RPH Newsletter 4 pages final v5

RileyPelvicHealth.com
March, 2011
Volume 1, Issue 1
Val Riley, MD Opens New Office for Gynecology & Urogynecology
W
Inside this issue:
The ABC’s of Kegel Exercises
2
Woman to Woman—a Public
Forum for Women’s Health
Issues
2
What is a Pessary?
3
Interstitial Cystitis—A Brief
Review
3
What does a Urogynecologist
Do?
4
Recipes for Interstitial Cystitis
4
elcome to 'The Riley Center for Pelvic Health.' For
the longest time I have wanted
to establish a private practice,
but was afraid. The changes in
healthcare have forced many
physicians to retire or join large
organizations which survive by
efficiency and economy of scale.
These changes often juxtapose
the physician with the patient.
Private practice allows me the
greatest freedom to realign
these relationships and provide
healthcare as though my patients are my family. When you
stroll into The Riley Center, I
hope you will notice the differ-
ence (see below), when you
leave, I hope you will feel the
difference. I would like to thank
my family, my friends, Embassy
bank, my suppliers and service
agents, but most of all my patients for giving me the courage
to make this change, and for
making this work. - Val
Conditions We Treat
T
he Riley Center for Pelvic Health provides a unique environment and philosophy to personally treat
your specific pelvic health needs. Many woman are embarrassed by their pelvic health issues and
limit their lives because they are not aware that their problems can be resolved - usually without surgery.
Our goal is to help you return to a normal life and lifestyle. Common conditions that we treat include:
Fun Facts

It takes only five minutes for
sperm to travel to the egg.

Rrhagia (raja) is Latin for
menstrual flow. Metrorrhagia is the term for irregular cycles—just like the
Metro bus.

Birth control pills, the patch
and the ring decrease the
risk of ovarian, endometrial
and colon cancer.
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Menopausal symptoms
Urinary incontinence
Menstrual irregularity
Overactive bladder
Interstitial Cystitis
Pelvic prolapse
Fecal incontinence
Recurrent bladder infections
Dysparunia
Chronic pelvic pain
Personalized Medicine
My husband, a surgical oncologist and cancer researcher is
excited about personalized medicine - the field of genomics and
its ability to tailor therapies to
individual patients. While I share
his enthusiasm - for me, personalized medicine is about the
relationship. In my younger
days, as a new mother I was
always excited to share experiences with my patients when I
delivered their babies. We
shared pictures and watched our
children grow up. As I matured I
acquired new experiences to
share. Raising three daughters
(and a husband) has taught me a
lot, I have also personally experienced many of the conditions I
treat as a urogynecologist. I
think being a patient helps me
be a more understanding physician. I will still 'keep up' on the
genomics too.
RileyPelvicHealth.com
Page 2
Volume 1, Issue 1
The ABC’s of Kegel Exercises
S
There are as many species of
orchids as there are of birds.
Two-thirds of women who are
initially helped by Kegel exercises
will still have favorable results
after ten years.
trong pelvic floor muscles
help women control urine
flow. Pregnancy and childbirth,
excess weight, and chronic
coughing all can weaken the
pelvic floor muscles. These factors in addition to the aging
process generally results in
weakened pelvic floor muscles
and in some cases incontinence.
Strengthening these muscles can
significantly improve your incontinence. Indeed, the majority of
women with urinary incontinence can be helped by strengthening the pelvic floor muscles,
and two-thirds of the women
who are initially helped will continue to have satisfactory results
for ten years (Cammu et al., BJU
Int. 2000 Apr;85(6):655-8).
The physiology behind strengthening the pelvic floor muscles is
similar to other muscles groups,
though you typically won't find
these exercise in most body
building manuals.
In general, to exercise your pelvic floor muscles, you need to try
and tighten your vagina or elevate your vagina higher in the
pelvis - as though you are trying
to stop urinating. Note: don't
do these exercises when you are
actually urinating. At the same
time you should try and relax
your thigh, buttocks and stomach muscles - this may take some
practice or coaching. Also, continue to breathe through the
contractions, don't hold your
breath. Doing these exercises
can be done in any position,
standing, sitting or laying down.
schedule that works for you.
There are three main ways of
performing these exercises.
 Remember to relax your ab-
The "quick-flick" is when you
contract for one second and then
relax for one second.
TIPS
 Remember to breathe normally during the exercises. DO
NOT hold your breath.
dominal and buttocks muscles
when you do your pelvic exercises.
 Do your exercises at times
During the "contract and release" method you should hold
the squeeze for three seconds
and then relax.
when you are most likely to remember to do them, such as
before breakfast, lunch and dinner.
The "elevator" approach is when
you partially contract your muscles, hold for two seconds, increase the strength of the contraction for another two seconds
and then increase the strength of
the contraction a third time.
When you relax, just reverse the
process in three steps as well.
 Do some exercises just before
Pelvic Floor exercises work best
when they are done a regular
basis. Try to do 10-20 Kegels in a
set. Do 3-4 sets daily.
Ask your doctor to develop a
sneezing or coughing.
 Keep on doing them. Do not
be discouraged. You should start
to see results in a few weeks.
After you reach your goal, continue to do your exercises at
least two times per day.
For more information and a workout
sheet on Kegel Exercises, see the
“forms” section at
Woman to Woman— A Public Forum for Women’s Health Issues
“During a typical office visit there
never seems to be enough time
to talk about all the issues that
concern patients.” This is a common complaint from patients,
nurses and physicians. To help
answer questions, Dr. Riley will
be giving lectures and leading
discussions with the public. The
talks will cover a variety of issues
and will occasionally include
guest speakers. The series will
be held at the Riley Pelvic Center
(at 3445 High Point Blvd, Suite
100, Bethlehem, PA 18017) the
first Wednesday of each month,
starting at 7PM. The first lecture, entitled “Menopause—
working through it” will start on
Wednesday, May 4th. Refreshments will be served. Seating is
limited. Call 610 882 3828 to
reserve your seats.
RileyPelvicHealth.com
Volume 1, Issue 1
Page 3
What is a Pessary?
A
pessary is a removable
device that is placed in the
vagina to treat pelvic organ
prolapse. Prolapse occurs with
the structures that support the
pelvis become weak and organs
like the bladder or uterus protrude (fall down). In addition to
treating uterine prolapse, pessaries can also be used to treat
bladder cystoceles, rectoceles
and urinary stress incontinence.
Pessaries are usually made of
silicone or rubber and come in a
variety of shapes and sizes. Your
physician may need to experiment with different types of
pessaries to find one that feels
right for you. Your health professional will teach you how to remove and clean your pessary
(about once every three
months). A properly fitted pessary should not be felt or notice
by the patient.
Pessaries may not work in all
patients, though according to
one well controlled study 92% of
women with a successful pessary
fitting trial were satisfied and
nearly all prolapse symptoms
resolved (Clemons, JL et. al, Am J
Obstet Gynecol 190:1025-9,
2004).
Complications from pessaries are
uncommon and can be minimized if the pessary is fitted
correctly. In post menopausal
women, estrogen cream may be
used to minimize or prevent
irritation of the sensitive vaginal
skin.
Interstitial Cystitis—A brief review
I
nterstitial Cystitis (IC) is a
noninfectious bladder condition that often presents with
urge urinary incontinence and
pelvic pain. Not uncommonly
patients experience intermittent
symptoms of a bladder infection
(otherwise described as infectious cystitis), and may see blood
in their urine. Only culturing a
sample of urine can determine
precisely if the symptoms are
from an infectious or noninfectious cause.
Interstitial cystitis patients often
have other associated disorders
such as fibromyalgia, constipation, irritable bladder syndrome,
pelvic floor dysfunction and migraine headaches.
Typically IC patients have acute
or chronic urinary urgency, frequency, nocturia, pelvic pain,
pain with intercourse, bladder
filling pain, low back pain and
suprapubic pain. Evaluation will
involve ruling out the presence
of other disorders or conditions
that cause similar symptoms. A
careful and extensive examination of the abdomen, back, pelvic
organs and supporting ligaments
is included in a complete physical
examination. Ultrasound or
other radiologic studies, cystoscopy or laparoscopy may be
needed to determine the exact
diagnosis.
The cause of IC is still unknown
despite research that has been
ongoing for a century, Once the
diagnosis is made, specific therapies can be started to address
the patients individual symptoms.
Behavioral therapy is initially
recommended with dietary
changes to avoid a variety of
foods and beverages that IC patients are commonly irritated by
such as carbonated, caffeinated,
citric and spicy foods. Patients
should ensure they are adequately hydrated to avoid concentrated urine which can irritate their bladder. In general it's
recommended to drink enough
fluids to see pale yellow urine.
An excellent source of recipes
for patients with IC is the online
IC Chef Cook book found at:
http://www.ic-network.com/
icchef.
Also see page 4 for a new
recipe.
 Ninety-two percent of women with a successful pessary fitting trial
remain satisfied after two months.
 Thirteen million Americans are incontinent—85% of them are
women.
 There are three main types of urinary incontinence—stress, urge,
and mixed. The treatments may be different for each one.
Our Mission
No two people are the same, healthcare needs to be
personal. At The Riley Center for Pelvic Health we listen
to YOU and understand your symptoms and concerns.
Frequently diagnostic studies are needed and tailored to
your specific issues. Then we offer you a personalized
therapy that best fits your condition. In order to accomplish this we must always be dedicated to providing excellence. . .
excellence in diagnostic evaluation
excellence in education and counseling
excellence in non-surgical treatments
excellence in surgical treatments
This is what we do... every day for everyone.
Riley’s Three Bean Soup for Patients with Interstitial Cystitis
Ingredients:
 3 cans of your favorite beans
(one can for each bean type)
 1 can corn
 Better than bouillon (chicken)
 6 large garlic cloves
 1 small yellow onion
 Cilantro
to the pot and simmer for ten minutes and then blend to a slurry with
Add two cups of water and one
a hand-held blender. This makes a
tablespoon of Better than bouil- rich, tasty base. Add the remaining
lon to a large pot. Bring to a boil. beans/corn and cook for an addiMeanwhile, mince the garlic and tional few minutes.
onions and sauté in the olive oil
Garnish with cilantro and serve.
along with one tablespoon of
Keeps well refrigerated or frozen.
Better than Bouillon. Once this
is soft, add the mixture to the
broth and simmer for ten minutes.
Directions:
Empty the beans and corn into a
colander and rinse clean.
Add one-half of the beans/corn