About Urogynecology & Pelvic Floor Disorders

A cystocele repair is a minimally invasive surgical procedure to put your bladder back in its normal place after it has prolapsed. A bladder prolapse can occur with age, obesity, after vaginal childbirth, after hysterectomy, frequent straining during bowel movements, or heavy lifting. To prevent the bladder prolapse from happening again, the surgeon will also fix the wall between the bladder and the vagina. Sometimes the surgeon will also use a midurethral sling, a piece of mesh to hold the urethra in place.

Urodynamic testing is used to determine the presence of urinary incontinence or other urinary tract symptoms. These tests can include one or more of the following assessments: cytometry, electromyography, pressure flow studies, and uroflowmetry. The tests measure nerve and muscle function, pressure in the bladder, and flow rates of urine. They can be used in men or women. You may be tested if you are experiencing urine leakage, sudden urge to urinate, painful urination, or problems emptying the bladder.

Enteroceles (also known as small bowel prolapses) are abnormal downward movement of your intestines. The intestines push on the back wall of the vagina and cause bulging. Symptoms include pain or pressure, heaviness in the vagina, trouble with urination, constipation, and/or pain during intercourse. Most treatments are conservative and non-surgical, including exercises to increase strength in the pelvic floor. If conservative treatments are not successful, you may need surgical repair. Surgical repair involves a minimally invasive procedure to make the walls of the vagina stronger using stitches.

A midurethral sling is a treatment for stress urinary incontinence. Stress incontinence is a type of incontinence that occurs when stress is put on the bladder. This could be anything as simple as a sneeze, or complex as exercising by jumping rope. The muscles around the bladder have become weak causing urethral dropping. Therefore, a piece of mesh is inserted via minimally invasive surgical techniques to prevent urethral dropping. The midurethral sling procedure can be done in an outpatient setting and only takes approximately 10-15 minutes to complete.

After a hysterectomy (the surgical removal of the uterus), the vagina can prolapse. This is relatively common among women. Symptoms may includre pressure on the vagina, changes in bladder and bowel function, or pain during sexual intercourse. When conservative treatments fail, a prolapse repair may be considered. This minimally invasive surgical procedure re-suspends the prolapsed vagina.

Rectoceles are abnormal forward movement of your rectum. The rectum pushes on the back wall of the vagina and causes bulging. Symptoms include pain or pressure, heaviness in the vagina, trouble with urination, constipation, and/or pain during intercourse. Most treatments are conservative and non-surgical, including exercises to increase strength in the pelvic floor. If conservative treatments are not successful, you may need surgical repair. Surgical repair involves a minimally invasive procedure to make the walls of the vagina stronger using stitches.

A uterine prolapse occurs when the uterus drops from its normal position and pushes against the walls of your vagina creating a bulging sensation. Symptoms include pain or pressure, heaviness in the vagina, urinary incontinence, constipation, and/or pain during intercourse. This can happen after childbirth or surgery, when the muscles around your pelvic organs become weak. Sometimes the cause is unknown. Minimally invasive surgical procedures will be used to repair the uterine prolapse, prevent it from happening again, and relieve patient symptoms.

Urinary incontinence is the unexpected and involuntary leakage of urine. It is a common condition, affecting one in four women. It is more common in older adults and less common in males. It can be caused by urinary tract infections, vaginal infection, or constipation. Some medications or other medical conditions can cause urinary incontinence as a side effect. Chronic incontinence (lasting longer than a few months) could be due to weak muscles, overactive bladder muscles, or damages to nerves controlling the bladder.

Overactive bladder syndrome is the frequent and sudden urge to urinate on a regular basis. The urges may be difficult to control and result in urinary incontinence. (Sometimes urinary incontinence is referred to as an overactive bladder.) Seek medical treatment and counseling from your physician if your overactive bladder starts to affect your ability to function in activities of daily living. The key to your overactive bladder not interfering with your everyday life is to establish the root cause. This will inform treatment strategies.

A pelvic organ prolapse occurs when a pelvic organ, such as your bladder, drops from its normal position and pushes against the walls of your vagina. Symptoms include pain or pressure, heaviness in the vagina, urinary incontinence, constipation, and/or pain during intercourse. This can happen after childbirth or surgery, when the muscles around your pelvic organs become weak. Sometimes the cause is unknown. Older age, obesity, a hysterectomy, chronic straining and abnormalities of the connective tissue are risk factors.

Urinary incontinence is the unexpected and involuntary leakage of urine. Stress urinary incontinence is a type of incontinence that occurs when stress is put on the bladder. This could be anything as simple as a sneeze, or complex as exercising by jumping rope. The muscles around the bladder and urethra become weak or there’s been damage to the urethra that causes leakage.

• Surgical approaches to pelvic floor disorders
  • There are several surgical approaches available to you for pelvic floor disorders. Most surgical approaches are minimally invasive, meaning that the size of incisions are much smaller compared to traditional surgery. They have several advantages over traditional “open” surgeries, including less postoperative pain, less blood loss, smaller incisions and less scarring, and fewer postoperative infections. Patients who undergo minimally invasive surgeries recover faster than traditional surgeries, resulting in an improved quality of life and allowing for a sooner return to normal life. While most pelvic floor disorders can be treated using minimally invasive procedures, some will still require open surgery. Be sure to talk to your gynecologist and healthcare team about your options.
    
    
• Nonsurgical approaches to pelvic floor disorders include:
  • If you are experiencing a pelvic floor disorder, your gynecologist and healthcare team will consider nonsurgical options first. These approaches will be implemented prior to consideration of surgery. The goal of these approaches is to treat the root cause of your pelvic floor disorder in order to help you experience relief and return to normal everyday function. The following nonsurgical approaches may be offered to you:
    
    
    • Medications
    • Pessaries
    • Pelvic floor
    • physical therapy
    • Biofeedback
    • Electrical stimulation (PTNS)
    • Urge suppression
    • Pelvic floor reeducation
    • Medical management of urinary incontinence