Focus of Care
Quality of life should not be compromised by health problems such as urinary incontinence, vaginal relaxation or bulges, bladder pain or other gynecologic conditions. At Urogynecology Consultants our providers have received advanced training to help you get over your symptoms and on with your life. Our focus:
- precise, individualized diagnosis of problems
- the correct treatment, whether non-surgical or surgical
- minimally invasive surgical techniques including da Vinci robotic assisted, laparoscopic or vaginal approaches.
In addition to treating complex gynecologic conditions our practice offers routine Well Women Care.
Urinary Incontinence:: A large number of women experience urinary leakage (incontinence) or other types of trouble controlling their bladder. These conditions can be embarrassing. Many women wear pads to stay dry or feel secure. Female urinary incontinence can be grouped into several distinct categories:
- Stress Incontinence: Urine leakage occurs with increases in abdominal pressure (leaking with coughing, sneezing, exercise, etc.).
- Urge Incontinence: Often referred to as “overactive bladder.” Inability to hold urine long enough to reach a restroom.
- Mixed Incontinence: When two or more causes contribute to urinary incontinence. Often refers to the presence of both stress and urge incontinence.
- Fistula: When urine flows directly through an abnormal connection between the bladder or urethra and the vagina. Fistulas can develop after surgery, trauma or radiation to the area and are relatively uncommon.
- Urethral Diverticulum: When urine collects in a small pouch within the urethra and dribbles out after urinating. A diverticulum can be congenital, develop after urethral trauma, urethral infection, urethral abscess or surgery.
- Overflow Incontinence: Leakage or “spill-over” of urine when the amount of urine exceeds the bladder’s ability to hold it. This can happen when the nerves to the bladder do not work well due to neurologic conditions such as diabetic neuropathy, multiple sclerosis or nerve compression. In addition, it can happen when there is some blockage or obstruction to the bladder’s emptying; the bladder is unable to empty well, and small amounts of leaking happens frequently.
Proper diagnostic testing will help diagnose the type of incontinence. Proper diagnosis is important to effective treatment. Not all types of incontinence require surgery.
Vaginal Relaxation (Pelvic Organ Prolapse): Prolapse occurs when the normal support of the vagina is lost, resulting in “sagging” or dropping of the bladder, urethra, cervix or rectum. Many women notice a bulge but others may feel a looseness or lack of sensation in the vagina with intimacy. As the prolapse of the vagina and uterus progresses, women can feel bulging tissue coming out the opening of the vagina. Different areas of the vagina can prolapse:
- Anterior Vaginal Prolapse (also known as cystocele): This type of prolapse occurs when the wall between the vagina and the bladder stretches or detaches from its attachment on the pelvic bones. This loss of support allows the bladder to prolapse or fall down into the vagina. Symptoms may include:
- abnormal bladder emptying
- urinary frequency
- night time voiding
- loss of bladder control
- recurrent bladder infections
- pelvic pressure
- Posterior Vaginal Prolapse (also known as rectocele): Weakening of the back wall of the vagina allows the rectum to bulge into the vagina, sometimes stretching low enough to come out of the vaginal opening. Symptoms may include:
- difficulty with bowel movements
- loss of stool
- pelvic pressure
- Uterine Prolapse: When the supporting ligaments and muscles of the pelvic floor that keep the uterus in the pelvis are damaged, the cervix and uterus descend into the vagina and eventually out of the vaginal opening. Often, uterine prolapse is associated with loss of vaginal wall support (cystocele, rectocele). When the cervix protrudes outside the vagina, the cervix can develop ulcers from rubbing on underwear or protective pads. Symptoms may include:
- sense of fullness, pain or pressure in the pelvis
- symptoms of anterior or posterior vaginal prolapse
- vaginal bleeding
- Vaginal Prolapse after Hysterectomy (also known as vaginal “vault” prolapse): If a woman has already had a hysterectomy, the very top of the vagina (where the uterus used to be) can become detached from its supporting ligaments. Depending upon how extensively the top of the vagina is turning inside out, one or several pelvic organs (such as the bladder, small and large bowel) will prolapse into the protruding bulge.
- Enterocele: Occurs when there is a separation of the strong connective tissue at the top of the vagina and the bowel presses against the vagina. This forms a hernia sac into which the bowel can protrude.
Studies have shown that vaginal birth is a risk factor for pelvic organ prolapse. During the birth process the muscles that surround and support the vagina might become stretched and torn. Urogynecology Consultants we offer a unique post-delivery muscle strengthening therapy to improve muscle tone and prevent development of prolapse. Other treatments include pessaries or surgery. At Urogynecology Consultants we specialize in minimally invasive repairs of prolapse with the da Vinci robotic system.
Interstitial Cystitis: Interstitial cystitis (IC) is a chronic inflammation of the bladder wall that affects as many as one million women in this country. Because its causes are unknown, IC is often incorrectly diagnosed as a bladder infection, stress-related or psychosomatic problem. Symptoms include:
- frequent urination
- the urge to urinate, sometimes accompanied by pain, pressure or spasms (dysuria)
- pelvic pain in the, bladder, urethra or vagina
- excessive nighttime voiding (nocturia)
- pain associated with sexual intercourse
For many IC patients, getting a proper diagnosis is difficult, primarily because it is a process of ruling out other possible disorders that have similar symptoms, such as chronic bladder infections. Urogynecologic specialists are familiar with the detailed diagnostic process and all the best options for reducing IC’s symptoms. Treatment options include dietary therapy, medical therapy or surgical therapy.
Chronic Cystitis: Most urinary tract infections (UTI or cystitis) occur in the lower urinary tract, which includes the bladder and urethra. Cystitis is caused when the normally sterile lower urinary tract is infected by bacteria and becomes inflamed. Chronic or recurrent urinary tract infection includes repeated episodes of cystitis (more than 2 in 6 months), or urinary tract infection that does not respond to the usual treatment or that lasts longer than 2 weeks. Symptoms often include:
- Pressure in the lower pelvis
- Painful urination (dysuria)
- Frequent need to urinate (frequency)
- Urgent need to urinate (urgency)
- Abnormal urine color — cloudy
- Blood in the urine (hematuria)
- Foul or strong urine odor
Conditions that can be contributing to or causing the bladder infections must be ruled out prior to treatment. Depending on the underlying condition treatment can range from medical to surgical therapy.
Fecal Incontinence: Fecal incontinence is the inability to control your bowels. When you feel the urge to have a bowel movement, you may not be able to hold it until you can get to a toilet. More than 5.5 million Americans have fecal incontinence. Fecal incontinence is more common in women than in men and more common in older adults than in younger ones. Treatment options include dietary modification, medication, pelvic floor therapy or surgical therapy.
Fistula: A fistula is an abnormal connection between two organs. Gynecologic fistulas can connect the vagina to the urinary bladder, the rectum, or other organs. In this country, fistulas are very rare and most occur after surgery to the pelvis. Women can develop this injury after C-Sections, hysterectomy, or reconstructive procedures. The most common complaint in affected women is the constant passage of urine or stool through the vagina. These rare injuries require very careful repair using specialized surgical techniques.
Vaginal abnormalities: Vaginal abnormalities can occur due to prior vaginal surgery or due to abnormal development.
- Vaginal surgery can cause scarring that causes the vaginal canal can be shortened or narrowed. A shortened or narrowed vagina can cause pain or discomfort with intercourse.
- Abnormal development of the vagina can lead to shortening or complete absence of the vaginal canal (also known as vaginal agenesis or Mayer-Rokitansky-Kuster-Hauser Syndrome). These abnormalities are usually discovered when girls do not begin to menstruate at the time of puberty.
- Labial enlargement can cause pain with intercourse or other activities or may not appear the way a woman wants. Labial reduction surgery (labiaplasty) can help alleviate these symptoms and create an acceptable appearance to the labia for the patient.
- Perineal scarring/stretching can occur after vaginal birth leading to a widened vaginal canal and vaginal opening with decreased sensation with intimacy. Perineoplasty and vaginoplasty can return the vaginal canal and vaginal opening to the pre-birth state.
Repairing a vagina scarred from prior surgery or constructing a new functioning vagina or neovagina requires specialized surgical training. The surgeons at Urogynecology Consultants are specially trained to perform these complex procedures. In fact, Urogynecology Consultants is one of the few centers in the country to offer laparoscopic creation of a vagina with a laparoscopic Vecchietti procedure for young women suffering from vaginal agenesis.
Female Pelvic Pain: Women of all ages can experience pain in their lower abdomen and pelvis. Pain can be worse during periods, with meals, with sexual intercourse, or other activities. Women often complain that the pain “is in my ovary”. However, there are many different tissues in the female pelvis, including muscles, nerves, and ligaments. In addition, the pain may actually occur in organs such as the rectum, intestines, or urinary bladder. For women with gynecologic sources of pain, surgeries to remove the uterus, ovaries, cysts or other problem areas may be needed. However, very often pain is due to non-gynecologic sources and responds well to non surgical therapies.
Endometriosis: This condition is the abnormal growth of the endometrium, the tissue lining the uterus. When this tissue grows on sites outside of the uterus (such as the ovaries, bladder, or bowel) it can lead to a number of symptoms. Women with endometriosis may complain of painful periods, difficulty getting pregnant, and pain in the pelvis. Treatment of endometriosis can involve using medicines such as birth control pills or hormone shots or surgery. If surgery is required, we are specially trained in the da Vinci robotic system which offers precise removal of endometriosis.
Uterine Fibroids: These are non-cancerous growths of the muscular wall of the uterus. Uterine fibroid tumors (also called leiomyomas) occur commonly in women. Most women with fibroids have no problems and require no treatment. Symptoms of uterine fibroids include:
- painful periods (dysmenorrhea)
- heavy periods (menorrhagia)
- pelvic pain
- abdominal pressure
- Urinary frequency
If surgery is required, we are specially trained in the da Vinci robotic system which offers precise removel of fibroids (da Vinci Myomectomy) with preservation of the uterus. However, if removal of the uterus (hysterectomy) is required it can be performed vaginally or robotically (da Vinci hysterectomy).
Menstrual Problems: The time of the menstrual cycle can be distressing for women who experience severe pain or heavy bleeding (menorrhagia). Often women complain that these symptoms keep them from enjoying normal activities or cause them to miss work. If you experience problems related to the menstrual cycle, it is important for you to seek evaluation and possible treatment. There is a long list of causes for abnormal periods. Treatments include medicines, conservative surgery, and hysterectomy. If surgery is required we are specially trained in vaginal hysterectomy, da Vinci hysterectomy, and laparoscopic hysterectomy.
Well Woman Care (Annual Exam): Most women pass through different phases of life without any medical problems. For these women preventative gynecologic care is all that is needed. At Urogynecology Consultants we can address preventative gynecologic issues through all phases of a woman’s life. Such issues include:
- Annual exams
- Pap Smear
- Breast Cancer Screening
- Decreased Libido/Sexual Dysfunction
- Hormone Replacement Therapy
- Menopause Symptoms
- Vaginal Dryness/Irritation
- Pelvic Floor Muscle Strengthening
- Weight Loss Counseling