Concerning symptoms associated with pelvic organ prolapse
Emy’s condition involved two conditions. One was a cystocele or prolapsed bladder. The supportive tissue attached to the sides of the pelvis and to the cervix, as well as the wall of the vagina, weakens. This allows the bladder, part of the urinary tract, to sag into the vagina. The other was a uterine prolapse, where weakened pelvic floor muscles and connective tissue allowed her pelvic organs to drop from their normal position. These types of pelvic organ prolapses can be common in women for a variety of reasons, including vaginal delivery, menopause, or other risk factors like obesity or family history. While not life-threatening, the symptoms of pelvic organ prolapse, including pelvic pressure, urinary incontinence, difficulty with bowel movements, and decreased quality of life, had become significant enough that Emy knew she needed treatment.
“I didn’t want anything major in terms of surgery because I’m a chicken—I’m not a good patient,” Emy admits candidly. Her medical background, rather than reassuring her, created additional anxiety. “Being a medical provider myself made me have more questions than I wish I had. In general, the more knowledge I have, the more I freak myself out.”
Emy is a nurse practitioner with over three decades of experience in healthcare. Being a knowledgeable medical professional made being a patient more challenging, not easier. When she developed bothersome pelvic organ prolapse (POP) and stress urinary incontinence, her medical expertise increased her anxiety rather than providing comfort. Her journey to finding Dr. Kuhlmann at Tower Urology represents how the right physician can transform fear into confidence through patience, expertise, and genuine compassion.
A frustrating search for the right treatment approach for pelvic organ prolapse
Emy sought multiple opinions from a handful of different doctors about her pelvic floor disorders. The recommendations she received didn’t align with her values. “They wanted to do a total hysterectomy, but there was nothing wrong with my uterus, so why take it out?” she questioned. For many women facing uterine prolapse, hysterectomy is often recommended. Emy wanted treatment options that addressed her prolapse without removing healthy organs.
Conservative approaches include pelvic floor exercises (Kegel exercises to increase pelvic muscle strength), pelvic floor physical therapy with a qualified physical therapist, pessary devices (silicone inserts that support the vaginal canal), and estrogen therapy. When these fail, surgical options like reconstructive surgery to repair the anterior vaginal wall, sacrocolpopexy (using sutures to restore organs to their normal position), or colpocleisis (which closes the vaginal opening) may be considered.
Meeting Dr. Kuhlmann: immediate connection and understanding
When Emy came to Dr. Kuhlmann, everything changed. “Dr. Kuhlmann, right from the start, was so kind and listened to my concerns. She always addressed them and never made light of them,” Emy recalls. This validation of Emy’s concerns and questions created the foundation for trust.
Dr. Kuhlmann suggested a colpocleisis. This procedure would return Emy’s organs to their natural position without removing any healthy organs, but would also prevent her from having sexual intercourse. In addition, Dr. Kuhlmann also proposed Bulkamid injections for Emy’s stress urinary incontinence (a minimally invasive procedure that bulks the tissue around the urethra to improve continence).
Dr. Kuhlmann understood that Emy needed time and information to feel comfortable with surgical treatment. She also understood that Emy needed visual confirmation to feel confident about proceeding with surgical treatment. “She offered all the tests I wanted to reassure me and make me feel comfortable, like a scan to see how bad the prolapse was and how it was affecting my bladder, instead of her just telling me,” Emy notes. “It made me more confident in my decision to have surgery.”
“After many visits, I decided, ok, I can have this procedure done,” Emy explains. This patient-centered approach, in which the physician respects the patient’s timeline and need for reassurance, exemplifies Tower Urology’s commitment to excellent women’s health care in urology and gynecology.
Dr. Kuhlmann’s patient-centered approach
But perhaps what stood out most to Emy was Dr. Kuhlmann’s commitment to her comfort. “All the way through she told me, ‘I won’t let you be in pain,’ and everything she said was true,” Emy emphasizes. For someone who self-describes as “not a good patient,” this reassurance was transformative. “I did not have the post-op pain I was so afraid of. She did everything she could to make me feel more comfortable,” Emy reports. The relief from her symptoms has been complete.
Emy’s admiration for Dr. Kuhlmann’s technical skill is evident. “She’s a perfectionist, which is everything you want in a surgeon. She pays attention to detail,” she observes. In pelvic surgery, where precision matters enormously for both functional outcomes and symptom relief, this attention to detail translates to excellent results. “I don’t have anymore symptoms and things are progressing well,” Emy says. “I’m doing great and I’m really thankful.”
Patience with endless questions and genuine responsiveness
Perhaps Dr. Kuhlmann’s most remarkable quality was her patience with Emy’s anxiety-driven questions. “Whenever I would email her, which I did a lot because I couldn’t help it, I had a lot of questions,” Emy admits. “She tolerated it, more than tolerated it, actually. She quickly answered my emails, even if I was repeating the same question I had asked just in a different way.”
This level of accessibility and responsiveness is rare in healthcare, as physicians often receive a deluge of correspondence while still attending appointments and performing procedures. Dr. Kuhlmann’s willingness to repeatedly and kindly engage with Emy’s concerns demonstrated a genuine commitment to her patient’s emotional well-being alongside her physical treatment.
Dr. Kuhlmann exceeded expectations
Emy acknowledges that she had some initial reservations because she places a high value on experience, which often equates with age. “I was hesitant because she’s young, or at least she looks young, and I look for experience more than anything,” she shares. Her extensive experience in healthcare made her value seasoned practitioners. “My experience in healthcare is longer than my doctor is old,” she notes with a laugh.
Although younger than Emy had expected, Dr. Paige Kuhlmann is no newcomer to expertise. She is involved with many relevant organizations such as the American Urological Association, the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, the Society of Women in Urology, and the International Society for the Study of Women’s Sexual Health.
Dr. Kuhlmann exceeded all Emy’s expectations. “She did everything she said she would do and more. I can’t speak more highly than I have of her because she’s just so attentive to everything and so skilled,” Emy declares.
One quality that particularly impressed Emy was Dr. Kuhlmann’s intellectual honesty. “She admits that she doesn’t know everything, but she always looked it up right away and researched it, and talked to me about it,” Emy explains. “She’s open to learning and not afraid to admit if she hasn’t heard of something new, but she’ll explore it.”
Rather than dismissing unfamiliar concerns or pretending to have all the answers, Dr. Kuhlmann demonstrated the curiosity and dedication that define excellent physicians. In Emy’s case, age and years in practice proved irrelevant compared to Dr. Kuhlmann’s skill, compassion, communication, and forward-thinking approach.
Exceptional surgical outcomes and ongoing care
The relief Emy experienced from her symptoms was a clear confirmation that she had made the right choice in entrusting her surgery to Dr. Kuhlmann. While Emy continues to see Dr. Kuhlmann for follow-up care, the frequency has decreased as her recovery progresses. “I will still see her occasionally, but I’m healing very well,” she notes, indicating the successful resolution of her pelvic floor disorders. “Dr. Kuhlmann is by far the best choice I have ever made,” she states. “I would recommend her to anyone for anything that’s in her expertise.”
Why choose Tower Urology for pelvic floor disorders and women’s health?
For women dealing with pelvic organ prolapse, urinary incontinence, or other pelvic floor disorders affecting their quality of life, Emy’s experience demonstrates the importance of finding a urogynecologic surgeon who combines technical excellence with genuine compassion, patience with anxious patients, and willingness to provide the time and information needed for confident decision-making.
At Tower Urology, our specialists understand that conditions like these can significantly impact quality of life. Dr. Kuhlmann and our team provide comprehensive evaluation and personalized treatment plans ranging from conservative approaches like pelvic floor physical therapy and pessary management to advanced surgical options, including colpocleisis, reconstructive surgery, and minimally invasive procedures.
We invite you to establish care with Tower Urology. Please make an appointment online or call us at (310) 854-9898.
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our dedication to delivering the highest standard of urologic care alongside the best urologists in Los Angeles. Our years of experience and access to Cedars-Sinai’s world-class facilities ensure that our exceptional and innovative urological care positions Tower Urology as a leader in Southern California.
Tower Urology is conveniently located for patients throughout Southern California and Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include comprehensive treatment for pelvic organ prolapse, urinary incontinence, pelvic floor disorders, and other women’s health concerns, with expertise in both conservative and surgical treatment options.
If you’re experiencing symptoms of pelvic organ prolapse or dysfunction, urinary incontinence, or other pelvic floor concerns, Tower Urology offers expert evaluation and compassionate care. Contact us to schedule a consultation.
Frequently asked questions about pelvic organ prolapse
Common types include cystocele (bladder prolapse), uterine prolapse, rectocele (rectum bulging into the posterior vaginal wall), and enterocele (small intestine pushing into the vaginal vault). Your urogynecologic specialist will perform a physical exam and may use imaging to determine which structures are affected.
Conservative treatments like pelvic floor exercises, pelvic floor physical therapy, and pessary devices should typically be tried first unless symptoms severely impact quality of life. Surgical options become appropriate when conservative measures fail or symptoms significantly interfere with daily activities.
Colpocleisis closes the vaginal opening to provide permanent support for prolapsed pelvic organs without removing the uterus. It’s an excellent option for women who are no longer wish to engage in sexual intercourse, want to avoid a hysterectomy, or prefer a highly effective procedure with a shorter recovery time.
Prevention strategies include maintaining a healthy weight, performing regular pelvic floor exercises (Kegel exercises), treating chronic cough or constipation, and avoiding heavy lifting when possible. Risk factors like vaginal delivery, menopause, obesity, chronic cough, heavy lifting, and family history all contribute to prolapse development.
Sources:
Pelvic Organ Prolapse
https://www.ncbi.nlm.nih.gov/books/NBK563229/
Pelvic Prolapse Imaging
https://www.ncbi.nlm.nih.gov/books/NBK551513/
Colpocleisis, patient satisfaction and quality of life
https://pmc.ncbi.nlm.nih.gov/articles/PMC3881705/
Pessary
https://my.clevelandclinic.org/health/treatments/16036-pessaries
