Christine Chu, MD, is a specialist in female pelvic medicine and reconstructive surgery.
Dr. Chu sees patients at:
Barnes-Jewish Center for Outpatient Health, 4901 Forest Park Ave., Suite 710, St. Louis, MO 63108.
Center for Advanced Medicine – South County, 5201 Midamerica Plaza, St. Louis, MO, 63129
PLEASE CALL (314) 747-1402 FOR AN APPOINTMENT
What happened in the course of schooling to influence you to choose your specialty?
When I started medical school I thought I’d go into emergency medicine. During my obstetrics and gynecology rotation, I really enjoyed working with women and helping them through the many problems that can affect them throughout the course of their lives – from their first gynecologic exam to pregnancy and to problems later on in life. Every stage appealed to me.
During my rotations, I found the urogynecologists in the residency program to be amazing mentors, talented surgeons, as well as very patient and kind teachers. I wanted to be like them.
What brought you to Washington University?
I’ve known about Washington University in St. Louis since I was young -- even before I began looking at colleges during high school. I loved their academic reputation and dedication to education.
When I had the chance to join the urogynecology faculty here, I was thrilled. The research done here is world class and my colleagues are remarkable people. Dr. Jerry Lowder (director of the division of female pelvic medicine and reconstructive surgery) and Dr. Chiara Ghetti are incredible physicians. We work together and collaborate on complex cases.
I also enjoy the fact that we have great relationships with the other departments. We work closely with oncology, urology, as well as the colorectal specialists. When it comes to pelvic floor problems, it often involves the bladder, as well as the vagina and the rectum. Having these close relationships allows us to treat the person as a whole and not just one aspect at a time.
Which aspect of your practice is most interesting?
Pelvic floor issues affect different areas of the body and every woman is different. We have the resources to individualize patient care through surgical or conservative management. I like the ability to discuss with my patients, one on one, the issues and options -- helping each woman decide the best treatment.
Urogynecology involves reconstructive surgery. We take vaginas that have fallen or prolapsed vaginal walls and put them back in place. There is almost an art to it and I enjoy that very much.
What would you say to a woman who suffers from incontinence?
I would say that a lot of women suffer from pelvic floor disorders and incontinence. In fact, over 200,000 patients a year undergo some kind of procedure for incontinence or pelvic floor disorders, and even more women try a conservative treatment. So you are definitely not alone in this.
There are many options available that will improve your quality of life. Incontinence can be treated surgically and non-surgically – talk to your doctor.
What is the difference between stress incontinence and urge incontinence?
There are different types of incontinence. The main two groups are stress and urge.
Stress incontinence is when you have leaking with coughing or sneezing or laughing, sometimes with activity. The reason for stress incontinence is a lack of support under the urethra or a weakness of the urethra.
Imagine stomping on a hose on concrete --it’s easier to shut the flow of water. But if you stomp on a hose on mud, it’s much harder to close that hose and prevent water from coming out. The urethra is very similar. Normally with coughing and sneezing, the body should be able to kink off the urethra and prevent it from leaking, or the urethra itself has components to close itself. But in the case of stress incontinence, that support is lost.
Urge incontinence is leaking with an urge to go to the bathroom. People may experience it when they are doing activities that trigger a response to go to the bathroom -- like washing their hands or putting the key in the door when they get home.
A lot of factors can trigger urge and leakage. This is often a sensitivity of the nerves of the bladder. The nerves are sending signals to the brain that the bladder is full, even when it is not that full. The bladder is also sending signals to itself to squeeze. When it squeezes, you feel the urge. If it squeezes too hard, then you have leaking with that urge.
Stress and urge incontinence are treated in different ways, so it is important to distinguish the two.
What are the ways to treat?
Stress incontinence is often treated by helping to support the anatomy. Conservative measures include pelvic floor muscle strengthening to support the urethra, as well as strategies to prevent leakage when coughing.
Another treatment uses an incontinence ring or knob. This is a small silicone device that goes into the vagina like a diaphragm and presses up against the urethra to prevent leaking with coughing and sneezing.
One of the most common and most successful surgical procedures is the mid-urethral sling -- an outpatient procedure. A small piece of mesh is placed underneath the urethra to support the urethra -- this allows you to cough and sneeze without leaking.
For urge incontinence, the treatment is slightly different because of the sensitivity of the nerves of the bladder. We are targeting the bladder in order to prevent it from squeezing as much. This often involves pelvic floor physical therapy to learn to use pelvic floor muscles to send signals to the bladder to help it relax.
Other treatments include medications that help relax the bladder, Botox ® injections into the bladder, as well as electric signaling to the bladder. This signaling may be stimulation through an acupuncture needle in the ankle or a bladder pacemaker that is implanted in the upper buttocks.
What new developments in your field are you most excited about?
I am very excited about the conservative outpatient treatments for urinary incontinence -- the acupuncture I mentioned is one of them. The needle is placed in the ankle and electric stimulation is sent to target the nerves in the bladder to help the bladder relax. It’s a new treatment that is slowly gaining steam and is for people who have failed to get relief from medication and pelvic floor physical therapy. These patients need a different treatment and may not be able to undergo Botox injections or the bladder pacemaker. This offers them a different option.
Other new developments I am excited about include research on the best techniques for preventing recurrent prolapse, as well as the best surgical techniques for treating primary prolapse -- so we don’t have to deal with recurrence.
What causes prolapse?
There are many different reasons for prolapse. A lot of it has to do with aging -- as we grow older the tissue becomes weaker and the support structures of the vagina weaken. Other contributing factors that cause weakness include childbirth, pregnancy, smoking and connective tissue disorders.
We are finding that genetics play a huge component -- so if your mother or grandmother had prolapse, it is quite possible that you will have prolapse as well.
Where are you from?
I’m originally from Winnipeg, Canada -- It’s the Midwest of Canada. I moved to the United States for high school – lived on the West Coast and the East Coast. I trained in New York for residency and Philadelphia for my fellowship. -- I’m a new re-transplant to the Midwest.
Which particular award or achievement is most gratifying?
I had this amazing opportunity to participate in a program in which Washington University is involved – to teach and work with the urogynecologic fellows at Hamlin Fistula Ethiopia. This organization was founded in Ethiopia by Dr. Reg Hamlin and Dr. Catherine Hamlin in 1974 to treat obstetric fistula patients and train obstetricians to specialize in this surgery.
These are women, usually in developing countries, who don’t have access to obstetric care. They develop fistulas, which are holes between a woman’s vagina and bladder and/or rectum that are a result of delayed childbirth. These women are often shunned from their societies and they are unable to work.
Hamlin Fistula Ethiopia helps these women get the surgical care they need, reintegrates them into society and gives them the skills they need to make a living for themselves. One of the other reasons I went into urogynecology is because I have always been interested in helping women with obstetric fistulas. Going to Ethiopia was an incredible experience and I am so thrilled to have been a part of it.
What is the best advice you’ve received?
One of the best pieces of advice I’ve received is “if you are not always learning and not challenging yourself -- you are not going anywhere.”
Here at Washington University, everyone is constantly reading up on current updates in their field, asking each other how to do better, challenging each other to do more and learn more. That is one of the things that drew me here.
If you weren’t a doctor, what would you like to be doing?
I am very interested in global health and humanitarian aid -- working with different international organizations to help provide care -- medical or otherwise.
I also always wanted to be a writer or a journalist. Being a doctor and a writer actually are not mutually exclusive – there are many great physician writers. That would be something I would love to do.