it is that you need, then that's a red flag to me, right? Because a lot of patients, yes, they need the strengthening exercises, but there are many patients who need the relaxation exercise. And of course, again, it's a conversation. It's a three way conversation, right, between your physician, The patient and of course the physical therapist, but that's where good communication is very important.

Kerry:

yeah. So how about the surgical options for women who basically aren't finding relief from conservative treatment? How do you decide when surgery is necessary?

Nabila:

Absolutely. Again, you know, I think it's a conversation that I have with my patients. I think a lot of my young patients, especially maybe women who are still not done with childbirth, I do encourage them to focus on more conservative stuff or like some conservative measures. like pelvic floor exercises. There are other conservative measures, depending on what pathology we're talking about, but once women are done with childbearing and they've given the conservative options a try and things are not improving and still getting worse, that's a time we discuss surgical options. Now, again, depending on what pathology we're dealing with, whether it's leakage of urine, there are some amazing treatment options, whether it's bowel incontinence, where you're not being able to control stool, there are amazing treatment options. The pain, the pelvic pain you know, there are not really a lot of surgical options for that. It's more kind of working with a good PT, like we talked about, you know, focusing on bifacial relaxation, pelvic organ prolapse. We have some amazing treatment options. And the good thing about this treatment options that I will say is most of the surgeries that I perform now, we call them minimally invasive techniques. And what that means is most of these surgeries are done with tiny incisions. For a lot of my abdominal surgeries, I do it using the robot. So essentially patients have tiny incisions, which are essentially a centimeter or less. Most of my patients are going home the same day. There's minimal blood loss. There's minimal pain afterwards and their recovery and how fast they get back to work is amazing. So, you know, again, for the right patient, surgery can be a game changer. So if that's what you're thinking, or if you're not sure, at least I would definitely urge patients to talk to a specialist, I'm a urogynecologist we go through specialized training, as I mentioned before, after our OBGYN residency to essentially take care of women who are suffering from these. You can also have some specialists who have the urology background, but they focus on female urology. So make sure you find the right specialist who can talk to you about different options. And then together we come up with a plan that works for each patient.

Kerry:

So you mentioned like the recovery is a lot better. Do they kind of jump right back into how they were before or how does

Nabila:

Yeah, yeah, again, it depends on what surgery we're talking about, right? So let's say, for example, for urinary incontinence. So for women who leak with laughing, coughing, sneezing, so that's the stress incontinence. So one of the most common surgeries we do for that type of pathology is something called a sling procedure, where we essentially put a tiny piece of mesh under the urethra, and that mesh supports the urethra like a little hammock, basically recreating that backdrop or that scaffold that the body was missing. Okay. Now those surgeries, they're 15 minutes. It's done with light sedation, patients going home the same day. Yes, in theory I tell patients that maybe don't do any heavy lifting for about four weeks or so, and then of course nothing in the vagina while the stitches heal, but they're walking, doing their normal stuff. They are going back to work. They can walk the stairs, no problem. I wouldn't recommend doing any heavy duty exercises, but you know, if you want to go for a walk, you want to do a light jog on the treadmill, that's totally fine. But I think the most important thing is, you know, before we used to have to have patients stay in the hospital for at least two, three days and then recover. Cause a lot of these were major abdominal surgeries. I mean, that's thankfully a thing of the past now.

Kerry:

That's definitely good to hear. So we kind of alluded to this, but some women might feel embarrassed or ashamed to talk about pelvic health issues. So how do you help them kind of feel more comfortable discussing all of their concerns?

Nabila:

Yeah, the first thing I will say is it is more common than you think. When it happens to somebody, patients, like you said they're so shocked, first of all, and then they think that they're the only person who's suffering with this. I'll give you some statistics. With regards to urinary leakage, one in two women will have urinary leakage at some point in their life. So that just tells you how common it is. Pelvic organ prolapse. So that's where the ball comes out through the vagina or you feel that laxity. 50 percent of women who have had pregnancies and vaginal birth will have pelvic organ prolapse, so it's more common than you think. Fecal incontinence, one in 12 women will have that. So it's definitely more common than you think. And I think that's why we're doing this conversation is to kind of create awareness that these are things that can happen. And yes, it's common, but it's definitely not normal. And then there are tons of amazing treatment options, whether it be conservative or surgical that can significantly improve their quality of life. So if you feel, especially after hearing this podcast that, Oh, something doesn't feel right. Like, I thought leaking urine was just a part of, aging or because I had a baby understand that there's nothing normal about leaking urine or leaking stool or having pain with intercourse when you didn't have it before. All of these conditions are pathologies, and there's a whole specialty that deals with women just like that, right? So I would 100 percent urge patients that even if you're not sure if you have a problem, go talk to a specialist, have a consultation, have them do an exam, have them tell you what it is that you're feeling or what you're seeing and what their evaluation looks like, and then you come up with a plot that works for you. Very often I see patients who come to me because maybe they thought they had something and I do an exam and I'm like, you know what, it's really nothing and we'll talk about some conservative measures. We'll talk about things that they can do to help prevent it from getting worse and that's it. And then some of those women may return many years later because now their conditions have gotten worse. Many of those women I never see, which, you know, I'm taking it as like they're, they're still okay. But what I would urge is do not suffer in silence. And I think for a long period of time, Women have suffered in silence because we have been told that these are all normal things. These are common things. This can happen after childbirth. These can happen with menopause. And I'm here to tell you, yes, they're common, but it's definitely not normal.

Kerry:

Yeah, I think you definitely summarize that very well. It's like, make sure to know that. Hey, if something is bothering you to go ahead and talk to your doctor about it and seek help. Yeah I did. Well, there were some things you wanted to touch about that we started before we were like recording and everything. I just want to make sure that we touch that.

Nabila:

Yeah, I think I know we've covered a bunch of different things. One thing I will say while we're talking about surgery, I know we didn't go into the specifics of surgery, but a term, a bad term in my world that comes up that creates a lot of fear factor in women is the term mesh. Early in 2000, there were a lot of controversies about mesh because a lot of women had surgeries with mesh, whether it be because of urinary leakage or whether it be because of prolapse. I will tell you a lot has changed in the last two decades. There's been extensive research put into it. The mesh has been extensively vetted. And my specialty is a really a baby specialty. Our specialty became a board certification in 2013. And that's because The society has realized that we need specialized surgeons who can focus on this and take care of women who have problems like this. So all that has significantly improved outcomes. So a lot of the complications that women used to have before, whether it be pain with intercourse after these surgeries, mesh coming out, mesh getting into their bladder, Like infections a lot of those we don't see them anymore, but again, it's a little bit more specific, but if you're ever talking to a specialist and they talk to you about a surgery that you need that involves mesh, don't have the automatic gut reaction that, oh my so and so friend had a mesh surgery and they had the most horrible experience. Because I hear this all the time in my office, like, oh, no, no, no, I'm not going to even talk about mesh because my so and so that I know had this problem. Yes, unfortunately, some women were harmed, But like I said, that's why we have specialties now that focuses on this, and that's why it's very important, especially if we're thinking about surgery, to find the right surgeon who have a lot of experience doing these surgeries, and they're doing it all the time, because that helps improve their outcomes, and that helps improve your outcome as well.

Kerry:

Yeah, no, that's a really good point. I do remember a lot of the controversy with mesh, even for hernia repairs, I think, right? Yeah. So Dr. Noor, if you could give one piece of advice, which I think you already gave to women who are pregnant or have recently given birth regarding their pelvic health, what would it be?

Nabila:

You know, first of all, congratulations. And what I'd say is, you know, pregnancy is an exciting time, but sometimes what I do feel, especially with social media, it can be very overwhelming because, you're hearing and seeing the stories of like the perfect gender reveal and then like the perfect, like birthing experience. What you don't hear about is, there's a whole other segment of women who may have not had the perfect, birthing experience, maybe they had a traumatic experience. They have problems and now they're Kind of suffering with a lot of the conditions that we talked about. First of all, it can happen. But again, like I said before, it's not normal. The good thing is there's lots of help. So if you happen to be those women who unfortunately had not the perfect birthing experience and you're suffering with any of these conditions, please know that there are lots of help. Start with asking your OBGYN. Ask them to give you a referral to see a specialist that can talk to you about some of the options that we touched based on, cause we definitely didn't go into much details because you know, we can definitely help you. What I don't want women to take away from it is that, Oh my God, I cannot have a vaginal birth because it's so traumatic. That's absolutely not true. And that's definitely not my intention. But know that yes, everything has a risk. And if if it is something that you're suffering with, please don't wait and get the right amount of help that you can get.

Kerry:

Yeah. I was going to say, we've said some negative things about vaginal delivery and negative things about breastfeeding, but I think it's important to recognize that these are still the traditional methods of and what everybody kind of recommends. Wouldn't you agree? And what

Nabila:

Absolutely. 100%. I think if you can have like a normal, uncomplicated vaginal delivery, that's the best for women, they recover. faster and of course I'm a surgeon, but understand every surgery has risks, right? So if I don't have to make a cut on your body, that's the best option for you. And again, all numbers, right? Majority of women will have a normal vaginal delivery, may have a little bit of laceration, that's fine. What we're talking about is that women, who may have not had the perfect delivery or had a complicated delivery, and now they're having these issues afterwards, that for them to know that This is not something that they have to suffer with for the rest of their lives because there are options. And to your point, I always encourage patients that just because maybe you had a complicated delivery before doesn't mean that your second delivery or third delivery is going to be the same way. Of course, each case is different, but that's a conversation to have with your OBGYN. But it's also important to know what it is that you can do to help reduce your chances of complications. And I think that's where things that we talked about, about focusing on strengthening your pelvic floor with guidance from PT, focusing on body postures, body alignment, those can be really helpful. Now, similarly with breastfeeding, absolutely. I mean, I have two children. I breastfed them both. Breastfeeding is absolutely the best option for your child. But as a result of breastfeeding, if you are having some of the issues that we talk about, whether it be, you know, pain with intercourse, whether it be the urinary symptoms, whether it be just vaginal burning and discomfort, know that you don't have to suffer just because you're trying to take care of your child. There are options. Talk to a specialist. And if you're suffering, have them give you some treatment options that can help your symptoms while you're breastfeeding.

Kerry:

Yeah, no, I definitely agree. Like reaching out to the, the doctor is very important. And then also, you know, we talked about the negative breastfeeding, negative vaginal delivery about the mom. And then now we just reiterated the positive thing, but you already alluded to this, but for the, baby, right? It's very good to try to breastfeed if you can, not everybody can. So we get that, right. But at least that breast milk for a little bit, it's great. And then also it's good for the baby to have the vaginal delivery, to have the gut microbiome and all the things that they get from the mom. Those are positive things. So I wouldn't say go ask for C sections cause you don't want this vaginal trauma or something like that. Right. But you really want to do what's best for mom and baby both. Yeah.

Nabila:

each patient story is different, right? And I think that's where that communication with your OBGYN as you're going through pregnancy can be really helpful, right? And there are markers that we that we can pick up during pregnancy that will give you or that will make your provider kind of guide you one way or the other. Again, of course, if it's a vaginal delivery without complications and there's no contraindications to it, absolutely, hands down, but if there are suggestions where maybe we have a macrosomic baby and it's a big baby that they're worried you may not be able to safely deliver vaginally, without causing a lot of damage to your pelvic floor muscles. And again, these are conversations that just doesn't happen at one visit, right? These are conversations as they're following you, because a lot of the times if there are any concerns, your OBGYN will be following you more regularly. They're probably doing more ultrasounds. So again, there are cues that will tell you if One is better than the other for you. Now, I will say though, for example, if you had a four degree laceration with your first vaginal birth and as a result ended up with a fistula, which is a false track between the rectum and the vagina, and now you're having stool coming out through the vagina, or vice versa, you had a false track developed between your bladder and the vagina, and you have urine coming out those patients I will recommend because I'll see a lot of those patients and I'll tell them like, you know, maybe if you're considering a second pregnancy, consider a c section because it can be protective to your anatomy. But again, they're very specific cases and it's a very individualized basis.

Kerry:

Yeah, that definitely makes sense. You mentioned something earlier before we were recording also about birth plans. I just wanted you to comment on that real quick.

Nabila:

Yes. So, a lot of the times patients have birth plans and that's okay, right? You know, you have a certain perception of how you want to have a baby you've seen it or you've heard it. And like, again, with social media, there's so much information out there. But to me, especially when I was practicing obstetrics, I don't do it anymore. I don't deliver babies, but when I was one thing that I would always talk to my patients about is to me, the best birth plan is to make sure that I help you deliver it. Okay. a happy and healthy baby while keeping you healthy, whether it be physically, emotionally, mentally, all those components, right? And a lot of the times, unfortunately in the world of obstetrics, things happen in seconds. You know, everything is going great and then all of a sudden something happens and you have to make very quick decisions. What I would urge patients to do is, or what I'll your audience to know is that If, God forbid, things are deviated away from your birth plan because of maybe some complications where your physician is recommending one thing don't try to just stick to your birth plan or because you've had this plan because I feel like that's when things can get complicated, right? It can be a not so positive experience for the patients, the physicians involved, and at the end of the day, We have to realize that there's another life at stake. So again, I would like to urge, yes, have your birth planned by all means, but also have an open mind that yes, if things do change for the safety of my baby, for my own safety that I'm willing to do what's necessary.

Kerry:

Yeah, it's very important. Do you have anything else that you want to tell the listeners that we've kind of missed or.

Nabila:

No, I think we touch base on a lot of different issues and I would just like to urge the same thing that I think has been the theme is that a lot of the times women feel very isolated when they develop these things whether it be urinary leakage, colic organ prolapse, bowel issues, you know, it's hard enough to have a newborn because there's so much that you're dealing with, you know, it's sleepless nights. It's having to take care of a baby. You're going through so much changes physically, and you're trying to adapt to a whole new normal for yourselves, add to that these insults that you weren't expecting, or you were maybe not even aware of. It can be really frustrating. It can be really debilitating. Emotionally, it can affect your relationship with your partner. But I'm here to tell you that, here we are talking about this and part of the reason why I feel very strongly about educating women, and pretty much every woman, I don't care if you're 19 years old or you're 90 years old, because I have patients in this whole gamut, is for a woman to be aware of their own body, know what can happen and going into everything, whether it be, you know, the birthing experience, whether it be in a surgery, whether it be in a relationship, knowing that, okay, you understand what can happen to your body and how to take that action best care of it and so that way, if something comes up, you don't feel lost. You have the ownership and you know where to get help. That's really what's important. And I feel very passionate about that.

Kerry:

I love that. Yeah. Well, thank you so much for coming on the podcast today. How can people find you if they want to work with you? Or you also had something you want to mention about your YouTube channel, I

Nabila:

Yes. Yeah, absolutely. So my website is drnabilianoor com. So that's basically a comprehensive place where you can find everything there. I practice in Allentown, Pennsylvania. So if you're in the area and you need to see me by all means, let us know. I'll be happy to see you. I'm also very active on social media and I do have a YouTube channel and it's all easy. It's all Dr. Nabila Noor. And I think what I was telling you earlier is I recently just made a video specifically about this topic that we were discussing today, which is essentially like things that women should know before getting pregnant about their pelvic floor. And I think it's a good video. It has a lot of helpful information. It kind of touches a lot on some of the things we talked about, but goes into a little bit more detail. So definitely check it out on my YouTube channel.

Kerry:

Yeah. Thank you so much. We'll put all that in the show notes and thank you for coming on and sharing your expertise today. We loved having you and everybody stay tuned next week for another episode of the get healthy Tampa Bay podcast. And if you need a new primary care or family and obesity medicine doctor. in Clearwater or Palm Harbor, Florida, please reach out to us. We are accepting new patients. Thanks, everybody.

Nabila:

Thanks everyone.

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Dr. Kerry Reller

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