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Spotlight: John Fischer, MD, wants to change the conversation around pelvic floor disorders

Pelvic floor disorders, including incontinence, can significantly affect a person’s life. But many women feel uncomfortable discussing the problem—or asking for help. Urogynecologist John Fischer, MD, is here to help.
Urogynecologist John Fischer, MD, specializes in treating pelvic floor disorders among women. He was recently appointed division chief for urogynecology.

Pelvic floor disorders, including incontinence, can be an uncomfortable subject to discuss with anyone—even your doctor. Urogynecologist John Fischer, MD, wants to erase the stigma around the topic.

Fischer, who has treated pelvic floor disorders for decades, joined University of Minnesota Health Women’s Health Services team in October 2017. He’ll be the first provider of his kind in the department to specialize in pelvic health and urogynecology.

“A lot of women feel uncomfortable discussing a pelvic floor disorder with their physician,” he said. “But these are very common problems. I want people to feel comfortable talking about them and seeking help.”

We asked Fischer to tell us more about pelvic floor disorders, urogynecology, his treatment approach and the effect that a pelvic floor disorder can have on a person’s life.

Let’s start with the basics. What is the pelvic floor?

The pelvic floor is a group of muscles, nerves and connective tissue that supports the organs in the pelvis, including the bladder, rectum, uterus and vagina. When the pelvic floor becomes weakened or damaged—which can occur during childbirth, for example—people may develop issues with bladder and bowel control, in addition to pain or pressure in the pelvic area.

What are some of the common conditions that result from this?

The two most common conditions I see are urinary incontinence, which includes stress incontinence and urgency incontinence, and pelvic organ prolapse. Stress incontinence occurs when a physical action—coughing or laughing, for example—causes a momentary loss of bladder control. Urge incontinence happens when a person feels a sudden, strong urge to urinate and may pass some urine before getting to the bathroom. A pelvic organ prolapse may develop after childbirth, and is caused by a loss of muscle support for the pelvic organs, such as the bladder or uterus. These organs drop, putting pressure on the walls of the vagina, which in turn causes discomfort, urinary problems and other complications.

Learn more about our women’s health services.

How do you treat these conditions?

There are many ways to treat pelvic floor disorders, including surgical and non-surgical options. Surgery or pelvic floor physical therapy can be used to correct stress incontinence. Medication, Botox, pelvic physical therapy and even neuro-modulation can help address urgency incontinence. Pelvic organ prolapse may require surgery or non-surgical techniques such as insertion of a pessary to help hold up the pelvic organs. Surgical treatment for these conditions has evolved over the past 12 to 15 years. The procedures and recovery times used to be extensive, but now we can do them laparoscopically, which reduces the length of hospital stays and leads to faster recovery times.

You work in a highly specialized unique field. How did you get here?

During my residency, my mentors worked in urogynecology. They inspired me to pursue this area of medicine. Pelvic floor disorders can significantly affect a person’s life. These conditions can be very limiting for women. They’re actually not as rare as most people think. Studies show that 20 to 30 percent of women will need care from a pelvic floor specialist at some point in their life.

Why isn’t there more awareness around pelvic floor disorders?

I think women are starting to understand that something can be done about these conditions—that they have options beyond simply living with a pelvic floor disorder. The presence of a dedicated specialist focusing on pelvic floor disorders can help “normalize” conversations about these conditions and make patients feel more comfortable discussing issues like incontinence.

Learn more about our pelvic floor disorder treatment options.   

Why did you choose University Minnesota Health?

Minnesota is home, actually. I’ve spent the last three decades in the U.S. Air Force, working in Ohio and most recently in Maryland at Walter Reed National Military Medical Center. But my wife and I are both from Minnesota and it’s always been our hope to come home. There hasn’t been a year where we haven’t come back at least once. The University of Minnesota is such a renowned institution in the state and I’m really looking forward to contributing to women’s healthcare.

What is urogynecology? Watch the video below to see John Fischer, MD, discuss his expertise.