Pelvic Health & Urinary Incontinence

Pelvic Organ Prolapse

Our practice is among the top five in the nation in robotic/minimally- invasive pelvic reconstructive surgery. Our physicians lead the region in minimally invasive procedures for the treatment of pelvic organ prolapse and urinary incontinence.

Bladder Prolapse

Normally a ‘hammock’ (a layer of connective tissue) between the bladder and the vagina supports the bladder. When it stretches or tears, the bladder bulges or presses into the vagina. Patients may notice vaginal pressure or pulling. If the bladder drops very low, you may have to ‘push’ the bladder back up to be able to urinate.

When the ‘hammock’ is just torn, we can sew it back together with stitches. If it is very weak and damaged, we may use a graft to replace it.

Vaginal Suspension

Normally, ligaments hold the vagina up in normal position. If these ligaments stretch or break, the top of the vagina will begin to drop. Sometimes, some of the intestines are pulled down with it, called an ‘enterocele’ or ‘bowel-hernia’. You may feel a bulge in the vagina, and feel a vaginal ache.

Vaginal suspension surgery reattaches the vagina to the ligaments meant to hold the vagina up. Sometimes we have to push the intestines up and out of the way, and stitch them back in place so they don’t drop down again.
If the ligaments that hold the vagina up are very weak, we use a different ligament (the sacrospinous-ligament) near the buttock muscles to hold the vagina up instead.

Dropped Uterus

Your uterus can drop after vaginal childbirth if the normal ligaments supporting the uterus stretch or tear. A vaginal hysterectomy can be done to remove the uterus and cervix through the vagina. Once the uterus is removed, we use additional stitches to support the top of the vagina, preventing it from dropping again.

Laparoscopic and Robotic Prolapse Surgery

We routinely use robotic surgery to treat uterine or bladder prolapse with a highly-effective procedure called abdominal sacral colpopexy.

The robot makes the procedure easier to perform and avoids the need for an abdominal incision. Our surgeons undertake extensive coursework and training, and go through an exacting credentialing process before using this robotic system.

Urge Incontinence

Patients with urge incontinence feel that they have to urinate immediately or they will leak urine. The most common treatment for urge incontinence is behavioral changes. This includes modifying types and amounts of fluid intake (caffeine and nicotine are irritants), bladder retraining with timed voiding, physical therapy, and weight loss. There are also medications taken by mouth that treat urge incontinence, Botox injections into the bladder to relax it, as well as treatments including acupuncture and nerve stimulation/neuromodulation (percutaneous tibial nerve stimulation [PTNS] and Interstim® Sacral Neuromodulation Therapy. Weight loss also reduces incontinence.

Stress Urinary Incontinence

The most common type of urinary incontinence, stress urinary incontinence involves the leaking of urine when you laugh, cough, sneeze, or exercise. It happens because the muscles and tissues supporting the bladder are weakened and the increase
in abdominal pressure from coughing, sneezing, etc. causes urine to leak. It happens to 25% of premenopausal women under the age of 50, and 30% of post-menopausal women over 50.

Treatment options for stress urinary incontinence include Kegel exercises, which must be done correctly and daily. Our pelvic floor physical therapists are specially trained in these techniques and the best ways to teach them to patients.

When active, patients may also use an “incontinence ring” (called a pessary), which is worn in the vagina and supports the urethra and bladder. Our incontinence specialists participate regularly in clinical studies focused on stress incontinence. We are currently researching a new device that strengthens the pelvic floor muscles.

For patients who do not respond to more conservative treatments, there are minimally invasive surgical options including slings and transvaginal tapes.

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Urology & Kidney