Lori Smith is an antiques hunter, so on any given weekend she can be found hoisting heavy furniture into her car. Tall and thin, this 60-year-old former swimmer takes pride in staying active and moving at “a pretty good pace.” Four years ago, however, a change in her health slowed that pace to a frightening halt.
“I was so scared,” Smith says, recalling a point in time when her condition made her fear something as simple as leaving the house to walk her dog. “I had six inches of stuff hanging out of me.” Her only relief came from lying down.
Smith would later learn that she was suffering from severe pelvic organ prolapse, a condition in which the pelvic organs, such as the bladder or uterus, drop from their normal place and push against the walls of the vagina. Prolapse affects approximately 40 percent of women, to some degree, and can be caused by vaginal childbirth, surgery or low estrogen resulting from menopause. Although the condition is quite common, most women are reluctant to discuss it openly, and many simply live with the condition while sacrificing their own comfort.
“I was trying to figure it out for myself,” Smith says. Her research led her to a CBS Philadelphia YouTube interview clip of Stephanie Molden, M.D., a board-certified urogynecologist—an OB/GYN with advanced training and expertise in the treatment of pelvic floor dysfunction in women—speaking confidently about disorders that affect women.
The Female Pelvic Health Center, the Newtown-based practice Dr. Molden founded in 2009, treats many of these disorders, specializing in female pelvic medicine and reconstructive surgery. Today, six years later, the Female Pelvic Health Center remains the only urogynecology specialty practice in Bucks County.
“We’re not gynecologists and we’re not urologists,” Dr. Molden says. “We’re somewhere in the middle.”
The discipline of urogynecology is, in fact, the newest of four boarded subspecialties of gynecology. A board-certified physician has received extensive training and has passed certain tests that qualify them as experts in this particular branch of medicine. In 2013, Dr. Molden was one of the first in the country to sit for the urogynecology boards.
“This is all we do,” Dr. Molden says, adding that patients come to the Female Pelvic Health Center for treatment far beyond the routine OB/GYN visit or Pap test. “Our two biggest categories [of patients] are women with incontinence and women with prolapse.”
About one in three women has incontinence, a condition which has two main forms. Stress urinary incontinence is the loss of control that occurs with physical exertion, including coughing, laughing or exercise. For women who do not suffer from the condition, the bladder is supported by pelvic floor muscles and ligaments, though aging, childbirth and menopause can cause these muscles and connective tissues to weaken, sometimes forcing the bladder downward and preventing the urethra from squeezing as tightly as it should. Urge urinary incontinence, on the other hand, is leakage that occurs after suddenly feeling the need to urinate. Instead of the incontinence occurring during physical exertion, leakage occurs on the way to the bathroom. A common cause is abnormal nerve signals that result in bladder spasms.
In either case, it’s important to get the diagnosis right, according to Dr. Molden. “Medication doesn’t help with stress incontinence,” she offers as an example.
For patients with incontinence who require surgery, Dr. Molden often performs the procedure at her onsite surgery center while the patient is under local anesthesia. Her practice is one of a handful of practices in the country that perform the surgery in this way—in a convenient location and with minimal anesthetic.
For patients struggling with incontinence who either don’t need or don’t want surgery, the Female Pelvic Health Center offers therapies that are hard to find elsewhere. The practice offers Pelvic Muscle Training sessions using the latest computerized equipment, along with electrical stimulation when appropriate, to teach women how to contract the pelvic floor muscles correctly. This is vastly differently than simply being told to do Kegel exercises at home.
Biofeedback is another therapy that teaches bladder and pelvic muscle control. In this form of therapy, patients gain positive feedback (either from an electronic device or a health professional) when she performs the desired action—in this case, exercising the proper muscles to effect greater control.
Then there is the issue of prolapse, the condition that had hampered Lori Smith.
“It is something that is an annoyance at first,” Smith says of the condition. “But it becomes something that you deal with from the time you wake up until the time you go to bed—every day. It was so embarrassing. You finally have no option but to seek help.”
Smith says she chose surgery—the option she feared the most, even though surgery success rates are in the range of 90 percent.
“All that’s on the Internet is the bad stuff,” Smith says. “I wanted to know the pros and cons of the procedure.” She asked Dr. Molden what she would do if there were complications. Dr. Molden promptly assured her, saying the majority of patients have no complications.
In addition to incontinence and bladder or uterovaginal prolapse, Dr. Molden and her all-female staff treat patients who have difficulty urinating or excessive nighttime urination, as well as patients who have rectoceles (prolapse of the wall between the rectum and the vagina) or enteroceles (small bowel prolapse). They also treat patients with “pelvic pain conditions that no one can figure out,” as Dr. Molden says.
Changing Lives
Ever since she was a child, Dr. Molden was drawn to “fixing things.” When she became a gynecologist, she gravitated toward the surgical aspects of the practice. She was then exposed to the urogynecology specialty and pursued a fellowship at St. Luke’s University Hospital in Bethlehem.
“I love what I do,” she says—specifically, helping women overcome problems that often go undiagnosed and untreated. In 2014, the Female Pelvic Health Center treated 600 new patients and conducted 4,000 office visits; also, Dr. Molden performed approximately 240 surgeries, not including the small procedures she does at her office.
Dr. Molden’s penchant for fixing things also led her to using state-of-the-art robotic technology in urogynecology. As the medical director of the robotics program at St. Mary Medical Center in Langhorne, she was the first surgeon to perform robotics-assisted surgery there.
Dr. Molden wants women with pelvic-floor dysfunction to know that they don’t need to suffer, to limit travel or to keep from visiting friends or family members because of pain or fear of embarrassment. In other words, they shouldn’t let their condition hinder them or affect their lives negatively.
“There’s usually an option,” she says. “We can actually cure a lot of patients. For those we can’t, there is usually something we can do to improve their situation.”
For Smith, treatment from Dr. Molden has been life changing.
“I’m telling you, I have a 60-year-old body with 20-year-old equipment,” Smith says. She explains how she left the hospital at 8 a.m. the day after the procedure. She felt so good that she had to keep reminding herself not to lift heavy objects or climb stairs.
“I have never had a complication,” Smith adds. “I feel terrific and do everything I did before. I’m still lifting furniture.”
Female Pelvic Health Center
760 Newtown-Yardley Road, Suite 115
Newtown, PA 18940
215-504-8900
www.fphcenter.com
