Non-Surgical
Experience counts. Dr. Bowen and Dr. Hilger have advanced training in treating complex gynecologic conditions. Some conditions can be addressed with non-surgical approaches, while others require surgery. If surgery is required Dr. Bowen and Dr. Hilger offer minimally invasive surgical approaches including vaginal, laparoscopic and robotic surgery. In fact, Urogynecology Consultants is one of the first practices in Northern California to use the da Vinci robotic system for pelvic floor disorders. Some of the treatment options we offer include:
Non-surgical treatment
Behavioral Management: Women with urinary incontinence can develop poor bladder habits. Counseling regarding bladder retraining can help change these habits and decrease incontinence symptoms. Also, dietary and fluid intake counseling can have a dramatic effect on bladder symptoms. Some women respond so well to behavioral management that bladder medication or surgery is not needed.
- Bladder retraining or bladder drills: This means going to the bathroom on a set schedule. Some women don’t get the message that their bladder is full until it’s too late. The goal of this exercise is to regain bladder control by emptying before the sudden strong urge comes. The interval between urination is extended every few days as long as leaking accidents are avoided. A comfortable goal to reach is urinating every 2 1/2 to 3 hours. The bladder retraining period can take several months and requires motivation. If you are consistent it works very well.
- Dietary changes
- Drink in moderation. What goes in – must come out! Many women drink more than they need for their body to function well. Generally speaking, eating a healthy diet and drinking six 8oz glasses of fluid per day is adequate.
- Eat plenty of fiber daily to avoid constipation. Use a stool softener or fiber supplement if you continue to struggle with constipation to avoid excessive straining with bowel movements.
- Avoid bladder irritants. Certain foods are known to irritate the bladder.
- Caffeine found in coffee, tea, chocolate, cola and some energy drinks
- Citrus foods and juices
- Artificial sweeteners
- Alcoholic drinks
- Restrict drinking after dinner to reduce the number of trips to the bathroom at night.
- Seek treatment for leg swelling. Many women will notice that as the day progresses their ankles and legs swell. This retained water is removed from the body by the kidneys as urine when the legs are elevated for a while. Some women report needing to empty a full bladder every 2 hours at night.
- Elevate your legs above your heart (lay on the sofa or bed with your legs propped on 2 pillows for 30-60 minutes in the late afternoon). Talk to your medical doctor about the benefits of a “water pill” or diuretic.
- Weight loss. Maintaining healthy body weight is very important for normal pelvic floor function. As little as a 5-10% reduction in weight in women who are overweight or obese will reduce weekly incontinence episodes by more than half. Weight loss should be part of an early effort to improve urine leakage along with pelvic muscle strengthening and other behavioral changes. At Urogynecology Consultants we offer weight loss counseling to help patients achieve their weight loss goals and reduce leakage of urine.
Pessary: A pessary is a ring, similar to a vaginal contraceptive diaphragm, which is used to either lift the bladder or to apply some compression to the urethra during activities that are known to cause leakage. They are a non-surgical treatment option for prolapse or urinary leakage. Typical pessary users are women who:
- Need temporary support during exercise
- Have mild symptoms and want to avoid surgery for the moment
- Have health problems that make the risks of surgery too great
- Need to delay surgery and are uncomfortable from their prolapse
There are numerous shapes and sizes of support pessaries to meet the individual support requirements of different patients. At Urogynecology Consultants we have extensive experience in pessary fitting and a wide selection of pessaries. Our experience improves the chances of getting a comfortable fitting pessary. In the ideal circumstance, a woman is taught how to remove, clean and reinsert her pessary at regular intervals. Frequently, vaginal estrogen cream, tablets or a ring are prescribed to women who use a pessary to strengthen the vaginal skin, especially for those in menopause.
Pelvic Floor Therapy: The pelvic floor includes the muscles (Kegel muscles) that surround the rectum, vagina, and urethra. The health and function of these muscles plays a large role in fecal continence, urinary continence and vaginal health. The muscles can be torn by vaginal deliveries and lose function with age and lack of use. Many women are told to do their “Kegels” but do not know how to perform them properly. In other cases women have been instructed in Kegel exercises incorrectly. Pelvic Floor Therapy may benefit patients with the following symptoms:
- Urinary leakage
- Stool leakage
- Vaginal looseness (decreased muscle tone)
- Decreased vaginal sensation
- Vaginal prolapse
At Urogynecology Consultants we use advanced technology such as Biofeedback and Electrical Stimulation to perform Pelvic Floor Therapy. We target the muscles that are weak to improve vaginal muscle tone. Improved vaginal muscle tone reduces urinary and fecal leakage and increases vaginal tone and sensation.
Eletrical Stimulation: This painless therapy involves placing a device in the vaginal canal that stimulates the pelvic nerves and muscles. Stimulation of the pelvic neuromuscular system can help patients with many pelvic floor complaints including:
- Urinary frequency
- Urinary incontinence
- Pelvic pain
- Incomplete bladder emptying
- Fecal incontinence
Patients who respond well to the office treatment may be prescribed a home unit for continued treatment.
