Urogynecology &
Pelvic Reconstructive Surgery

Improving Quality of Life for Women of All Ages

Treatment for incontinence and other disorders of the lower urinary tract and pelvic floor

If you are a woman living with urinary incontinence, interstitial cystitis, chronic pelvic pain, pelvic organ prolapse or any other disorder of the lower urinary tract and pelvic floor, take comfort in this fact: You are not alone. Disorders of this kind affect women of all ages, particularly after childbirth. Left untreated, they can become a constant source of discomfort and pain.

It’s time to feel like you again.

With help from our team, these difficult medical issues can be successfully managed, and even cured. We offer a broad range of treatments, from simple diet and exercise regimens to minimally invasive surgical procedures, all designed to help women overcome their urinary and pelvic disorders permanently.

It’s important to learn about your options; if you are a woman suffering with a disorder of the lower urinary tract and pelvic floor, expert help is available at Newark Beth Israel Medical Center. During your initial consultation, you will have a complete physical evaluation then we will discuss your treatment options with you. Together you can decide on your best course of therapy.

What Is Urogynecology?

Urogynecology is a specialty field of medicine dedicated to the diagnosis and treatment of disorders of the lower urinary tract and pelvic floor. Physicians who practice this specialty are obstetrician/gynecologists who have completed further medical training through a fellowship in urogynecology.

Urogynecologic Conditions

Urogynecologists are taught to treat problems due to pelvic floor disfunctions including:

• Urinary incontinence, such as:
  • Stress incontinence, when urine leakage is experienced while coughing, sneezing, laughing or performing strenuous activity. Stress incontinence often occurs in younger women and can result from childbirth and some surgeries that weaken the pelvic floor.
  • Urge incontinence, when a woman feels as if she can’t reach the bathroom fast enough. Urge incontinence can be caused by infection in the bladder or urethra, or by major conditions like stroke and diseases of the nervous system.
  • Mixed incontinence, when a woman experiences both stress and urge incontinence.
• Frequency and urgency of urination
• Interstitial cystitis, a chronic, painful inflammatory condition of the bladder wall
• Overactive bladder, the frequent need to void, bladder pressure, urgency, urgency incontinence or difficulty holding back a full bladder
• Recurrent urinary tract infection
• Pelvic organ prolapse, where muscle and tissues holding pelvic organs in place are stretched or weakened during childbirth, causing organs to move from their natural positions. Prolapse can affect the bladder, rectum, small bowel, uterus and vagina (after hysterectomy).
• Chronic pelvic pain
• Fecal incontinence or uncontrolled leakage of liquid or solid stools.
• Sexual dysfunction

These problems can affect virtually any woman at any stage of her adult life.

Treatment and Techniques to Help Restore Your Quality of Life

Incontinence and pelvic dysfunction are not normal consequences of aging. But rather than seeking treatment, many women keep their symptoms a secret, even when those symptoms begin to interfere with normal activities like going to work or taking long trips.

If your symptoms are beginning to affect your quality of life, it may be time to take action. There are a variety of treatment techniques that range from behavior modification to the use of specially designed medical devices and minimally invasive surgical procedures, including:

• Biofeedback, a self-training technique in which the patient consciously controls a body function that normally is automatically regulated by the body.
• Diet and exercise regimens
• Pelvic reconstructive surgery and TVT sling urethropexy
• Interstim sacral nerve stimulation (bladder pacemaker), an FDA-approved, implantable device that regulates the bladder
• Advance laparoscopic procedures, including minimally invasive laparoscopic uterine suspension, vaginal vault suspension, supracervical hysterectomy, laparoscopic assisted vaginal hysterectomy
• Robotic-assisted sacral colpopexy using the da Vinci® Surgical System

Many patients do well with conservative management and do not need surgery. For those who do, our team is trained to perform minimally invasive laparoscopic and robotic-assisted surgical procedures that leave minimal scarring, are less painful, and can often be performed on a same-day basis.

Frequently Asked Questions

Below are some answers to questiosn you might have about urogynecology.

What Is a Urogynecologist?

A Urogynecologist is an obstetrician/gynecologist who has specialized in the care of women with pelvic floor dysfunction.

What Kind of Training Does a Urogynecologist Have?

Urogynecologists have completed medical school and a four-year residency in Obstetrics and Gynecology. These doctors become specialists with additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs. The additional training focuses on the surgical and non-surgical treatment of non-cancerous gynecologic problems including pelvic reconstructive surgery, the evaluation of bladder with cystoscopy and urodynamic testing.

When Should I See a Urogynecologist?

Although your primary care physician or OB/GYN may have knowledge about these problems, a Urogynecologist can offer additional expertise. You should see (or be referred to) a Urogynecologist when you have problems of prolapse, and/or troublesome incontinence such as frequency and urgency of urination or getting up at night to urinate, or when your primary doctor recommends consultation. Other problems for which you or your doctor might think about consulting a urogynecologist include: problems with emptying the bladder or rectum, pelvic pain, and the need for special expertise in vaginal surgery.

How Can I Prevent Urinary Incontinence and Prolapse?

We don't fully understand all the factors that cause urinary leakage and prolapse, so it is difficult to recommend ways to prevent these problems. Pelvic Floor Exercises (Kegel's) - are probably the best way to prevent stress incontinence and prolapse. Other things that might help include not smoking, avoiding repetitive strenuous activities that involve very heavy lifting (for example lifting 50lb boxes onto a truck several hours a day) and avoiding the use of forceps or vacuum assistance during childbirth.

There is much discussion among urogynecolgists about how much vaginal childbirth (as opposed to cesarean section) and pregnancy itself predisposes to the development of urinary incontinence and pelvic organ prolapse. It is clear that being pregnant and delivering babies are important contributors. However, it is important to remember that there are women who have never been pregnant who leak urine or have prolapse - and women who have delivered many times who do not. There is no clear answer at this time.

If you are troubled by your uncontrolled urine loss or prolapse you should consider seeing your primary care physician or a urogynecologist who can evaluate the problem and recommend appropriate treatment. Seeing a specialist does not mean that you will have to have surgery. Other suggestions are listed below:

• Get yearly pelvic exams to watch for changes or problems.
• Call between visits if you have increasing symptoms.

Follow these suggestions:

• Avoid heavy lifting (no more than 20 pounds).
• Watch your weight. Being over weight increases pressure on your pelvic floor.
• If you smoke, try to quit. Smoking decreases circulation to your pelvis and a chronic cough will aggravate pelvic floor prolapse.
• Avoid constipation. Straining with bowel movements increases prolapse. If constipation is a problem for you, talk to us about treatment.
• Learn and practice pelvic floor exercises.
• Hormone replacement may be an option to increase the circulation to your pelvic, and restore some tissue tone.
• Be sure your doctor is measuring your prolapse in a systematic way – so that he/she will be able to notice subtle changes over time. The most commonly used system of measure for prolapse is called the “pelvic organ prolapse quantification” or POP-Q system.

For more information about urogynecologic services at Newark Beth Israel Medical Center, contact us.