Urogynecology

Millions of women suffer from accidental leakage of urine. Unfortunately, women do not seek treatment and live socially isolated. Women often won’t enjoy activities that once made them happy out of fear or embarrassment of having an accident.

Stress urinary incontinence, also called effort incontinence, happens when a women coughs, sneezes, laughs or performs certain exercises. We offer conservative (pelvic floor physical therapy or incontinence pessary) and surgical options. Many women can undergo a simple, same-day procedure called a single-incision midurethral sling, and can quickly return to normal activities.

Women with overactive bladder syndrome have irritating bladder symptoms, like urgency and frequency. These women may suffer from accidental urine leakage with an overwhelming urge to void. This can be difficult to overcome. Through a discussion about your symptoms and a workup that may include bladder diaries, urodynamic testing and in-office cystoscopy, we can diagnose OAB and offer treatment for you. This may include behavioral and lifestyle coaching, diet and fluid management, pelvic floor rehabilitation and medications. If initial treatments are unsuccessful, there are advanced options (including bladder Botox® therapy and InterStim®) to help manage OAB.

Some women may experience a bothersome protrusion of their pelvic organs (including the bladder, bowel or uterus/vagina) through the vagina. This is called pelvic organ prolapse and is caused by weakness of the support structures inside the pelvis that help keep organs in proper position. Prolapse is not a normal consequence of aging. Certain risk factors for developing prolapse include:
• Older age
• Obesity
• Chronic activities or behaviors that put stress on the pelvic floor (like strenuous exercises or chronic coughing from certain lung diseases)
• Vaginal deliveries
• Family history

Based on your symptoms, severity and needs, we can tailor a treatment plan for you that may include pelvic floor therapy, pessary or surgery. (A pessary is a non-surgical option where a small silicone device is inserted comfortably in the vagina to keep the prolapse from coming out of the body.)

Surgical options include vaginal reconstructive repairs using your own tissues or safe and effective biologic graft to reinforce weak tissues. Hysterectomy, or removal of the uterus, may or may not be necessary. Some women prefer to retain her uterus through a procedure called hysteropexy. We also offer minimally-invasive robotic surgery, especially in cases of large, post-hysterectomy prolapse.

Some women who desire an effective surgical option, but cannot undergo a long reconstructive procedure and don’t desire sexual intercourse, may consider colpocleisis. Colpocleisis is where the vagina is completely closed.

Fecal incontinence is the accidental leakage of stool beyond one's control. This may happen with liquid/formed stool or gas. We understand this condition may be embarrassing, but we are here to help you manage it. Through dietary and behavioral counseling, we will help improve your regularity and consistency of bowel movements. Pelvic floor physical therapy may be recommended to help improve pelvic muscle tone. Surgical options are also available to help tighten the anal sphincter. We also offer FDA-approved InterStim® therapy. This minimally-invasive "pacemaker for the pelvis" delivers electrical impulses to the pelvic nerves to help regulate bowel control. This can be implanted in a short outpatient procedure with minimal postoperative pain and allows for a quick return to work/activities.

(Formerly interstitial cystitis) Imagine not being able to sit through a movie because you are going to the bathroom to void every 20 minutes. You think you are always suffering from a bladder infection, but your doctor tells you that your urine is negative. Unfortunately, for many women, young and old, this is a way of life.

You may have a chronic condition called Bladder Pain Syndrome (BPS). Some women with this condition may also experience painful intercourse and pelvic muscle spasms. BPS is diagnosed clinically, and no tests are needed to confirm a diagnosis. Although no definite causes are known, we believe BPS is caused by a nerve imbalance in the bladder. Effective treatments help to control this nerve imbalance.

Many women with BPS also suffer from anxiety disorders, so we recommend alternative therapies including mindfulness/meditation, yoga, behavioral/lifestyle modifications and dietary changes. Other therapies offered include cystoscopy with hydrodistention, instillation of a soothing "cocktail" into the bladder, trigger point injections and pelvic floor rehabilitation.

As a consequence of menopause and lack of the hormone estrogen, many postmenopausal women experience bothersome symptoms including:

• Urinary urgency
• Vaginal/vulvar irritation
• Painful intercourse due to dryness

We can offer hormonal and non-hormonal treatment options, as well as vaginal dilator therapy, to help improve symptoms. In severe cases of vaginal stenosis, or narrowing of the vagina, surgery may be required, especially if this is interfering with intimacy or voiding.

If you suffer from three or more confirmed urinary tract infections in 12 months or two in six months, you may have recurrent urinary tract infections. We will thoroughly evaluate your upper (kidneys and ureters) and lower (bladder, urethra, and vagina) urinary system to determine any related causes. You may be offered low-dose prolonged antibiotics, and some postmenopausal women may benefit from vaginal estrogen to help restore normal vaginal pH.

Sometimes women may see blood in their urine (called gross hematuria) and other times they may not (called microscopic hematuria). However, any amount of blood in the urine is abnormal and needs to be properly evaluated to rule out causes such as cancers or stones. You may be referred to Urogynecology for this reason.

Fistulas are abnormal connections between pelvic organs. The more common types include vesicovaginal (bladder to vagina) fistulas and rectovaginal (rectum to vagina) fistulas. These can result after pelvic surgeries (like hysterectomy), radiation treatment, obstetric injuries or from chronic inflammatory bowel diseases.

Women may have continuous leakage of urine though the vagina (vesicovaginal fistula) or stool from the vagina (rectovaginal fistula). Fistulas can often be promptly diagnosed and managed. Surgery is usually indicated, and most fistulas can be successfully repaired through the vagina without having to enter the belly cavity.

This is an abnormal outpouching of the urethra, or the tube that drains the bladder. Women may report pain when urinating, urinary urgency/frequency, dribbling urine after having finished voiding, pain during intercourse or urinary incontinence. Diagnosis is usually made by an examination, but additional imaging of the lower urinary tract may be requested. Surgery is typically done through the vagina to repair the diverticulum.