What is Urogynecology?

Urogynecologists are are either OB/GYN or urology doctors who undergo additional training to treat problems of the bladder, vagina and bowels in women. These doctors are experts in evaluating and treating conditions that affect the pelvic organs, and the muscles and supportive connective tissue. They are are able to provide special expertise including minimally invasive surgical and nonsurgical therapies.

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Why would I need to see a UROGYN Specialist?

Problems in the pelvic floor can arise due to increasing age, delivering a baby, or having surgery. These problems include:
• Pelvic organ prolapse (cystocele/rectocele/enterocele)
• Accidental urine or stool leakage
• Overactive bladder
• Problems with emptying the bladder or rectum
• Pelvic pain
• Bladder Pain Syndrome (also called Interstitial Cystitis)
• Problems after vaginal delivery
• Fistulas (or holes between organs in the pelvis)
• Recurrent bladder infections
• Pain with sex
• Blood in the urine on urinalysis

Facts & Statistics

If you have these problems, you are not alone!
• 24% of women had symptoms of at least 1 pelvic floor disorder
• Between 16-30% of women have accidental urinary leakage
• 9% of women have accidental bowel leakage
• % of women have severe pelvic organ prolapse

Frequently Asked Questions.

What causes pelvic floor problems?
• If the pelvic muscles are weakened or there is damage to the muscles, nerves, or connective tissue, your pelvic floor cannot provide strong support to your organs. The bowel, bladder, uterus, vagina, and rectum can all be affected.
• Pregnancy and childbirth, menopause, nerve damage, increasing age, genetic factors, chronic increased pressure on the pelvic floor (due to chronic cough, constipation, heavy lifting or obesity), smoking, and prior surgeries can all increase your risk of developing a pelvic problem.

Risk factors to not getting treatments.

• Living with these conditions can be isolating, embarrassing and frustrating. Some conditions remain stable for years, but many get worse over time.
• Living with these conditions can be isolating, embarrassing and frustrating.
• Women with pelvic floor problems for years also have a lower body image, lower sexual function, and more mental health issues compared to similar women without these problems.
• Elderly women with urinary and fecal leakage are more likely to enter care facilities as families struggle to keep their relatives clean and safe.

Treatment options for each condition.

Urinary incontinence:

Associated with urge and overactivity:
• Bladder training and dietary changes
• Pelvic floor physical therapy
• Medications
• Bladder Botox
• Sacral neuromodulation (Interstim or Axonics)

Associated with exercise/cough/sneeze/laughing-
• Home pelvic floor strengthening- Kegel exercises, home biofeedback
• Pelvic floor physical therapy
• Physical support devices- pessaries or Impressa OTC devices
• Surgical repairs- Mesh sling, Burch procedure, or fascial slings
• Urethral bulking

Fecal Incontinence:

• Medications, lifestyle changes, vaginal support devices
• Sacral neuromodulation
• Repair of the anal sphincter

Pelvic Organ Prolapse:

• Pelvic floor physical therapy/Home Kegel exercises
• Vaginal pessary
• Reconstructive surgery. I offer surgeries to fix prolapse:
• With or without removal of the uterus
• With or without mesh
• Minimally invasive options: Vaginal, laparoscopic and minilaparotomy

Pelvic pain and pain with sex: ** Treatment is very dependent on type of pain

• Pelvic floor physical therapy
• Oral and vaginal medications
• Pudendal Nerve Blocks
• Vaginal Botox

Interstitial Cystitis/Bladder Pain Syndrome

• Dietary and lifestyle changes
• Pelvic floor physical therapy
• Medications
• Bladder instillations
• Hydrodistention and treatment of bladder ulcers if present
• Bladder botox for overactivity
• Sacral Neuromodulation for overactivity


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