Physical Therapy May Be the Answer

Advanced Pelvic Surgery treats women’s pelvic floor issues, but surgery is not the only tool we have.  There are other options including physical therapy.

Physical therapy

Physical therapy

When I was doing a fellowship in Urogynecology and Pelvic surgery, I met a wonderful Physical Therapist named Kathleen Novicki.  She was getting a Master’s Degree in Pelvic Floor Physical Therapy and was several years ahead of what traditional doctors and hospitals were offering patients with pelvic issues. And her results were impressive, to say the least. Some problems are treated well with surgery and others with medications.  But some issues fall between the two mainstays of treatment and that’s where Physical Therapy fills the bill. Over the years we have worked together with many patients, resulting in great outcomes without surgery.  I have seen women who have suffered for long periods of time and after their initial consultation and examination, we opted for physical therapy and have had amazing results.

“When I was still in medical school I saw a lot of women who had horrible back pain. Some of it was related to pregnancy, some to other issues. Not many doctors were treating it so I decided to focus on Women’s Health and pelvic floor issues were part of the training,” said Kathleen Novicki.  “Now I see more and more symptoms that are related to the pelvic muscles—incontinence, bladder control and bowel movement issues are just a few.”

Kathleen went on to say that because it is a muscular problem, it is often undiagnosed or not recognized. With physical therapy and some form of biofeedback, Kathleen and Dr. Owens see remarkable improvements with their patients.

“Once we can determine which muscles need to be strengthened, I recommend exercises that the patient can do at home. Generally in a three-to-six month time frame there is dramatic improvements,” Kathleen said.  “The number one thing patients say is that they are happy to be off medications with results that didn’t require surgery.”

The pelvic region is supported in part by muscles.   Many conditions, such as pregnancy, constipation, chronic coughing, obesity or injury can weaken or damage the pelvic floor muscles. This lack of support can cause leaky bladder, painful intercourse, bulging organs into the vagina.  Physical therapy by a trained and specialized therapist can be the treatment needed.

As with most pelvic floor issues, women aren’t talking about their problems. Painful intercourse and leaking bladders just don’t seem to be the lunchtime topic of conversation.  But we know that one in four women have these issues.  Physical therapy could be the prescription for your pelvic floor conditions.

Call our office at Advanced Pelvic Surgery to discuss how we can work together.

Physical therapy

It’s a Woman’s World

Being a maImagen in a woman’s world has provided me a perspective that not many men are privileged to experience.  Yes, I said privileged. Every day in my practice, I meet with a variety of women of all ages, all careers, all phases of their lives and all sizes, shapes and colors. 

I have noticed, however, that all of them have at least one thing in common (other than the fact that they are women). They all want to feel good about themselves.

Many of these women come to me lacking self-confidence because of the medical problems that they have kept secret from others in their life. For whatever reason, embarrassment, shame, or pride, they feel that they are not only alone with their issue, but somehow it is almost a disgrace. Urinary incontinence affects one in four women! You are not alone with this problem.

Yet I watch other women who come in with conditions like fibroid tumors, urinary tract problems, bladder cancers–a myriad of conditions, some which require much more extensive medical treatment—and there is no hesitation at telling me, or others, their medical problem.  Women with sexual dysfunction have no problem sharing their symptoms; those with painful periods and the inability to empty their bladders don’t hesitate at telling me to “fix” them.  But those with a leaky bladder feel like they are wearing a Scarlet Letter – P!

I wanted to share this with all of you who have isolated yourself, who have quit going out on the town, who have stopped dancing with your husband or working out at the gym. For all of you who have stopped picking up your children, who run for the bathroom when you sneeze, and sadly, for those of you who have quit laughing—come in and let me help you. I cannot promise you won’t be embarrassed, but I can promise that I will do everything in my power to “fix” your leaky bladder so you can get back to a normal, enjoyable and happy life. You need to get back to feeling good about yourself.  And I can help. 

You Are Not Alone!

by Guest Blogger, Patricia Stirnkorb


When I was in my late 20s and early 30s, our family had a tradition of hosting a family reunion each year. It was held at a local company-employee park complete with volley ball courts, baseball diamonds, putt-putt golf, and so forth. These were some of my favorite memories when our whole family was present; aunts and uncles, cousins and in-laws and kids everywhere!  We had dinner in the shelter house and then off for a spirited game of baseball.

My cousin was a great ball player, playing on several leagues for his work and others for play. We would pick sides, whittling down the players until the “old people” (those over 40), were the ones left.  Then it was grab a glove and head to the outfield.  

My aunt is one of those ladies who makes everyone laugh. Whether she is saying something hilarious, or laughing at someone else, her laughter is infectious. And in her younger days, well, we were generally in stitches when we were around her.  Baseball was not her stronger skill. For some reason she was generally the short stop and inevitably, the other team would make sure the ball came to her. It could land in her glove and bounce out. Or roll between her legs and she still couldn’t make the play! Every time something happened, she would begin her incredible gales of laughter, infecting the whole playing field! And when she began to laugh, she began to pee!

Then she would cross her legs, generally too late, with pee running down both legs! Before long she would relent to giving up her position to a younger player and she would laugh her way off the field, dripping as she went, to the bathroom to change her clothes!  Although she always made a joke of it, I never knew if I should laugh with her or cry for her. It embarrassed me, I think, more than it did her!

It was at that time when I began to see many women with the same issue. My grandmother once was so nervous once when she began coughing in a mall and peed in the floor! Another time it was a cousin of mine, again laughing hilariously, and she left a trail of drops behind her as she hurried off to the bathroom!

I tell you all this to ensure you of this one fact: Bladder leakage is a common thing. In today’s modernized world, there are certainly more ways to stop the embarrassment. But some things still linger on—the horrible wet feeling we get when we cough or sneeze; the embarrassment if we “leave a puddle” on the seat or floor; the worry about odor or spots on our clothing.  Leaky bladders are no fun!

Dr. Greg Owens specializes in this very thing. He recently came on my TV program and talked about women’s health issues and hysterectomy, robotic surgery and, yes, even leaky bladders.  If you are plagued with this embarrassing problem, don’t give yourself over to a life of wearing mini-pads or worse! There is a quick and virtually painless fix.  He has helped so many women in his career. In fact, one in four women have a leaky bladder.  My New Year’s advice—seek help for this issue. Call Dr. Greg Owens today and start your new year with gales of laughter!

Spain Mission Trip

Spain Mission Trip

Spain Mission Trip

My wife Julia and I and our two children, have recently returned from a marvelous trip to Spain where we visited with our dear friend, and founder of Betel International, Dr. Elliott Tepper.   We followed Elliott as he made his rounds, staying at the missions across Spain and Morocco.  Betel is a Christian Drug rehabilitation organization that began in Madrid in the 1980’s and has grown to over 70 cities in 20 nations around the world.  Elliott is a truly remarkable, energetic and dynamic individual.  Born Jewish, he received an MBA from Harvard, and studied at Cambridge.  While at Harvard, he was heavily involved in drugs and the counter culture.  He had a conversion experience during his time there in the 1970‘s and has been an evangelical missionary ever since.

I had the privilege of meeting and working with Elliott in 2006 when a medical missionary and I went to India to help Elliott establish medical care for the six new Betel centers across India.  I was deeply impressed with the transformation that was occurring in the lives of destitute people.  Outside was squalor; yet inside, the compounds looked like a Marine barracks.  Meticulous landscaping, bunks neatly made and absolutely no clutter of any kind.  Every staff member at Betel is a former client.  People are given a new lease on life and a new sense of self-worth through loving Christian support and hard work. Care at a Betel is free of charge because they are mostly self-supporting. Each Betel mission brings in revenue through business ventures such as manufacturing furniture and selling it in retails stores, selling second hand furniture, bakeries and cafes and repair shops.  However, it is a constant struggle and donations are still needed and appreciated.   Each mission is overseen by a pastor and his family who also act as managers of the businesses.

Our goal for our children was to instill in them the true effects of drugs on people, a sense of how blessed they are, and a need to serve others.  There is a Spanish saying “El que no sirve, no sirve” which can be translated as “A tool that serves no purpose is useless” or “He that does not serve has no worth.”  That message was really brought home by our visits to Betel, Spain and Morocco.  We traveled with Elliott from the headquarters in Madrid to Malaga where we lunched with the Betel group. Then we went on to Algeciras where we took the ferry across the Strait of Gibraltar to Ceuta Spanish Morocco. (see pictures) We stayed in Betel Ceuta then traveled across the border to Tetuoan Morocco (picture) to visit some missionaries.  We had to be very covert as Morocco has thrown out all the non-Muslim organizations from Morocco. We traveled into the market place, where business is still conducted the same way it was before Christ. (pictures) On the way back, we stayed in Betel Algeciras (pictures) and stopped at Gibraltar (pictures) for a tour of the rock.  The kids saw the limit of the ancient world at one of the “Pillars of Hercules”.  Amazing how much things have changed.

Back in Madrid, we went to the Gypsy Camp, which is a rundown part of Madrid that the police don’t frequent much.  It is the largest drug market in Madrid.  We were able to go because Betel brings food and offers relief on a weekly basis and are known and allowed there.  The kids saw former well to do business people whose lives had been destroyed by drugs.  While handing out sandwiches and pamphlets, my wife and I were able to point out things to the kids such as the neat row of tract marks on the hands and arms of the Heroin addicts.  (picture).  A former Betel client who had come into a large sum of money and fallen back into a life of drugs came up to us and asked to be taken in.  He was–within an hour he was on his way to a nearby Betel facility.

The experience was very rewarding and I hope, it was life altering for our Kids.  Julia and I will continue to expose them to mission work in an effort to give them some perspective on life.  If you would like more information about the Betel group, you can visit their web site–they also appreciate any and all donations.  Visit them at


Pelvic Floor Dysfunction

Pelvic Floor Dysfunction Report

Pelvic Floor Dysfunction


Dr. Gregory Owens


Pelvic floor dysfunction affects about 25% of the women ages 30-70 around the world.  While many go undiagnosed and untreated, the symptoms can be frustrating, embarrassing, and lifestyle altering.

Who does it affect?  The stage is set for dysfunction with a loss of pelvic support from injury to the pelvic floor tissues.  The most common cause is childbirth but other factors can contribute.  These include women who are overweight; Women who have asthma or chronic constipation, women who have physically strenuous jobs; women who have had abdominal surgery; women who do strenuous exercises (like weight lifting), and women who are aging.  Pelvic pain from various sources can cause spasm of the pelvic floor muscles which can affect voiding and intercourse. If you are lucky enough to live to be a senior citizen, there is a good chance you will experience some type of pelvic floor dysfunction in your life.

Symptoms of Pelvic Floor Disorders

There are many different symptoms which manifest themselves as a result of Pelvic Floor Disorders. The following is a list of some of the most common symptoms:

Urinary incontinence

Fecal Incontinence

Painful Intercourse

Bulging Organs in the Vagina

Painful Bladder

Inability to have regular bowel movements

Difficulty urinating

Bloated or heavy feeling in the abdomen

While these are the most common symptoms, it is far from being a complete list which can be as individual as the women who have these issues.

Causes of Pelvic Floor Disorders (In Laymen’s Terms)

The condition, called pelvic organ prolapse, is caused when the connective tissue supporting the internal organs (uterus, bladder, vagina or rectum) have been damaged by childbirth, strenuous exercise, or chronic increases in abdominal pressure.  When the supporting tissue cannot hold the organs in place, they fall to an unnatural position within the pelvic area, causing a myriad of problems.  Women can experience anything from organs bulging from the vagina to a heavy feeling in the pelvic area; obstructive urinary symptoms, or the strong urge to urinate with no success, and even the inability to have regular bowel movements.  While not life-threatening, the problems can affect every area of a normal lifestyle as women are afraid to leave their homes, have no desire for, or experience painful sexual relations, or are uncomfortable doing every day chores like shopping, housework or even walking.

Treatments for Pelvic Floor Disorders

There are several approaches to Pelvic Floor Dysfunction.

For mild cases of prolapse, or pelvic floor muscle dysfunction, Physical Therapy is very helpful.  Muscle strengthening can be instrumental in treating urinary incontinence, fecal incontinence and mild cases of prolapse.  Muscle relaxation can be the key to treating things such as painful intercourse or voiding dysfunction. Sometimes medications are used in conjunction with the therapy.

Pessaries are a cornerstone of non-surgical treatment for prolapse.  They are silicon devices (similar to the diaphragm) that holds the organs in their normal position.  The can either be removed by the patient or she can leave it in and the doctor will do the care and maintenance.

Definitive treatment would be surgical reconstruction of the supporting pelvic anatomy.  The thinking is normal function follows normal form.  Abdominal suspensions of the vagina (called sacrocolpopexies) are felt to be the most durable surgeries for severe prolapse.  These can be accomplished with minimal incisions using the robot.  Slightly less durable but very effective and the least “invasive” of repairs are done through the vagina.  Hysterectomies (removal of the uterus) are often done at the same time to facilitate the suspension, but it is not absolutely necessary.  Talk to your doctor about whether hysterectomy may be right for you.

The most effective surgeries for urinary incontinence are slings.  These can be done through a small incision and done on an outpatient basis with return to work, in most cases, in a few days.

For more information on Pelvic Floor Disorders, visit Dr. Greg Owens web site at

Will Hormone Replacement Help with Bladder Control?

Many women complain of urine leakage with activity (stress incontinence) or with an uncontrollable urge (urge incontinence).  Some women feel there is a worsening of the urinary incontinence around the time of the menses.  Still others notice a worsening of incontinence symptoms with menopause, when estrogen levels drop to very low levels.  That estrogen plays a role in these symptoms is pretty certain, but exactly how it affects urinary incontinence is not clearly understood.  Estrogen has a enhancing effect on the vaginal and urethral mucosa, and the pelvic floor muscles, rejuvenating the tissues and making them more elastic.  The most noticeable effects of estrogen on urinary tract symptoms occur when it is applied locally.  This provides high  levels that produce dramatic tissue effects, while limiting blood levels and exposure  to other body areas such as uterus or breast. Studies show an significant improvement in post menopausal women urinary symptoms with vaginal estrogen, but ironically an increase in the symptoms when estrogen is given orally.  The latter is consistent with women complaining of a worsening of the incontinence with the profession of their cycle, although it is not known exactly why this seems to occur.  The take home message is that vaginal estrogen can significantly improve urinary incontinence symptoms in post menopausal women.