Conditions and Treatments
Urogynecology is a subspecialty within obstetrics and gynecology that focuses on disorders of the female pelvic floor, such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence, and constipation. After their residency in obstetrics and gynecology, urogynecologists spend several years completing fellowship training, focusing exclusively on these disorders.
Many women with these sorts of “female problems” are uncomfortable discussing them, even with their own physician. Under the care of a specially trained urogynecologist, who remains up-to-date on the latest medical advances and treatment options, the vast majority (an estimated 80%) of women with these complaints can be cured and the rest will realize significant improvement in the quality of their lives.
There are certain times in a woman’s life when incontinence is likely to be a problem. As many as a third of new mothers experience incontinence after childbirth; treatment (usually involving physical therapy) can help you heal and recover normal function faster. Midlife brings more changes, with as many as 25% of women over age 50 experiencing some incontinence and for many women, the problem worsens with age. One recent study reported that over half of all postmenopausal women had at least one episode of incontinence each week.
There are two main types of incontinence – you may have either, or sometimes even both.
Stress Incontinence occurs when the urethra (the tube that carries urine from the bladder out of the body) becomes weak. This causes urine loss with activities such as laughing, coughing or lifting heavy objects.
Urge Incontinence, or overactive bladder, happens when the bladder muscle unexpectedly contracts, forcing urine out of the urethra. You might feel a strong need to go to the bathroom, but can’t get there before the leakage begins. The sound of running water may stimulate your urge to urinate.
Factors that contribute to incontinence include pregnancy, childbirth, menopause, medications, infections, excessive caffeine and urinary tract infection.
Vaginal prolapse occurs when the muscles that support the uterus and vagina weaken and drop somewhat from their usual positions. If you have this problem, you may experience a feeling that something is falling out of the vagina, a sensation of pelvic pressure, or a dragging sensation in your lower abdomen. You may also experience incontinence.
Factors that may cause or exacerbate prolapse include childbirth (including multiple pregnancies, twins, or giving birth to a large baby), family history of prolapse, obesity, estrogen status, smoking, and lung disease.
Cosmetic and Restorative Vaginal Surgery
There are many reasons why a woman might seek cosmetic or restorative vaginal surgery, including medical and emotional ones. For women who are unhappy with their appearance and/or sensation, we utilize techniques to make desired changes to the labia or vagina. Labioplasty (or reducing the size of the labia) may be performed alone or with another procedure. For women whose vaginas have been stretched by childbirth, perineoplasty is a procedure that can restore the normal dimensions of the vagina. Many women report that this procedure helps them to have more satisfying sex life.
Your Evaluation
Urogynecology and Pelvic Surgery, LLC offers advanced technology in a state-of-the-art setting, for diagnosis and treatment of these problems. We begin with a comprehensive medical history, conduct a thorough physical examination, and ask detailed questions about your urinary habits and symptoms, all in order to determine exactly what the cause of your problem might be. We may also order tests, which may include:
- Blood and urinalysis, to check for different chemicals.
- Cystoscopy, to check for abnormalities in the bladder and lower urinary tract. A cystoscopy involves inserting a small lighted telescope through the urethra to see inside the urethra and bladder.
- Stress test, to check for urine loss when stress is put on the bladder muscle.
- Urodynamic testing, to test bladder and urethral sphincter function, in some cases involving use of a catheter.
Your Treatment
Depending on your diagnosis, we will design a plan specifically to solve your problem. We offer the latest and most advanced treatments, focusing on non-surgical and minimally invasive techniques. Options include:
- Behavior training, including pelvic exercises, dietary and fluid modification, and bladder training. Our biofeedback program promotes neuromuscular re-education to learn bladder muscle control.
- Medications that help tighten or strengthen the urethral and pelvic floor muscles, and/or calm overactive bladder muscles.
- Injections using collagen, botox or other materials to add bulk to the tissue around the urethra and keep the sphincter muscles closed, to stop urine from leaking.
- Supportive devices to hold up the bladder, which are inserted into the vagina. These may include a pessary or a bladder neck support. We will fit these plastic devices and show you how to insert and remove them.
- Surgery, sometimes required to remove blockages, add support to severely weakened muscles, add permanent bulk to tissues, and/or improve the position of the bladder neck.
