Have you ever wondered if there was a specialized doctor that handles female conditions outside of the scope of your OBGYN? What happens after you have a baby and your OBGYN clears you for "life" again, but you still don't feel like yourself? Did you know that women's urology was a field? Admittedly, we didn't before chatting with Dr. Angelish Kumar! Dr. Kumar is a mama, a women’s urologist, and a certified menopause practitioner with a private practice affiliated with New York's Mount Sinai Hospital. She has developed a clinical focus on the care of female patients that specializes in postpartum and menopausal issues. As each woman has her own individual story, much of her practice is centered around creating a safe and welcoming space where women feel supported, comfortable and able to openly share what they are dealing with in their postpartum journey. Dr. Kumar aims to elevate the level of genitourinary care for postpartum, peri-menopausal and post-menopausal women. She fully dedicates her practice to educating women, while offering medically sound, evidence based and state of the art treatment options in this field. We were super intrigued by her work, and asked her to share more about the ins and outs of what she sees with her patients on the daily. Her work helps normalize issues that are often considered taboo, or things that women should just “have to live with.” Here’s what she had to say…
We are so fascinated by your work. Can you tell us a little more how you would define women’s urology and what led you to specialize in it?
Thanks. I find it fascinating as well! In female urology, we deal with urinary, vaginal and pelvic floor issues. About 40-50% of women suffer from issues like overactive bladder, urinary tract infections, and urinary leakage. So that is a lot of us! And these issues are very related to the phases of life we go through, from becoming sexually active, to giving birth, to becoming peri-menopausal and postmenopausal. So, we need to consider what is going on hormonally, what type of contraception a woman is using, if she is sexually active, where she is in terms of being postpartum, if she is breastfeeding, and other factors that relate to her symptoms and how we are going to treat them. I knew we needed to provide care for women’s genitourinary issues in a more comprehensive and meaningful way, so I decided to dedicate my entire practice to women’s urology.
Before we chatted, we didn’t even realize urology for women existed! What differentiates your practice from that of an OBGYN practice for women’s health-related issues?
This is such a commonly held belief, that you are supposed to see your OBGYN for urinary problems, or for anything that is going on, “down there”. In an OB/GYN practice, gynecologists are managing issues such as birth control, pregnancy and delivery, sexually transmitted diseases, breast health, menstrual irregularity and pain, as well as ovarian and cervical diseases. So, they are already covering a lot of ground! They will often also manage simple urinary tract infections or give referrals for pelvic floor physical therapy, but if this is a serious issue, it is best to see a gynecologist who has specialty training in urinary problems (urogynecologist), or a urologist who specializes in female urology. So yes, urology for women does exist, and I especially encourage younger women who are postpartum to see a urologist if they are suffering from persistent bladder leakage that is preventing them from doing things they enjoy, like exercising.
What are some of the most common issues women come to you for?
The most common issues are recurrent urinary infections, stress incontinence (leakage with exercise, cough, laugh, or sneeze), overactive bladder (when you feel like you just can’t hold it like you used to), and in post-menopausal women, I see a lot of genitourinary syndrome of menopause. That is when women experience vaginal dryness, pain with intercourse, urethral burning, vaginal irritation, urinary frequency or urgency, and feel more prone to leaking urine or getting urinary tract infections. I also see women with interstitial cystitis, which is a non-infectious painful inflammation in the bladder, vaginal pain, kidney stones, and bladder cancer.
In regards to postpartum health, there is so much that is not talked about… for the issues you mentioned above, do you find that women feel they should just “live with it”, and how do you go about reshaping that “norm”?
Yes. It is so ingrained in our culture that urinary leakage after childbirth is something you live with, and don’t talk about. It affects one out of every three postpartum women, so it is extremely common. And yet, women feel extremely embarrassed about mentioning it. Or when they do, they are not given adequate advice and referrals to specialists who can help. More importantly, it is not the role of primary care doctors or general gynecologists to manage incontinence. Women should see urologists and urogynecologists who specialize in this. As you mentioned earlier, most women don’t know we exist! So, it is our job to make ourselves known, and we also need women to advocate for their own health. The more we get out there and discuss pelvic floor health during and after childbirth, I hope we can break down the, “just live with it,” mentality.
As a postpartum mama, what are some best practices or exercises that help with pelvic floor dysfunction?
I love this question because most women don’t recognize how important it is to maintain pelvic floor strength during pregnancy and postpartum. One great form of exercise is Pilates. It not only engages your pelvic floor muscles but helps with core strength. This corrects your posture and prevents lower back pain. It keeps your whole body strong. When you are pregnant, there is more laxity in your ligaments, and this can cause pain in the joints for some women. By strengthening the muscles around the joint, you can really prevent strain and subsequent pelvic floor dysfunction. I also think that every woman who has a vaginal delivery should do pelvic floor physical therapy.
What was your postpartum journey like?
I never could have imagined how challenging the postpartum experience would be. And despite the lack of sleep, the hormonal shifts, and the stress on our bodies (whether you have had a c-section or vaginal delivery) women are so pressured to give off the appearance that everything is perfect and beautiful. And if you don’t feel that way (which I did not!), you feel so guilty about it. I had a very difficult time breastfeeding because I never produced enough milk. I made myself miserable trying to pump or feed every two hours. I gave the girls as much breast milk as I could, and I had to supplement with formula for the rest. If I could do it all again, I would have been easier on myself. I would have just given whatever breast milk I had, supplemented with formula, and not worried about it. I wish I had tossed that breast pump in the East River!
Were there any gold nuggets of advice that you received pre- or post-birth that have stuck with you through motherhood?
People gave me all kinds of advice about breastfeeding, napping, maternity leave, and sleep training, and none of it worked for me. You can choose what advice to take and ultimately you figure out what works for you. The most important thing is to cultivate a great support system. Whether this is your network of friends, your close family, your partner, or your colleagues, you know who your people are. I felt so lucky I had people to lean on.
Quick! Can you name three essential items or products (specific to being a mama) that you couldn’t live without?
- A good pilates instructor (Thank you April Nicole Silverman!)
- A great husband, mother and nanny (thank you Home Team!)
- A bathing suit that looks great, and that you can breastfeed in (thank you MOLOCO!)