Updates in Pelvic Surgery

Podcast Transcript

Dr. Scott Steele: Butts and Guts, a Cleveland Clinic podcast exploring your digestive and surgical health from end to end.

Dr. Scott Steele: Hi again everybody, and welcome to another episode of Butts and Guts. I'm your host, Scott Steele, the Chair of Colorectal Surgery here at the Cleveland Clinic in beautiful Cleveland, Ohio. And super excited to have Dr. Anna Spivak who is a Colorectal Surgeon with a specialization in leading our pelvic floor surgery center here. Anna, welcome to Butts and Guts.

Dr. Anna Spivak: Thank you.

Dr. Scott Steele: So, we're going to talk a little bit about pelvic surgery today. But before we get there, I know it, but the other people may not, so tell us a little bit about yourself. You have a very interesting background in how did it come to the point that A: you're a doctor in B: that you're here at the Cleveland Clinic?

Dr. Anna Spivak: So, I do have an interesting background. I did other things before doing medicine. I was in finance before and started medical school a little bit later in life, and fell in love with surgery in medical school and then colorectal from there. And, all of a sudden, interest in pelvic floor, sort of a challenging field. Every patient is different, and it's interesting to figure out exactly what the underlining issue or problem may be. And, after I did my residency in Philadelphia, then fellowship in Pittsburgh and started in private practice after fellowship and got recruited by Dr. Steele to come and do what I love at the Cleveland Clinic.

Dr. Scott Steele: Well, we're super excited to have you here. There's no doubt about that. And so, you treat individuals who have concerns regarding controlling their bowels, whether it's fecal incontinence, constipation, rectal prolapse, a whole bucket of processes out there that fall into the pelvic floor. As we've said in the past on this particular podcast, this can be tough for patients to talk about. I always say that people may go decades and not even tell their most significant other about their pelvic floor, about their bowels in general. So, can you give us a feel a little bit about how common some of these more major ones, whether it's incontinence or constipation or obstructive defecation or rectal prolapse, and what type of disorders, otherwise, can you help deal with?

Dr. Anna Spivak: So, it actually is a very common problem, especially constipation. Actually, 16 out of 100 adults in the United States will have constipation at some point of their life. And for many, it's a chronic problem. For incontinence, it's one in 12 adults, and that's quite frequent, as well. And that's a lifetime, so mostly affecting people over 60, but can be also present in younger patients. And pelvic organ prolapse, whether it's uterine prolapse or rectal prolapse can be as common as in 30 percent or 40 percent women. And like you said, many patients do not talk to their family or anyone else, and of course, their primary care about their problems until it's almost too late. But I think one of the goals of this is to let the patients know that treatment is available, and if you address problems early doesn't lead to worsening problems.

Dr. Scott Steele: We're talking a little bit about surgery today and specifically pelvic surgery. But before we go into there, can you talk a little bit about some of the nonsurgical, either procedures or medications or whatever it might be, to help people who continue to struggle with their bowels?

Dr. Anna Spivak: One of the most important ones is, of course, getting in a bowel regimen if you have constipation. One thing that I want to highlight is that if you have a new onset of constipation or incontinence, it's very important to get evaluated and get a colonoscopy because that can be a symptom of a bigger problem. But, as far as medications are concerned, getting in a bowel regimen, always start with over-the-counter medications and it can help with that. And then, there's multitude of prescription medication for that, as well. For obstructive defecation, if that's diagnosed in a patient, pelvic floor physical therapy can be very helpful. Other medications that can be used, whether it's muscle relaxants and things like Botox injections, can also help with some of the problems.

Dr. Scott Steele: So, who qualifies then for pelvic floor surgery? Is it just the people who fail these other ones or are there people that you're like, oh, you know what, that's a surgical problem and we need to be able to go there?

Dr. Anna Spivak: So, one of the things that is very commonly operated on and no medication will help that is the rectal prolapse. So, if somebody has a rectal prolapse, there is no amount of medication or physical therapy that will help with that. Having said that, it's very important to address the underlying problem before we take the patient to surgery. So, if constipation is the cause of the prolapse and straining, then getting the patient in a proper bowel regimen and getting them to physical therapy to kind of undo the bad habits is essential before and afterwards, as well.

Dr. Scott Steele: So, are there any recent pelvic floor surgical advancements that have been made?

Dr. Anna Spivak: Pelvic floor surgery keeps advancing all the time. One of the things that we do here is that we approach the pelvic prolapse in a multidisciplinary approach, meaning that we evaluate the patient where they need to have a combined surgery with urogynecology, and we do our surgery robotically, as well, which gives the patient a faster recovery and better return to daily activities of life.

Dr. Scott Steele: So, what are the chances of success following surgery? If I'm out there and I'm a listener, I'm thinking, oh my Gosh, I got to get surgery on my pelvic floor? That's a little bit daunting. It's a little bit scary, even with some of the advances that you just talked about. So, take me through a little bit of that. Is this something that we should avoid at all possible, it's a last resort? Can you walk me through that?

Dr. Anna Spivak: Well, nobody wants to live with the pelvic prolapse. Whether it's both uterine and rectal prolapse or just the rectal prolapse, that's not a fun thing. And that certainly contributes to decreased quality of life. Patients have told me that they wouldn't leave the house, they would come up with all different kind of devices to get through the day. So, the success rate when we address the underlying problem is very good. It is a surgery that has a certain risk of recurrence, but what we find is when we approach it in the combined approach and minimally invasively, patients do very, very well.

Dr. Scott Steele: So, I know this differs depending on the type of surgery that may happen. So how long is the recovery process after some of these types of surgeries?

Dr. Anna Spivak: So, if we do the surgery minimally invasively, meaning robotically in our case, patients sometimes have been able to go home the same day. And those who do not feel well immediately after operation, and maybe the case is later in the day they go home, most people go home the following day. You go on a regular diet, we do ask you to limit weightlifting for the first couple of months, but otherwise, there's no real restrictions. And with minimal invasive surgery, there's really very little pain, and people are able to return to most of the activities and to work in about one to two weeks.

Dr. Scott Steele: When should a patient avoid surgery? Kind of looking at it the other way.

Dr. Anna Spivak: That's good you ask because I think, like I mentioned before, one of the important things is to address the underlying factors, right? So, if somebody has bad constipation and they haven't fixed the medical part of the problem, then they're more likely to occur. And this is where my expertise comes into play to make sure that those problems are addressed before surgery.

Dr. Scott Steele: So, what else is on the horizon when it comes to pelvic floor surgery?

Dr. Anna Spivak: We're always looking at improving surgery. We're always looking at improving our techniques. We are looking at our outcomes, how patients do years out, are they recurring? And I think approaching it combined with urogynecology, making sure that we are fixing everything in the pelvis at the same time and approaching it robotically is where the advances are going to.

Dr. Scott Steele: And that's fantastic. So, now it's time for our quick hitters, which is a chance to get to know you just a little bit better. So, first of all, what's your favorite food?

Dr. Anna Spivak: Mm. Sushi.

Dr. Scott Steele: Do you make your own sushi, Anna?

Dr. Anna Spivak: Sometimes. Yeah.

Dr. Scott Steele: Fantastic. What's your favorite sport to watch and or to play?

Dr. Anna Spivak: Tennis.

Dr. Scott Steele: Do you have any favorite tennis players out there?

Dr. Anna Spivak: Hmm. That'd be hard. There are many good ones. Probably Nadal.

Dr. Scott Steele: Okay, fantastic. And then, can you tell us about a favorite place, favorite trip, or even maybe even something on your bucket list that you'd like to go to?

Dr. Anna Spivak: Well, I'm from a beautiful City of St. Petersburg. Always love to go back, but my ever-favorite place to visit is Israel. I keep going back many times.

Dr. Scott Steele: That's fantastic. Beautiful, beautiful places. And then finally, you're a relative newbie here to Northeast Ohio. So, tell us something that you like about living here.

Dr. Anna Spivak: I found that the summers are absolutely beautiful, and Mitchell's Ice Cream.

Dr. Scott Steele: Mitchell's Ice Cream is fantastic. So, give us a final take home message for our listeners.

Dr. Anna Spivak: If you have an issue with whether it's constipation or incontinence, pelvic organ prolapse, we can help you. And, as embarrassing as it may be to talk about it and bring it up to your healthcare provider, it is something that can be fixed, and there is help out there. So, encourage everybody to keep an open mind and seek help if you need to.

Dr. Scott Steele: That's great, great advice. And so, for more information, download our pelvic floor disorders treatment guide by visiting clevelandclinic.org/pelvicfloor. That's clevelandclinic.org/pelvicfloor. You can also call 216-444-7000. That's 216-444-7000. Dr. Spivak, thanks so much for joining us on Butts and Guts.

Dr. Anna Spivak: Thank you for having me.

Dr. Scott Steele: That wraps things up here at Cleveland Clinic. Until next time, thanks for listening to Butts and Guts.