Urogynecology and Pelvic Floor Disorders

Loss of support of the pelvic organs can result in pelvic organ prolapse. Pelvic organ prolapse may cause symptoms including pelvic heaviness, a bulging sensation, discomfort with intercourse, or difficulty emptying the bladder or bowels. 

The loss of support may be from tears in the connective tissues, weak muscles, or loss of nerve supply to the area. If the loss of support involves the anterior vaginal wall (which supports the bladder) a cystocele develops. Loss of support of the posterior vaginal wall (which supports the rectum) is called a rectocele. Loss of support of the top or apex of the vagina results in uterine prolapse or vaginal vault prolapse (if the uterus has previously been removed.) 

Pelvic organ prolapse treatment options:

• Observation
• Pelvic floor exercises
• Pessary – vaginal support devices
• Surgery – we specialize in vaginal, laparoscopic and robotic surgical approaches
• Additional information can be found at https://www.voicesforpfd.org/pelvic-organ-prolapse/

Female urinary incontinence affects up to 50% of woman at some point during their life. It becomes more common as women get older, but is never considered “normal.” There are several different types of urinary incontinence, so it is important to determine the type of incontinence as the treatment options differ. 

Stress incontinence: Leakage which occurs with increases in abdominal pressure such as cough, sneeze or exercise. 

Urge incontinence: Leakage which is associated with a sudden urge to empty the bladder. This is frequently referred to as overactive bladder and can be associated with urinary frequency during the day or night. 

Overflow incontinence: Leakage or “spill-over” of urine when the bladder does not empty well due to a blockage or obstruction of urine flow. 

Functional incontinence: Leakage due to the inability to get to the bathroom in time because of a physical condition, such as arthritis. 

Fistula: Leakage due to an abnormal connection or hole between the bladder and vagina. 

Treatment options include:

• Pelvic floor physical therapy
• Pelvic floor electrical stimulation
• Pessaries (vaginal support devices)
• Medications
• Transurethral injections
• Surgical repair
• Sacral nerve neuromodulation

Stress urinary incontinence involves leakage which occurs with activity and increases in abdominal pressure such as with a cough, sneeze or exercise. 

In general, female urinary incontinence affects up to 50% of woman at some point during their life. It becomes more common as women get older, but is never considered “normal.” There are several different types of urinary incontinence, so it is important to determine the type of incontinence as the treatment options differ. 

Stress urinary incontinence treatment options: 

• Pelvic floor physical therapy
• Pelvic floor electrical stimulation
• Pessaries -- vaginal support devices
• Urethral bulking - Learn about Bulkamid
• Midurethral slings
• Additional information can be found at: https://www.voicesforpfd.org/bladder-control/sui-treatment/

Urgency urinary incontinence involves urinary leakage which is associated with a sudden urge to empty the bladder or without a true awareness that one needed to void. Overactive bladder involves urinary urgency, frequency (day or night), and/or urgency related leakage. 

In general, female urinary incontinence affects up to 50% of woman at some point during their life. It becomes more common as women get older, but is never considered “normal.” There are several different types of urinary incontinence, so it is important to determine the type of incontinence as the treatment options differ. 

Overactive bladder/urgency urinary incontinence treatment options: 

• Pelvic floor physical therapy
• Pelvic floor electrical stimulation
• Percutaneous tibial nerve stimulation
• Intravesical botox (botox injection into the bladder)
• Sacral nerve neuromodulation
• Additional information can be found at: https://www.voicesforpfd.org/bladder-control/oab-treatment/

Accidental bowel leakage or fecal incontinence may result from weak or torn pelvic floor muscles and/or anal sphincters. 

Fecal incontinence treatment options:

• Pelvic floor exercises
• Dietary Changes
• Oral medications
• Sacral nerve neuromodulation
• Surgery
• Additional information can be found at:https://www.voicesforpfd.org/bowel-control/

Painful bladder syndrome or interstitial cystitis, encompasses a group of conditions that can cause debilitating urinary frequency, urgency and pain. Although we do not understand what causes painful bladder syndrome, we know that there is an abnormality in the lining of the bladder wall. 

Treatment options include:

• Dietary Changes
• Pelvic floor physical therapy
• Acupuncture
• Medications
• Bladder instillations(placing a combination of medications directly into the bladder which help to heal the bladder)
• Bladder hydrodistention (stretching of the bladder)

For more information about painful bladder syndrome, we recommend that you visit the Interstitial Cystitis Association website.

Pregnancy and deliveries are times that can involve significant trauma to the pelvic floor. Vaginal lacerations may lead to ongoing symptoms including pain, stool leakage, infection. 

Additional information can be found at: https://www.voicesforpfd.org/new-mothers/pelvic-floor-health-for-new-moms/

Leakage due to an abnormal connection or hole between the bladder and vagina.

Many patients suffer from frequent bladder infections/urinary tract infections. Evaluation includes a thorough history, physical examination, and possible cystoscopy or imaging studies. Preventative and treatment options are possible.

Blood in urine. Sometimes this is something a patient sees, or often something seen only from lab work. Evaluation may include imaging studies and cystoscopy (a camera to look inside of the bladder)