Urogynecology

Overview

Problems with the pelvic floor and bladder are rarely life threatening, but they can have a big impact on a woman’s quality of life and relationships. Urogynecology is a medical specialty that combines gynecology and aspects of urology to address dysfunctions of the pelvic floor, which can affect the bladder, reproductive organs, and bowel. Our expert team of female providers address gynecological issues typically associated with bladder problems, pelvic organ prolapse, urinary or fecal incontinence, pelvic pain, and painful bladder syndrome. We strive to improve the quality of life for women suffering from these disorders. We use leading-edge, minimally invasive techniques whenever possible. Our overall goal is to return women quickly and comfortably to their active daily lives without the hindrance of bladder or pelvic problems.

Our female urogynecologists, diagnose and treat pelvic floor disorders, including:

  • Prolapse of pelvic organs
  • Urinary or stress incontinence
  • Urinary frequency or urgency syndrome
  • Difficulty urinating
  • Bowel incontinence
  • Pelvic pain and pain with intercourse
  • Interstitial Cystitis/ Painful Bladder syndrome

Symptoms

Symptoms

Many women may not have symptoms of pelvic floor problems at first. If, however, you start to develop some of these symptoms, you should not be embarrassed to tell your health care provider about them. Symptoms of pelvic floor disorders can include the following:

  • A bulge or something visibly coming out of the vagina
  • Heaviness, fullness, pulling, or aching in the vagina that is worse at the end of the day or during a bowel movement
  • Having a hard time peeing or emptying your bladder completely
  • Leaking pee when you cough, laugh, or exercise
  • Feeling an urgent or frequent need to pee
  • Having frequent urinary tract infections

Any of these symptoms can be embarrassing but you don’t have to continue to suffer with them. You can see a Urogynecologist and get treatment. Addressing your symptoms and regaining the quality of life you desire (and deserve) could involve:

  • Referrals for physical therapy to strengthen, relax or better coordinate the muscles of the pelvic floor.
  • Recommendations for lifestyle or dietary modifications to reduce the causes of urinary and fecal incontinence.
  • A vaginal pessary, which is a plastic device inserted into the vagina to help support the pelvic organs and relieve the symptoms of incontinence.
  • Medication to treat urinary urgency incontinence, chronic constipation or diarrhea.
  • Office procedures to treat overactive bladder, urgency incontinence and stress incontinence.
  • Surgery to support the organs that have dropped. Often, these surgeries can be performed in a minimally invasive way by going through the vagina or through several small incisions—either using traditional laparoscopic surgery or a surgical robot.
  • There are all kinds of treatments and cures for this issue. Together, we will find the best one, or ones, for you and your symptoms.

Pelvic Organ Prolapse

Pelvic Organ Prolapse

A condition that occurs when muscles and ligaments supporting the pelvic organs weaken, allowing the pelvic organs to slip from their normal position, creating a bulge in the vagina. Severe prolapse can cause the uterus to slip partially into the vagina and may cause the upper part of the vagina to sag into the vaginal canal or even outside of the vagina.

Some women with prolapse have no symptoms, however, many experience symptoms such as the feeling of sitting on a ball, pulling in the pelvis, pelvic or abdominal pain, painful intercourse, protrusion of tissue from the vagina, bladder infections or frequent urination. Prolapse is common and can be caused by pregnancy and childbirth, aging, obesity, chronic cough, chronic constipation or heavy lifting. Typically, pelvic prolapse worsens over time, but can be corrected by various surgical or non-surgical options.

Urinary & Fecal Incontinence

Urinary Incontinence - Involuntary leakage of urine due to loss or weakened voluntary control of the urinary sphincter. Approximately 13 million Americans suffer from urinary incontinence, which occurs more often in women than men. The main symptom is the involuntary release/leakage of urine. When and how this occurs depends on the type of urinary incontinence. The two most common types are: Stress Incontinence - Refers to the leakage that happens when physical pressure is placed on your bladder. Such causes include sudden cough, sneezing, laughing, heavy lifting and exercise. Stress incontinence can be caused when pelvic floor muscles lose some of their strength from:

  • Pregnancy
  • Childbirth
  • Menopause - when estrogen levels drop, the muscles may get weaker
  • Hysterectomy
  • Other surgical procedures
  • Age
  • Obesity

Urge Incontinence - This condition is also known as “got to go” incontinence and is present when there is an overactive or unstable bladder. There is a sudden, involuntary contraction of the muscular wall of the bladder that causes urinary urgency. Most often, there is an involuntary loss of urine for no apparent reason while still feeling the sudden urge to urinate. When this urge happens, the person has a very short time to reach the bathroom regardless of what they try to do.

This urge can be caused by a sudden change in position, the sound of running water or sex.

Overactive Bladder - Frequent urination occurring during the day and night, as well as urinary urgency that, in most cases, interferes with your lifestyle and habits. An overactive bladder causes a sudden and unstoppable need to urinate, even though the bladder may contain only a small amount of urine. It is typically caused by spasms of the muscles of the bladder, resulting in an urge to urinate. It is primarily a problem of the nerves and muscles of the bladder.

An overactive bladder's muscles and nerves may have been affected by pregnancy and childbirth, surgery, medication, natural aging, chronic disease, trauma or obesity.

Fecal Incontinence - The inability to control bowel movements, causing stool to leak unexpectedly. Also called bowel incontinence, fecal incontinence ranges from an occasional leakage while passing gas to a complete loss of bowel control.

Fecal incontinence can be caused by diarrhea, constipation, or muscle or nerve damage.

The muscle or nerve damage may be associated with aging or giving birth. Muscle damage is injury to the rings of muscles at the end of the rectum, making it difficult to hold stool back, while nerve damage affects the nerves that sense stool in the rectum or those that control the anal sphincter. Nerve damage may be caused by childbirth, constant straining during bowel movements, spinal cord injury or stroke.

Constipation, if it is chronic, may lead to a mass of dry hard stool in the rectum that is too large to pass. The muscles of the rectum and intestines stretch and eventually weaken, allowing watery stool to move around the impacted stool and leak out. Chronic constipation can also lead to nerve damage that causes fecal incontinence.

Painful Bladder Syndrome

Painful Bladder Syndrome/Interstitial Cystitis

A condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. Many women experience mild discomfort, pressure, tenderness or intense pain in the pelvic region. Symptoms may include an urgent need to urinate, frequent urination, or a combination of these symptoms. Pain intensity is sharpened as the bladder fills with urine or as it empties. These symptoms often get worse with menstruation, and pain can be experienced with intercourse. Many women have other conditions such as irritable bowel syndrome and fibromyalgia.

Because the causes of painful bladder syndrome/intestinal cystitis are unknown, treatments are aimed at relieving symptoms. Such treatments include bladder distention, bladder instillation, oral medications and electrical nerve stimulation. Surgery is considered when all available treatments have failed.