Age or childbirth causes many women to develop pelvic floor disorders that affect the uterus, bladder, vagina and rectum.
The first symptom may be pressure or heaviness in the pelvic area or difficulty keeping a tampon in the vagina. Some women may even feel as though something is falling out of the vagina. Others find they have urine loss during everyday activities like coughing, laughing, sneezing or vigorous exercise.
Half of all women experience some of these symptoms which can limit normal daily activities, but few of them seek treatment. Sometimes women are embarrassed by these symptoms and hesitate to mention them to a physician, but these conditions are not a normal part of aging and they do not have to be endured. There are a number of ways to correct or manage these problems.
UofL Physicians – Urogynecology treats women with pelvic floor disorders such as incontinence (urinary or fecal) and prolapse (bulging or falling) of the vagina, bladder or uterus.
Urinary incontinence means not being able to control the flow of urine. This condition affects about two in 10 women younger than age 65 and more than half of women age 65 or older.
Prolapse means to fall or slip out of place. Prolapsed organs bulge or sag. Although this can sometimes happen quickly, prolapse usually takes many years. One in 10 women undergoes surgery for this condition.
Women often have both prolapse and incontinence. Each may be caused by damage to the pelvic floor after delivering a baby. Constant heavy lifting, chronic coughing, severe constipation and obesity also may contribute to prolapse and incontinence.
UofL Physicians offers a complete diagnostic evaluation of your condition and a variety of treatment options from drug and physical therapies to surgery, including a vaginal surgical approach using less invasive options such as advanced laparoscopy/robotic surgical reconstructive procedures.
When your prolapse becomes more pronounced, or when urine leakage becomes bothersome, our compassionate, appropriate and effective care offers the latest most practical solutions. Our services can help you enjoy an active lifestyle.
What is a urogynecologist?
A board-certified urogynecologist specializes in the diagnosis and treatment of female urologic and pelvic problems. Urogynecology is a specialty area, so these physicians have more experience in treating these conditions. The conditions most frequently treated include:
- Incontinence: leaking of urine or loss of bladder control
- Overactive bladder: urge to urinate more frequently
- Prolapse: weakening of the pelvic floor muscles that causes the vagina and uterus to drop down
- Emptying disorders: difficulty with urination or bowel movements
- Pelvic pain or discomfort
A urogynecologist is board-certified in female pelvic medicine and reconstructive surgery and is also board-certified in general obstetrics and gynecology. After completing a residency in obstetrics and gynecology, they complete a three-year fellowship in urogynecology, also known as female pelvic medicine and reconstructive surgery, focusing specifically on pelvic floor disorders.
There are few physicians in the Louisville area who have had this fellowship training and are board-certified in female pelvic medicine and reconstructive surgery. The University of Louisville School of Medicine is also one of about 50 programs in the U.S. to offer this fellowship program and train the future of urogynecology.
Who should visit a urogynecologist?
Women who have pelvic or vaginal discomfort, involuntary urine leakage, difficulty with emptying the bladder or bowel or feelings of vaginal fullness or heaviness should visit a urogynecologist. Additionally, any woman who has been told by a physician that she must have a large abdominal incision for a pelvic floor disorder or a hysterectomy should seek a urogynecologist for a second opinion because they have advanced training in minimally invasive techniques (such as robotic-assisted surgery) that can result in smaller scars, less bleeding, less pain and a faster recovery.
- International Pelvic Pain Society
- Video: Neuromodulation for Fecal Incontinence
- Video: Neuromodulation for Constipation
Diseases and conditions
Our expert physicians treat stress urinary incontinence (any unintentional loss of urine during physical activities such as laughing, coughing, sneezing or lifting) or urgency (a powerful need to urinate immediately).
- Overactive bladder (a sudden uncontrollable urge to urinate)
- Dysuria (painful urination)
- Nocturia (excessive frequency of nighttime urination)
- Fecal (stool) incontinence
- Recurrent cystitis (an infection that causes an urgency to urinate immediately and frequently)
- Interstitial cystitis (chronic painful bladder inflammation)
- Pelvic organ disorders or prolapse, such as a cystocele (bulging of the bladder into the vagina), rectocele (weakened tissues that allow the front wall of the rectum to bulge into the vagina), enterocele (vaginal hernia caused when the small bowel descends and bulges into the vagina), uterine prolapse (falling of the uterus into the vaginal canal) Blog article: Have you talked to your doctor about pelvic floor prolapse?
- Pelvic pain
- Problems with former vaginal mesh
Treatments and services
- Cystoscopy/urethroscopy/laparoscopy: An in-office procedure using a small, lighted scope to examine the internal lining of bladder and urethra for the evaluation of incontinence, pelvic pain, overactive bladder and interstitial cystitis.
- Urinalysis or urine culture (microscopic and chemical test of the urine)
- Ultrasound: The use of sound waves to study pelvic organs such as the anal sphincter, bladder, urethra, kidneys or ureters.
- Cystometrogram/urodynamic testing: An in-office procedure that uses a small catheter inserted into the bladder to study how well the bladder and urethra store and empty urine.
- Anal manometry: The use of a small catheter inserted through the rectum to determine how well the anal sphincter works.
- Dynamic fluoroscopy of the pelvic floor: The use of X-ray images and a contrast dye to study the extent of prolapse in the rectum, vagina and bladder during a bowel movement.
- Electrodiagnostic testing (EMG) of the pelvic floor: The use of EMG sensors in adhesive patches to test nerve and muscle response to light electrical impulses.
- Intravenous pyelography (IVP): The use of X-ray images to track a contrast dye as it moves from the kidneys through the ureters into the bladder and out of the body.
Management and treatment options
- Management of pelvic floor disorders, such as urinary incontinence and pelvic organ prolapse
- Sacral nerve modulation (InterStim® Therapy) for treatment of overactive bladder
- Botox injections to the bladder for treatment of overactive bladder
- Pessary fitting and placement: A treatment for pelvic organ prolapse. Pessaries are worn inside the vagina like a diaphragm to provide internal support.
- Bulking injections, such as collagen or other materials, are inserted next to the opening of the bladder to build up the urethral wall.
- Suburethral sling: A surgical procedure to support the urethra by means of a sling made of synthetic or natural materials.
- Minimally invasive surgical repair (laparoscopic or robotic), also known as bandaid or keyhole surgeries, because instruments and a camera are inserted into the body through small incisions.
- daVinci® Robotic Surgery
Our nurse practitioner at UofL Physicians – Urogynecology, Alyce Goodman Abraham, APRN, WHNP, specializes in chronic pelvic pain. She has spent more than 20 years seeing gynecologic and pelvic pain patients, most of which was dedicated to the evaluation, treatment and management of chronic pelvic pain. She uses her knowledge, skills and expertise to help patients maximize their physical and emotional well-being.
What is chronic pelvic pain?
Chronic pelvic pain (CPP) lasts more than six months and occurs in the pelvis or lower abdomen. Sometimes the cause is not obvious. Other times the problem that caused the pain originally goes away, but the pain continues.
CPP is one of the most common health care problems in our society.
- It’s estimated 25 million women suffer from CPP
- 25% may spend 2-3 days in bed each month
- More than half must cut down on their daily activities one or more days a month
- 90% have pain with intercourse
A wealth of information on chronic pelvic pain can be found on the International Pelvic Pain Society website.
To make an appointment for chronic pelvic pain at UofL Physicians – Urogynecology, call 502-588-7660.