Female Pelvic Medicine and Reconstructive Surgery
Urogynecology is the specialty of Ob/Gyn that deals with the diagnosis and treatment of female urinary incontinence, fecal incontinence, bladder pain and pelvic organ prolapse. These are collectively called Female Pelvic Floor Disorders. Physicians who specialize in Urogynecology can become board-certified in the subspecialty of Female Pelvic Medicine and Reconstructive Surgery.
Urinary incontinence is the involuntary leakage of urine. There are several general types of urinary incontinence:
- Stress Incontinence
- Urge Incontinence
- Mixed Incontinence
- Overflow Incontinence
- Continuous leakage
Fecal incontinence is defined as the involuntary loss of fecal material or flatus through the anal canal any time after toilet training. It is a very distressing problem that frequently goes undiagnosed and untreated because patients are hesitant to discuss it with their physician.
Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS)
Interstitial Cystitis/Painful Bladder Syndrome (IC/PBS) is a chronic condition defined as “an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder…of more than 6 weeks duration, in the absence of other identifiable causes.”
Pelvic Organ Prolapse (POP)
Pelvic Organ Prolapse (POP) occurs when there is a weakness in one or more of the support structures in the pelvis. This causes one or more of the pelvic organs (vagina, uterus, bladder, rectum, intestine) to fall or drop (prolapse). Patients may perceive this as pelvic pressure, pain or something protruding/bulging through the vagina. It may be associated with leakage of urine or difficulty in voiding. Also, it may be associated with difficulty having bowel movements or having to press against the vaginal wall in order to have a bowel movement.
Diagnosing Female Pelvic Floor Disorders
The diagnosis of Female Pelvic Floor Disorders begins with obtaining a history and performing a physical exam. Part of the history may include asking you to complete a voiding diary and/or a bladder pain scale. The purpose of these is to try and quantify your symptoms, both to help with the diagnosis and to set a baseline to evaluate how effective your treatment is working.
In addition, there are additional tests that may be performed in the office, depending on your symptoms. These include:
- Bladder Scan for post-void residual measurement.
- Urodynamic testing for urinary incontinence.
- Potassium Sensitivity Testing for Interstitial Cystitis/Painful Bladder Syndrome
- Ano-rectal manometry for fecal incontinence.
- Anal ultrasound for fecal incontinence.
Treatments for Female Pelvic Floor Disorders
Depending on your particular diagnosis, there may be several different treatment options available. Listed below are some of those:
- Dietary Modifications
- Bladder Training
- Kegel (Pelvic Floor) Exercises
- Pelvic Floor Rehabilitation (PFR)
- Oral Medication
- Instillation of medication into the bladder
- Cystoscopy and hydrodistension of the bladder
- InterStim Therapy (Sacral nerve stimulation)
- Botox Injections
- Coaptite Injections
- Sling procedures
- Vaginal surgery for pelvic organ prolapse
- Laparoscopic surgery for pelvic organ prolapse
- The use of mesh to correct pelvic organ prolapse
Having a problem like urinary incontinence, bladder pain, fecal incontinence or pelvic organ prolapse can be very troubling and life altering. Patients may suffer for years with these treatable problems because of embarrassment. We want you to know that you don’t need to suffer in silence; we are here to help.
Dr. O’Neil is board-certified in Female Pelvic Medicine and Reconstructive Surgery as well as Obstetrics and Gynecology. His interests are in pelvic and vaginal reconstructive surgery, urogynecology, robotic and minimally invasive surgery.