Episode 149: Unlocking Pelvic Health with Dr. Nabila Noor

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss,

[00:00:04] where I help you get on track and stay on track with your

[00:00:07] weight loss journey. I'm your host Dr. Alicia Shelly. So let's

[00:00:12] get started. Hello, and welcome to the Back on Track

[00:00:30] Achieving Healthy Weight Loss podcast. I'm your host, Dr.

[00:00:34] Alicia Shelly. Now, have you ever had any difficulties with

[00:00:39] some leaking of urine? Or if you laugh, you feel something

[00:00:42] trickle down in your underwear? Well, I was so surprised

[00:00:47] because this has happened to me. And I was so surprised that by

[00:00:51] me having obesity, how that puts me at more risk for having

[00:00:55] pelvic floor disorders. In fact, obesity is associated with

[00:01:00] high prevalence, which means an increased risk of high

[00:01:04] pelvic disorders. And people with obesity or living with

[00:01:07] obesity present with a wide range of urinary, bowel, or

[00:01:11] sexual dysfunction problems, as well as uro vaginal prolapse,

[00:01:14] which is basically the uterus coming down through the vagina. And

[00:01:18] then we see these at higher risk and people living with

[00:01:22] obesity. And so that's why today I invited Dr. Nor and Nabila

[00:01:27] Nor, who is a board certified, fellowship trained uro

[00:01:30] gynecologist and reconstructive pelvic surgeon to

[00:01:34] come in and explain all of this to us. Now, Dr. Nor, she's

[00:01:39] currently practicing at Lee Valley Health Network in Allentown,

[00:01:43] Pennsylvania. In her practice, she takes care of women with a

[00:01:47] variety of pelvic floor disorders such as urinary

[00:01:50] incontinence, pelvic organ prolapse, people incontinence,

[00:01:53] tissue us, just to name a few. So welcome to the podcast,

[00:01:57] Dr. Nor. We're so happy to have you.

[00:01:59] Thank you so much, Dr. Shelley for having me. I am very

[00:02:02] excited to share this platform with you and thank you for

[00:02:05] that wonderful introduction. I think you're absolutely

[00:02:08] right. Obesity plays such an important role in how it affects

[00:02:12] our pelvic floor, as we will discuss throughout this

[00:02:15] podcast. But I'm actually really looking forward to talk to

[00:02:18] you today, because you know, what you do and what I do is so

[00:02:22] connected. And on behalf of all my patients, thank you so

[00:02:26] much for doing what you do because it really truly makes

[00:02:29] a huge difference to their lives. So I'm very excited

[00:02:32] to be here.

[00:02:32] Thank you. And thank you for coming on. I really

[00:02:34] appreciate that. Well, before we get started, tell us a

[00:02:37] little bit more about yourself. How did you get into this

[00:02:40] field of your Organic College?

[00:02:41] Yeah, so you know, that's an interesting question because

[00:02:43] when I went into medical school, I actually thought I

[00:02:46] wanted to be a cardiologist and look at where I am now,

[00:02:48] right? But it was really, I think my interest in women's

[00:02:51] health started when I was in college, I did go to Smith

[00:02:54] College, which is an all women's college really sparked

[00:02:56] my interest in doing something in the realm of women's

[00:03:00] health. So when I was in medical school, and I was

[00:03:02] going through all my specialties kind of rotating

[00:03:04] through them, I really enjoyed OBGYN, which is

[00:03:08] obstetrics and gynecology because it truly is an

[00:03:10] amalgamation of medicine, surgery, and even a lot of

[00:03:14] psychology. Because you know, you're dealing with

[00:03:16] patients that are very vulnerable stage of their

[00:03:18] life, whether you're dealing with pregnancy,

[00:03:20] whether you're dealing with patients who have cancer

[00:03:22] of their GYN organs, or in my case, whether you're

[00:03:25] dealing with pelvic floor disorders, because all

[00:03:27] these conditions are infertility for that

[00:03:29] matter. All these conditions can have a

[00:03:31] significant impact on a woman's health at

[00:03:34] different stages of their lives. And I think the

[00:03:36] reason I decided to choose the field of gynecology

[00:03:39] is because it really allowed me not only to serve

[00:03:43] my patients and be of service to them, but

[00:03:46] because of some of the amazing development that

[00:03:49] has happened in our field over the last two

[00:03:51] decades, primarily, you know, with the advent of

[00:03:54] various minimally invasive surgery, robotic

[00:03:57] surgery, we're truly able to fix somebody's

[00:04:01] problem and give them a completely different

[00:04:03] life. Very rarely can you do that in many other

[00:04:06] fields of medicine. For example, like you

[00:04:08] mentioned in the introduction, like leakage of

[00:04:10] urine, there are surgeries that I'll do which

[00:04:12] is 12, 15 minutes. And all of a sudden, you're

[00:04:15] dry. I mean, can you imagine the impact that

[00:04:17] can have on somebody's life? So that was very

[00:04:20] gratifying. So yeah, so that's how I ended

[00:04:22] up doing what I do.

[00:04:23] Yeah, because I have family members who have

[00:04:25] to have hands and it's uncomfortable. So you're

[00:04:28] absolutely right. Just being dry is amazing.

[00:04:31] You know, it's amazing. For those who may not

[00:04:34] know what exactly is your pelvic wall and what

[00:04:38] can cause you to have a dysfunction?

[00:04:40] Yeah, I think that's an excellent question

[00:04:42] because, you know, we kind of talk about

[00:04:43] pelvic floor and kind of have an idea of

[00:04:45] what's the pelvic floor. But what the

[00:04:47] pelvic floor is essentially, you know, it's a

[00:04:49] combination of different muscles, your

[00:04:51] connective tissues, your ligaments, which

[00:04:54] helps support your pelvic organs. And it

[00:04:56] essentially forms the base of our torso.

[00:04:59] So when we talk about pelvic organs, that

[00:05:00] could include your uterus, your bladder,

[00:05:03] your rectum, your intestines. So basically

[00:05:06] the pelvic floor helps support all these

[00:05:08] organs. So when we talk about pelvic

[00:05:10] floor dysfunction, essentially what we mean

[00:05:13] is weakening of those pelvic floor muscles,

[00:05:15] the ligaments, the connective tissue.

[00:05:17] And that can happen for a whole host of

[00:05:19] reasons. Age is a big risk factor.

[00:05:21] Menopause is a big risk factor. As we're

[00:05:24] talking about obesity can cause it to

[00:05:26] weaken, as well as things that can cause

[00:05:28] trauma to the pelvic floor. For example,

[00:05:30] pregnancy, childbirth, any kind of surgery

[00:05:33] in that area. So all those can affect

[00:05:35] the strength of the pelvic floor. And when

[00:05:37] that support system is compromised, you

[00:05:40] can essentially have things like pelvic

[00:05:42] organ prolapse where your pelvic organs

[00:05:44] are essentially trying to push through

[00:05:46] the vaginal wall or essentially a kind

[00:05:48] of hernia. Or you can have a leakage

[00:05:51] of urine with laughing, coughing, sneezing,

[00:05:52] what we call stress-unuring

[00:05:54] incontinence. Because your urethral,

[00:05:56] which is the pipe through which urine

[00:05:57] comes out, is not well supported. So it

[00:05:59] can cause a whole host of conditions

[00:06:02] which essentially is what I see in my

[00:06:03] everyday practice.

[00:06:05] So how does obesity cause these

[00:06:07] conditions? Why are there increased

[00:06:09] risks?

[00:06:10] Right. So with obesity, what happens

[00:06:13] is you have increased intra-abdominal

[00:06:15] pressure. Right? So because of that

[00:06:16] excess weight, it's increasing the

[00:06:18] pressure that's generated in your

[00:06:20] abdomen. That constant pressure over

[00:06:23] that pelvic floor, because remember the

[00:06:24] pelvic floor is the base of your torso,

[00:06:26] is that constant pressure can help it

[00:06:28] to weaken. Also what happens is, you

[00:06:31] know, with obesity, because of that

[00:06:33] compromised pelvic floor, now women

[00:06:35] can have a lack of support for their

[00:06:37] urethral, the bladder and you can

[00:06:39] develop symptoms such as

[00:06:40] urinary incontinence, pelvic organ

[00:06:42] prolapse and all those. But it's

[00:06:44] really the increased pressure and that

[00:06:46] constant pressure on that pelvic floor

[00:06:48] that causes the damage.

[00:06:49] And I know you mentioned a couple of

[00:06:51] symptoms like the leaking of urine.

[00:06:52] Are there any other symptoms that

[00:06:54] people should look out for?

[00:06:55] Maybe we pay attention to it.

[00:06:57] Yeah, no, that's a great question.

[00:06:58] So, you know, when we talk about urinary

[00:07:00] leakage, there are two big categories.

[00:07:02] So we commonly talk about, I think

[00:07:03] what most women think about leakage

[00:07:05] with laughing, coughing, sneezing,

[00:07:07] pretty much any kind of physical

[00:07:08] activity. So that's known as

[00:07:10] stress urinary incontinence.

[00:07:12] There's also another kind of leakage

[00:07:13] known as overactive bladder.

[00:07:15] So those are the patients who may

[00:07:17] not leak with any kind of activity,

[00:07:19] but when they have the urgency to go,

[00:07:21] they can't hold it. They feel like

[00:07:22] they have to go all the time and when

[00:07:24] that urgency hits, they either leak

[00:07:25] or not able to make it to the bathroom.

[00:07:28] So even with obesity, we see

[00:07:30] a relationship to overactive bladder

[00:07:31] because what happens is

[00:07:33] with obesity, as you know,

[00:07:35] a lot of women with obesity will have

[00:07:36] things like obstructive sleep apnea.

[00:07:39] They can also have a low back

[00:07:40] issues and the spine,

[00:07:42] the nerves that's controlling our

[00:07:43] bladder is actually coming

[00:07:45] from your lower lumbar area.

[00:07:47] So a lot of the times when women

[00:07:48] have back issues, we do see

[00:07:51] that it worsens their

[00:07:52] overactive bladder symptoms.

[00:07:54] And then similarly, pelvic organ

[00:07:55] prolapse, right? When you have

[00:07:57] that excess weight on your pelvic

[00:07:58] floor, your pelvic organs are

[00:08:00] essentially trying to herniate

[00:08:01] through. So we see that commonly

[00:08:03] as well.

[00:08:04] OK. Wow. Amazing.

[00:08:05] So if somebody is having

[00:08:07] these symptoms, what is the work

[00:08:09] up that should be done?

[00:08:11] They go to your gynecologist

[00:08:12] like yourself.

[00:08:13] Yeah. So I think the first

[00:08:15] thing is realizing,

[00:08:16] you know, and I talk about this

[00:08:17] all the time that any of these

[00:08:19] conditions that we're discussing,

[00:08:20] they can happen with each.

[00:08:22] It can be common, in fact,

[00:08:24] more common than we think

[00:08:25] because women don't talk about it

[00:08:26] enough, but they're never normal.

[00:08:29] Whether you're in your 20s

[00:08:30] or whether you're in your 90s

[00:08:31] because I see the whole gamut

[00:08:33] of this age group of patient

[00:08:34] population. Never is it normal

[00:08:36] to have urinary symptoms.

[00:08:38] In fact, I forgot to mention

[00:08:39] bowel issues as well, right?

[00:08:41] A lot of women with obesity

[00:08:42] can also notice problems

[00:08:44] with their bowel function.

[00:08:45] So it's never normal to leak

[00:08:47] stool. It's never normal to leak

[00:08:48] urine, pelvic organ prolapse.

[00:08:51] So definitely start with talking

[00:08:52] to your primary care doctor.

[00:08:54] If you have an OBGYN, they can

[00:08:55] also do a pelvic exam.

[00:08:57] And if they're not comfortable

[00:08:58] with treating it any further,

[00:09:00] then have them refer you

[00:09:01] to a urogynecologist, which

[00:09:03] is a sub specialist, somebody

[00:09:04] like me because we do go

[00:09:06] through additional training.

[00:09:08] And in our training, it combines

[00:09:10] like gynecology, urology,

[00:09:12] colorectal surgery, so

[00:09:13] multiple different specialties

[00:09:15] so that we're able to provide the

[00:09:17] most comprehensive care to our

[00:09:18] patients.

[00:09:19] So when I see patients

[00:09:21] with these conditions and in the

[00:09:22] office or they come to see me

[00:09:23] as a new patient visit,

[00:09:25] the first thing I start with is

[00:09:26] a good history, just like any

[00:09:27] other specialty.

[00:09:29] What's interesting, though, is

[00:09:30] sometimes patients may come to

[00:09:31] me thinking they have one

[00:09:32] problem, but I always make sure

[00:09:34] I ask them about their bowel

[00:09:36] function, what kind of leakage

[00:09:38] they're having, if they're

[00:09:39] having any pain with intercourse,

[00:09:41] if they're having any laxity,

[00:09:42] do they feel like a ball is

[00:09:43] coming out? And what you

[00:09:44] really realize is while patients

[00:09:47] may think that they have only one

[00:09:48] issue, and then by the time we're

[00:09:50] done with history in my mind, I

[00:09:52] know that it's going to be

[00:09:53] multiple different things

[00:09:54] because they're all related.

[00:09:55] And then of course I do a full

[00:09:57] detailed pelvic exam,

[00:09:58] and it's similar to what you

[00:09:59] may expect at a gynecological

[00:10:01] or a gynecologist's office,

[00:10:03] but it's a lot more detailed

[00:10:04] because I'm actually doing

[00:10:05] measurements to look for changes

[00:10:08] in the vaginal walls.

[00:10:09] Also, you know, there are tests

[00:10:10] that we can do to see whether

[00:10:11] or not you're emptying your

[00:10:12] bladder properly and then

[00:10:14] whether or not you're having

[00:10:15] leakage of urine.

[00:10:16] So all that with the history,

[00:10:18] with the exam, then, you know,

[00:10:20] we discuss, well, what are the

[00:10:21] pathologies that the patients

[00:10:22] are having and what are some

[00:10:24] treatment options?

[00:10:25] Because not every treatment is

[00:10:26] surgical and similarly not

[00:10:28] every treatment is non-surgical.

[00:10:29] So we discuss all the different

[00:10:30] options and then come up with

[00:10:32] a plan for each patient

[00:10:33] based on what's their lifestyle

[00:10:35] like, you know, what are they

[00:10:37] hoping to get from this?

[00:10:38] And it's different for every

[00:10:39] patient. Oh wow.

[00:10:41] That's amazing. I hope everyone's

[00:10:42] hearing this, that if you

[00:10:43] are having symptoms, definitely

[00:10:45] go to your primary care and

[00:10:46] then if they can't handle them,

[00:10:48] they'll see you're a gynecologist.

[00:10:50] Now, you mentioned therapies.

[00:10:52] It doesn't have to always be

[00:10:53] surgery. What are some options

[00:10:55] that you would use to help

[00:10:57] with managing somebody with

[00:10:58] that pelvic floor dysfunction?

[00:11:00] Yeah, you know, and that's a

[00:11:01] great question because it always

[00:11:02] comes up. And in fact, it's

[00:11:04] good that you asked that

[00:11:05] because a lot of the times the

[00:11:06] misconception is, oh, I'm going

[00:11:07] to see a surgeon.

[00:11:08] OK, they're just going to

[00:11:09] do surgery. I don't want

[00:11:10] surgery. So I'm not even

[00:11:11] going to bother.

[00:11:12] And I'm here to tell you

[00:11:13] that, yes, I'm a surgeon.

[00:11:15] I'm trained very well to do all

[00:11:17] of the sorts of surgeries that

[00:11:18] is going to be good for my

[00:11:19] patients. But just as much as

[00:11:21] I love to do surgery, I'm

[00:11:23] equally equipped to talk about

[00:11:24] some of the non-surgical

[00:11:25] options because you know,

[00:11:26] you're right. Many patients

[00:11:28] for whatever reasons may not

[00:11:29] want surgery at a certain time

[00:11:31] of their life. Most of the

[00:11:33] pelvic floor disorders that we

[00:11:34] deal with can be treated with

[00:11:36] some sort of non-surgical

[00:11:38] treatment options.

[00:11:39] So for example, if we're

[00:11:40] talking about urinary leakage

[00:11:41] or pelvic floor prolapse or

[00:11:43] even fecal incontinence, so

[00:11:45] pelvic floor physical therapy

[00:11:47] is always a good place to start

[00:11:49] because it helps strengthen

[00:11:51] your pelvic floor muscles.

[00:11:52] We talk about kegel exercises

[00:11:54] all the time, but something

[00:11:55] that I see in my practice

[00:11:57] which is always interesting,

[00:11:58] like patients will come and

[00:11:59] they'll be like, oh, Dr.

[00:12:00] Neuer, I've been doing

[00:12:00] kegel exercise. It's not

[00:12:01] working. And then when I

[00:12:02] actually go to evaluate them

[00:12:04] and ask them, OK, do a

[00:12:05] kegel for me? I could tell

[00:12:07] that they're not

[00:12:08] isolating the right muscles

[00:12:09] so you can kegel away all

[00:12:11] day.

[00:12:12] But if you're not doing it

[00:12:13] correctly, it's not going to

[00:12:15] help. It's like working out

[00:12:16] in the gym, right?

[00:12:17] You could think that, OK, I'm

[00:12:18] running in the treadmill, but

[00:12:19] if you're actually, if your

[00:12:20] machine is not on, it's not

[00:12:22] moving, you're not going to

[00:12:23] lose that weight, right?

[00:12:24] So sometimes, you know, it's

[00:12:25] helpful for patients to

[00:12:28] either have their physician

[00:12:29] tell them, OK, what are some

[00:12:30] of the muscles that I'm

[00:12:31] trying to contract?

[00:12:32] What's the feeling that I

[00:12:33] should have? Or if

[00:12:35] necessary, working with a

[00:12:36] pelvic floor physical

[00:12:37] therapist.

[00:12:38] So these are specialized

[00:12:40] therapists. They're all

[00:12:41] female for obvious reasons

[00:12:42] because they do such internal

[00:12:43] work. But these specialized

[00:12:45] therapists, they deal with

[00:12:47] essentially pelvic floor

[00:12:49] disorders. So they have a lot

[00:12:50] of experience and they have

[00:12:51] various different tools to

[00:12:52] make sure the patient can

[00:12:54] understand that they're

[00:12:55] isolating the right muscles

[00:12:57] so they can do things like

[00:12:58] biofeedback where they can

[00:12:59] put a little sensor in the

[00:13:00] vagina. And as the patients

[00:13:02] contracting the muscles,

[00:13:03] they can actually see

[00:13:04] whether or not they're

[00:13:05] isolating the right muscles.

[00:13:06] It's almost like working out

[00:13:07] in the gym but with a

[00:13:08] trainer so they can guide

[00:13:10] you to make sure you're using

[00:13:12] each machine properly, doing

[00:13:13] everything the right way.

[00:13:14] And then of course the onus is

[00:13:16] on the patients, right?

[00:13:17] You can have the best trainer

[00:13:18] in the world but if you're not

[00:13:19] going to be putting in the

[00:13:20] work, it's not going to work.

[00:13:21] Another thing I tell patients

[00:13:22] is if you're going to do the

[00:13:23] physical therapy, make sure

[00:13:25] you know at least two to

[00:13:26] 10 sets of repetitions

[00:13:28] like starting with 15

[00:13:29] repetitions each day and it

[00:13:30] takes time, at least two to

[00:13:32] three months of good PT

[00:13:34] before you start noticing

[00:13:35] some improvement. But that's

[00:13:36] a good place to start.

[00:13:37] Now when would you consider

[00:13:39] surgery in a patient?

[00:13:40] Was it like they failed

[00:13:42] physical therapy or is it like

[00:13:43] now your symptoms are just too severe?

[00:13:45] Right. I think that's a very

[00:13:47] individualized questions

[00:13:48] and I'll tell you why

[00:13:49] because I have patients who come

[00:13:51] to me by the time they've come

[00:13:52] to me, they've already

[00:13:53] seen PT, they've already

[00:13:55] done their research and

[00:13:57] they're here now because

[00:13:58] they want something

[00:13:58] definite and dumb.

[00:13:59] Because surgery is

[00:14:01] the more definitive therapy

[00:14:02] it's something, you know,

[00:14:03] do it right now and you'll

[00:14:04] see the result tomorrow,

[00:14:05] right? And then I have

[00:14:06] patients who come to me

[00:14:08] and they just want to know

[00:14:09] about all their options.

[00:14:10] Maybe they're not in the

[00:14:11] stage of their life where

[00:14:12] they can commit to surgery

[00:14:14] and the recovery afterwards.

[00:14:16] So it really depends.

[00:14:17] Like I said, you know,

[00:14:17] I always go through

[00:14:18] all the different options

[00:14:19] when I first see patients

[00:14:21] and then together we have

[00:14:22] a discussion like, OK,

[00:14:24] what are you thinking?

[00:14:25] Where would you feel like

[00:14:26] you want to be headed?

[00:14:27] And the answer is always

[00:14:28] different based on

[00:14:29] patients responses.

[00:14:30] Some people may know

[00:14:31] what they want to do

[00:14:32] some people may need

[00:14:33] a little bit more guiding

[00:14:34] and then together we come

[00:14:35] up with a plan that works

[00:14:36] for them. The thing

[00:14:37] I want everyone to know

[00:14:38] is that there's no right or wrong answer.

[00:14:40] It really depends on

[00:14:42] what your quality of life is.

[00:14:44] And at the same time,

[00:14:45] sometimes I'll hear patients say

[00:14:46] that am I not too young

[00:14:47] to have surgery

[00:14:48] or am I not too old to have surgery?

[00:14:50] There's no right age

[00:14:51] to have surgery either, right?

[00:14:52] If you're suffering, for example,

[00:14:54] if you're a 40 year old mom

[00:14:56] who loves to go outside,

[00:14:57] loves to go to the gym,

[00:14:58] but you cannot do that

[00:14:59] because you're worried

[00:15:00] like every time you're going to

[00:15:01] take your kids to the trampoline

[00:15:02] park, you're going to have

[00:15:03] a wet underwear.

[00:15:04] And similarly, you're not

[00:15:05] exercising because

[00:15:07] you're worried that

[00:15:08] people around you

[00:15:08] can smell urine.

[00:15:09] And yet, even as a 40 year old,

[00:15:11] you need something definitive.

[00:15:13] Similarly, if I have an 80 year old

[00:15:15] who is isolating themselves

[00:15:17] is missing her daughters

[00:15:19] or grandsons graduation

[00:15:20] or not socializing anymore

[00:15:22] because she has to wear a diaper.

[00:15:24] That's not a way to live.

[00:15:25] Definitely talk to your providers

[00:15:27] so they can talk to you

[00:15:28] about the different options.

[00:15:30] Now, I know one common

[00:15:31] option that you all do

[00:15:32] as far as surgeries,

[00:15:33] either like the sling

[00:15:34] in the nest surgery.

[00:15:35] Is that the same thing

[00:15:36] or is it two different types of surgery?

[00:15:38] Yeah. So the sling surgery is essentially

[00:15:41] the same as mesh.

[00:15:42] So mesh is the material

[00:15:43] that the sling is made up of.

[00:15:44] So it's actually made up of something

[00:15:46] called polypropylene.

[00:15:47] So we kind of use it interchangeably

[00:15:48] like mesh surgery or sling surgery.

[00:15:50] But mesh can also be used

[00:15:52] for prolapse surgery as well.

[00:15:54] So when we're talking about sling,

[00:15:56] so that's a form of treatment

[00:15:58] for the stress

[00:15:59] reunion continence.

[00:16:00] So that's the leakage

[00:16:01] with laughing, coughing,

[00:16:02] sneezing, any kind of physical exertion.

[00:16:04] So I mean, this particular surgery

[00:16:06] has really changed

[00:16:07] how we treat women.

[00:16:09] Because we started doing this

[00:16:10] as of the mid 90s.

[00:16:12] Because prior to that,

[00:16:13] a surgical treatment

[00:16:14] for stress incontinence

[00:16:15] would be a major abdominal surgery.

[00:16:17] But with the advent of this sling,

[00:16:19] really all we're doing

[00:16:21] is we're making a tiny centimeter incision

[00:16:23] through the vagina.

[00:16:24] We put this tiny piece of mesh.

[00:16:26] Surgery is done in 1215 minutes

[00:16:28] and patients do amazingly well.

[00:16:31] Early in 2000,

[00:16:32] there were a lot of controversies

[00:16:33] about mesh.

[00:16:34] And when patients come to see me,

[00:16:35] I do spend a significant amount

[00:16:37] of time talking to them

[00:16:39] about some of that history,

[00:16:40] making sure they feel real short.

[00:16:42] But in short, in summary,

[00:16:43] for our audience,

[00:16:44] mesh has come a long way

[00:16:46] since the early 2000.

[00:16:48] And like we were talking about earlier,

[00:16:49] like my specialty

[00:16:50] is such a new specialty.

[00:16:52] And that's because we realize

[00:16:54] it's so important

[00:16:55] to have specialized surgeons

[00:16:57] who have extensive training,

[00:16:59] who can treat these particular conditions

[00:17:01] as well as deal with complications

[00:17:02] when it happens.

[00:17:04] So now that urogyne ecology

[00:17:05] is a whole other board specialty,

[00:17:07] those of us who do these kind of surgeries,

[00:17:09] we have a lot of training,

[00:17:10] a lot of experience.

[00:17:11] And that has significantly improved outcomes

[00:17:13] and patients do amazingly well.

[00:17:15] Amazing, amazing.

[00:17:16] Now I have one more question here.

[00:17:18] So I had a patient

[00:17:20] who had a pessory.

[00:17:22] Does the pessory help

[00:17:24] or is that not something you should do?

[00:17:26] I know there's probably some cons

[00:17:27] or side effects with it.

[00:17:29] Yeah, no, absolutely.

[00:17:30] So pessory is another form

[00:17:32] of non-surgical treatment options.

[00:17:34] In fact, so for the audience

[00:17:36] who may not know what a pessory is,

[00:17:38] it's essentially a silicon device.

[00:17:39] The most common one that we use

[00:17:41] looks like a little donut,

[00:17:42] like a plastic ring.

[00:17:43] They come in different shapes and sizes.

[00:17:45] And essentially it's a vaginal insert.

[00:17:47] And the idea is you put it in the vagina

[00:17:49] to help support the pelvic walls

[00:17:52] so it can help women with

[00:17:53] leakage of urine

[00:17:54] so stress-reunerary incontinence

[00:17:56] as well as pelvic organ prolapse.

[00:17:58] The thing about pessory

[00:17:59] or the thing to know about pessory

[00:18:00] is it is something that has to stay

[00:18:02] in the vagina all the time

[00:18:03] for it to be effective.

[00:18:04] So for a lot of my young patients

[00:18:06] who may be sexually active,

[00:18:07] it can be a little bit cumbersome

[00:18:09] because they have to remove it for intercourse.

[00:18:11] It does increase your vaginal discharge.

[00:18:13] And sometimes the silicone

[00:18:15] just rubbing against your vaginal wall,

[00:18:17] especially for my patients

[00:18:18] who are menopausal

[00:18:19] where the tissue is already thin

[00:18:21] can cause some bleeding and discomfort.

[00:18:23] Having said that,

[00:18:24] if that's the route patients want to go,

[00:18:26] then there are ways

[00:18:27] that we can counter some of those issues.

[00:18:29] And I have many patients,

[00:18:30] you know, especially my older patients

[00:18:32] who may not want surgery.

[00:18:33] It can really be very helpful

[00:18:35] for some of them.

[00:18:36] Well, thank you so very much, Dr. Noor,

[00:18:39] for coming and just teaching us

[00:18:40] all about pelvic floor dysfunctions

[00:18:42] and how we should treat it.

[00:18:44] And definitely for those people

[00:18:46] who are experiencing this,

[00:18:48] definitely I recommend to see your doctor

[00:18:49] about what other treatments you can do.

[00:18:51] But just before we end,

[00:18:53] can you maybe share any last minute

[00:18:55] strategies, tidbits,

[00:18:57] or just advice you want to leave with the audience?

[00:18:59] Yeah, so I think, you know,

[00:19:00] it's important to know

[00:19:01] that pelvic floor dysfunction,

[00:19:03] whether we're talking about urinary leakage,

[00:19:05] prolapse, bowel leakage,

[00:19:06] as we discussed can happen,

[00:19:08] but there's no reason to suffer with it.

[00:19:10] Talk to your primary care doctors,

[00:19:12] have them refer you to your organic colleges.

[00:19:14] Let's talk about the treatment options.

[00:19:17] If you want surgery,

[00:19:18] there are amazing surgeries

[00:19:19] that we can offer,

[00:19:20] like we discussed with minimally invasive techniques

[00:19:23] and patients do well.

[00:19:24] Most of my patients go home the same day.

[00:19:26] But if surgery is not for you,

[00:19:28] there are non-surgical treatment options

[00:19:29] is there as well.

[00:19:31] What I don't want patients to do is like,

[00:19:32] okay, I don't want surgery.

[00:19:34] I'm just going to suffer with it

[00:19:35] for the rest of my life.

[00:19:36] That's what I hope that the patients can take

[00:19:38] that it's never normal

[00:19:40] to be having these conditions.

[00:19:41] And especially in today's day and age,

[00:19:43] there's really no reason to suffer with this.

[00:19:45] Well, thank you so much.

[00:19:47] Before we end, how can someone work with you?

[00:19:49] Yeah, so like you said,

[00:19:51] I'm currently practicing in the Allentown area.

[00:19:53] So if you're in my neighborhood,

[00:19:54] please find us.

[00:19:55] We'll be happy to take care of you.

[00:19:57] I am starting to be more active on social media.

[00:19:59] So I do have a YouTube channel that I started.

[00:20:02] And it's actually raised our recommendations

[00:20:04] from my patients because sometimes they'll be like,

[00:20:06] you know, I saw someone's video.

[00:20:07] You should do one video too.

[00:20:09] So I'm starting to do more kind of educational videos

[00:20:12] of little topics just like we were talking about today

[00:20:14] so that patients can go back and review it.

[00:20:17] So by all means check it out.

[00:20:18] You can always find me on social media,

[00:20:21] Instagram, Facebook as Dr. Nabila Noor.

[00:20:23] And that's the same handle for my YouTube as well.

[00:20:25] All right.

[00:20:26] Well, thank you again, Dr. Noor,

[00:20:27] for coming on today.

[00:20:28] And thank you all for joining us

[00:20:30] on the Back on Track Achieving Healthy Weight Loss Podcast.

[00:20:34] If you liked this episode,

[00:20:35] please share it with others, like it and subscribe.

[00:20:38] And don't forget to leave a five star review

[00:20:41] and we'll see you all next time.