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Incontinence and Pelvic Support

Our urogynecologists – gynecologists who complete additional training focusing on treating urinary incontinence, pelvic organ prolapse, fecal incontinence, overactive bladder, and similar conditions – provide first class, specialized gynecologic care.

Our team evaluates and treats female pelvic floor problems including urinary urinary stress incontinence (SUI) and urge incontinence, pelvic organ prolapse, and pelvic bladder syndrome, and performs minimally invasive gynecologic and urogynecologic surgery.

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Urogynecologic Conditions We Treat Include:

Urinary Incontinence

There is no need to suffer in silence – incontinence can often be treated without surgery. If surgery is required, it can usually be performed minimally invasive and is covered by most insurance plans. 

What is Incontinence?

The two most common types of incontinence are stress incontinence and urge incontinence:

  • Stress incontinence is the leakage of urine with activities such as coughing, laughing, sneezing, and exercise.
  • Urge incontinence is the sudden desire to pass urine, which can be accompanied by leakage.

Treatment will vary depending on the type of incontinence you have.

Treatment Options for Stress Incontinence

Kegel Exercises

Strengthening the muscle of the pelvic floor helps to regain bladder control, effectively treating leakage for a large number of patients. Kegel exercises alone or with a physical therapist are often the best treatment option.

Pessary

If those more conservative options do not work, your doctor may recommend a pessary. Pessaries are small devices that are placed in the vagina to provide support to the urethra to prevent leakage associated with activity. Pessaries can be left in the vagina or can be placed as needed for activity.

Minimally Invasive Sling

The urogynecologic surgery procedure combines the use of a safe material – polypropylene mesh tape – with a traditional incontinence treatment called the "sling" procedure to support the urethra. The procedure takes about thirty minutes and only requires tiny and discrete incisions, and patients go home within hours afterwards.

Treatment Options for Urge Incontinence

Your doctor will begin by evaluating what you drink and how much. Understanding your habits, your doctor can then recommend behavior changes that often help considerably. Urge incontinence (overactive bladder and urinary retention) patients also respond to pelvic floor exercise or physical therapy. If behavioral changes and exercise do not work, your doctor will consider the following treatment options.

Medication

Medications can help to relax the bladder muscle, and are chosen specifically for each patient's needs. 

Percutaneous Tibeal Nerve Stimulation (PTNS)

For this procedure, your doctor will use a small acupuncture-like needle to help control the bladder. You will attend weekly 30 minute sessions for 12 weeks. Behavioral changes are also important during this time.

BOTOX® for the bladder

Using a mild anesthetic, we place botulinum toxin (commonly known as BOTOX®) into the bladder to help relax the muscle and decrease the spasms that sometimes cause leakage and frequent urination. This procedure is done with sedation and takes about ten minutes. BOTOX® can last for 6-12 months depending on the patient.

Sacral Neuromodulation

When more conservative treatments fail or are intolerable, we offer an innovative intervention for urge incontinence  called sacral nerve stimulation. This treatment, which involves a device resembling a pacemaker, provides urinary control therapy that addresses the nerve component of bladder control problems.

 

 

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the pelvic floor muscles become weak or damaged and can no longer support the pelvic organs. There are a number of different types of prolapse that can occur in a woman's pelvic area. These are divided into three categories according to the part of the vagina they affect: front wall, back wall or top of the vagina. It is not uncommon to have more than one type of prolapse.

Four main types of pelvic organ prolapse can occur:

Cystocele (bladder prolapse)

When the bladder prolapses, it falls towards the vagina and creates a large bulge in the front vaginal wall. This is called a cystocele and is the most common type of prolapse in women.

Enterocele (prolapse of the small bowel)

Part of the small intestine that lies just behind the uterus (in a space called the pouch of Douglas) may slip down between the rectum and the back wall of the vagina. This often occurs at the same time as a rectocele or uterine prolapse.

Rectocele (rectum bulging into the vagina)

This occurs when the end of the large bowel (rectum) loses support and bulges into the back wall of the vagina. It is different from a rectal prolapse (when the rectum falls out of the anus).

Uterine Prolapse/Vaginal Vault Prolapse

In a patient that has had a hysterectomy, the uterus or the top of the vagina can bulge into the vagina causing the feeling of pressure and fullness.

Treatment

Your doctor will talk to you about treatment options depending on the severity of the prolapse and your degree of discomfort.

Physical Therapy

If you have early stage or mild prolapse, we may offer physical therapy to strengthen the muscles of the pelvic floor. This can improve symptoms and the degree of bulge in patients.

Pessary

If physical therapy is not an option for you, your doctor may recommend a pessary. Pessaries are small devices that come in different shapes and sizes and can be used to manage the prolapse non-surgically. If you are bothered by a prolapse but are unable to go through surgery, your doctor may recommend fitting you with a pessary.

Surgery

For more definitive management, your doctor will talk to you about surgical options including vaginal, laparoscopic, or robotic procedures. The procedure that is right for you will depend on the severity of your prolapse and your age, lifestyle, and goals.

 




Interstitial Cystitis/ Bladder Pain Syndrome (IC/PBS)

Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual.

People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area.

Symptoms may include:

  • An urgent need to urinate
  • A frequent need to urinate
  • A combination of these symptoms

Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation. They may sometimes experience pain during vaginal intercourse.

Diagnosis and Treatment

Scientists have not yet found a cure for IC/PBS, nor can they predict who will respond best to which treatment. Because the causes of IC/PBS are unknown, current treatments are aimed at relieving symptoms. Many people are helped for variable periods by one or a combination of treatments. As researchers learn more about IC/PBS, the list of potential treatments will change. We recommend discussing your options with your doctor. 

Some patients require cystoscopy (a procedure that allows your doctor to examine the inside of your bladder). If there are obvious signs of interstitial cystitis, we can then begin treatment. 

There are multiple treatment options for painful bladder syndrome, including but not limited to dietary modification, physical therapy, medications for chronic pain, and medications to address urinary frequency. There are also medications we can place directly into the bladder to improve pain. For very hard to treat cases, there are additional treatment options that your doctor will discuss with you.

Overactive Bladder

Overactive bladder is a problem with bladder-storage function that causes a sudden urge to urinate. The urge may be difficult to stop, and overactive bladder may lead to the involuntary loss of urine (incontinence).

If you have an overactive bladder, you may feel embarrassed, isolate yourself, or limit your work and social life. The good news is that a brief evaluation can determine whether there's a specific cause for your overactive bladder symptoms.

Management of overactive bladder often begins with behavioral strategies, such as fluid schedules, timed voiding and bladder-holding techniques using your pelvic floor. If these initial efforts don't help enough with your overactive bladder symptoms, second line and third line treatments are available including medications and some outpatient procedures.

Vaginal Fistula

A vaginal fistula is an abnormal connection between the vagina and another organ, such as your bladder, colon or rectum, allowing stool or urine to pass into the vagina.

Vaginal fistulas can be caused by trauma, a surgery, infection or radiation therapy. Regardless of the origin, a surgery is usually necessary to close the fistula and restore normal function. There are several types of vaginal fistulas:

Vesicovaginal Fistula

Also called a bladder fistula, this opening occurs between your vagina and urinary bladder and is the type that doctors see most often.

Ureterovaginal Fistula

This type of fistula happens when the abnormal opening develops between your vagina and the ducts that carry urine from your kidneys to your bladder (ureters).

Urethrovaginal Fistula

In this type of fistula, also called a urethral fistula, the opening occurs between your vagina and the tube that carries urine out of your body (urethra).

Rectovaginal Fistula

In this type of fistula, also known as a rectal fistula, the opening is between your vagina and the lower portion of your large intestine (rectum).

Colovaginal Fistula

With a colovaginal fistula, the opening occurs between the vagina and colon.

Enterovaginal Fistula

In this type of fistula, the opening is between the small intestine and the vagina.

Congential Vaginal Anomalies

Abnormal formation of the uterus and vagina is rare. This condition occurs before birth, during the development of the embryo in the uterus. Vaginal anomalies include absence, obstruction, and duplication of the vagina. In most cases, the uterus is not present or underdeveloped.

Most of these problems are recognized in childhood. However, some patients are not diagnosed because they do not experience menstrual activity during adolescence.

Surgery may be necessary to establish reproductive and sexual function.Our expert staff provide comprehensive treatment, which includes minimally invasive techniques.

Fecal Incontinence

Fecal incontinence is the inability to control bowel movements, causing stool to leak accidentally from the rectum. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage of stool while passing gas to a complete loss of bowel control.

Common causes of fecal incontinence include diarrhea, constipation, and muscle or nerve damage. The muscle or nerve damage may be associated with aging or with giving birth.

Regardless of the cause, losing bowel control can be embarrassing. However, you should talk to your doctor. There are many treatments available which may improve fecal incontinence and your quality of life.

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