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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What conditions would be treated by a Urogynecologist?

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

Treatment Options

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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