Urogynecology

Pelvic organ prolapse occurs when the muscles and tissues supporting the pelvic organs become weakened, allowing the bladder, uterus, vagina, rectum, or other pelvic structures to move downward or bulge into the vagina. Symptoms may include pelvic pressure or heaviness, a vaginal bulge, difficulty emptying the bladder or bowel, or discomfort during sexual activity. Treatment depends on the type and severity of prolapse and may include pelvic floor therapy, a pessary, or surgery.

Female urinary incontinence is the involuntary leakage of urine. It can happen when you cough, sneeze, laugh, exercise, or lift something heavy, or when you have a sudden, difficult-to-control urge to urinate. Incontinence is common and can occur at any age. Our urogynecology specialists can identify the underlying cause and recommend treatment options based on your symptoms, health, and lifestyle.

Urinary voiding disorders occur when it is difficult to empty the bladder completely or urination does not happen normally. Symptoms may include difficulty starting the urine stream, a weak or intermittent stream, straining to urinate, feeling that the bladder has not emptied, or needing to urinate frequently. Evaluation can help determine whether the cause is related to the bladder, pelvic floor muscles, nerves, medications, or another condition.

Overactive bladder (OAB) is a condition characterized by a frequent or sudden need to urinate that can be difficult to control. Some people also experience urinary leakage before reaching the bathroom. Symptoms may include urgency, frequent urination during the day or night, and urge incontinence. Treatment options can include lifestyle changes, pelvic floor therapy, medications, bladder injections, nerve stimulation, and other therapies.

Recurrent urinary tract infections are UTIs that happen repeatedly over time. Symptoms can include burning or pain with urination, frequent or urgent urination, pelvic discomfort, or blood in the urine. Recurrent UTIs may have an underlying cause that requires evaluation, particularly when infections continue despite treatment. Our specialists can assess your symptoms, identify contributing factors, and develop a plan to help prevent future infections.

Painful bladder syndrome, also known as interstitial cystitis (IC), is a chronic condition that can cause bladder or pelvic pain, pressure, or discomfort along with urinary urgency and frequency. Symptoms can vary from person to person and may come and go. Because IC can resemble other bladder conditions, an evaluation can help rule out other possible causes and guide an individualized treatment approach.

A fistula is an abnormal connection between two organs or tissues. A rectovaginal fistula is an opening between the rectum and vagina that can allow stool or gas to pass through the vagina. A vesicovaginal fistula is an opening between the bladder and vagina that can result in continuous or unexpected urine leakage through the vagina. These conditions can have several causes and may require specialized surgical repair.

Surgical mesh has been used in certain procedures to provide support for pelvic organs or treat urinary incontinence. In some patients, mesh can cause complications such as pain, bleeding, infection, urinary or bowel symptoms, mesh exposure or erosion, or problems with sexual activity. Evaluation by a specialist can help determine whether mesh is contributing to symptoms and whether observation, nonsurgical treatment, revision, or removal may be appropriate.

Neurogenic bladder occurs when nerve or neurological conditions interfere with the normal communication between the brain, spinal cord, nerves, and bladder. This can affect the bladder’s ability to store or empty urine and may result in urgency, incontinence, difficulty urinating, or incomplete bladder emptying. Treatment focuses on protecting bladder and kidney function while improving urinary control and quality of life.

Sexual dysfunction can affect desire, arousal, orgasm, or comfort during sexual activity. For women with pelvic floor conditions, symptoms may be related to pelvic pain, hormonal changes, pelvic surgery, prolapse, urinary or bowel conditions, or pelvic floor muscle dysfunction. Our team provides evaluation and individualized treatment focused on the underlying cause and the patient’s goals.

Our specialties evaluate and treat a variety of vulvovaginal concerns, including Bartholin cysts, Skene's gland cysts, labial hypertrophy, dyspareunia (painful intercourse), vulvodynia, vaginal dryness and more. 

• Bartholin cysts: Fluid-filled cysts that can develop near the opening of the vagina when a Bartholin gland becomes blocked.
• Skene’s gland cysts: Cysts that develop near the urethral opening when one of the small glands in this area becomes blocked.
• Labial hypertrophy: Enlargement or asymmetry of the labia that may cause irritation, discomfort, or difficulty with physical activities or clothing.
• Dyspareunia: Pain that occurs before, during, or after sexual intercourse.
• Vulvodynia: Persistent or recurring pain or discomfort of the vulva without an identifiable cause.
• Vestibulitis: Pain, burning, or tenderness involving the vaginal opening, particularly with touch or pressure.
• Other vulvovaginal conditions: Our specialists also evaluate and treat other conditions affecting the vulva and vagina, tailoring treatment to each patient's symptomsand diagnosis.
   

Fecal incontinence is the involuntary leakage of stool or difficulty controlling bowel movements. It can range from occasional leakage of stool or mucus to a complete loss of bowel control. Causes may include childbirth-related injury, changes in the pelvic floor muscles, nerve problems, bowel disorders, surgery, or other conditions. Treatment may include dietary and lifestyle changes, medications, pelvic floor therapy, or surgical and procedural options.

Defecatory disorders affect the ability to have a bowel movement normally. Symptoms may include chronic constipation, straining, difficulty passing stool, a sensation of incomplete emptying, or the need to use a finger or change position to have a bowel movement. These symptoms can sometimes be related to pelvic floor muscles that do not coordinate properly during defecation. Evaluation can identify the cause and determine whether pelvic floor therapy or other treatments may help.

Urodynamic testing evaluates how well the bladder, urethra, and pelvic floor muscles store and release urine. The testing can help identify the cause of symptoms such as urinary leakage, urgency, frequent urination, difficulty emptying the bladder, or incomplete bladder emptying. Results can help your urogynecology specialist determine the most appropriate treatment for your individual needs.

Cystoscopy is a minimally invasive procedure that allows your specialist to examine the inside of the bladder and urethra using a small, flexible camera called a cystoscope. It may be used to investigate symptoms such as recurrent UTIs, blood in the urine, bladder pain, or other urinary concerns.

When appropriate, Botox® (onabotulinumtoxinA) may be injected into the bladder wall during cystoscopy to help treat overactive bladder and urinary urgency or urge incontinence. Botox works by relaxing certain bladder muscles, which can reduce unwanted bladder contractions and help improve urinary symptoms.

Transurethral bulking is a minimally invasive treatment for certain types of stress urinary incontinence. During the procedure, a bulking agent is injected into the tissue around the urethra. This helps increase support around the urethra and can reduce urine leakage that occurs with activities such as coughing, sneezing, laughing, or exercising.

The procedure is typically performed without an incision and may be an option for patients who prefer a minimally invasive approach or for whom other treatments may not be appropriate.

Bladder instillation involves placing medication directly into the bladder through a small catheter. This treatment may be used for certain bladder conditions, including painful bladder syndrome/interstitial cystitis. Depending on your symptoms and diagnosis, the medication may help soothe the bladder lining and reduce pain, pressure, urgency, or other bladder symptoms.

Your specialist will determine which medication or combination of medications Is appropriate based on your individual condition.

Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive treatment that uses gentle electrical stimulation to target nerves involved in bladder control. A small electrode is placed near the tibial nerve in the lower leg during each treatment session.

PTNS may help reduce symptoms of overactive bladder, including urinary urgency, frequency, and urge urinary incontinence. Treatments are performed in the office and typically take about 30 minutes.

Peripheral nerve evaluation (PNE) is a temporary test used to determine whether nerve stimulation may help improve bladder or bowel control. A small lead is placed near the nerves that influence bladder or bowel function, and the lead is connected to an external stimulator.

During the evaluation period, you track your symptoms and response to stimulation. The results can help determine whether you may benefit from longer-term sacral neuromodulation therapy.

A pessary is a removable medical device placed inside the vagina to provide support for pelvic organs. It is commonly used to manage pelvic organ prolapse and, in some cases, stress urinary incontinence.

Our specialists can help you select and fit the appropriate pessary based on your anatomy, symptoms, and lifestyle. We also provide ongoing pessary management, including follow-up visits, removal and cleaning when needed, and evaluation of the vaginal tissues.