Urogynecology & Reconstructive Pelvic Surgery
St. Joseph’s Health’s Urogynecology & Reconstructive Pelvic Surgery Program offers compassionate and personalized care for women affected by common pelvic floor disorders.
Pelvic problems include, but are not limited to, pelvic pain, leakage of urine or feces and vaginal bulge symptoms. These problems affect about one in four women in the United States. Most women with these disorders suffer in silence, never mentioning it even to their physicians.
While many women find it difficult to discuss pelvic floor disorders, these conditions can greatly affect your quality of life. We understand that you want an accurate diagnosis as soon as possible. It’s important to find a healthcare team that is experienced in treating these conditions.
St. Joseph’s Health’s fellowship-trained urogynecologists are highly skilled in treating the following conditions:
- Atrophic Vaginitis
- Blood in the urine (hematuria)
- Complications from previous pelvic surgical procedures
- Fecal incontinence
- Pelvic organ prolapse
- Pelvic pain syndromes, including interstitial cystitis and dyspareunia
- Postpartum pelvic floor issues including wound healing
- Recurrent Urinary Tract Infections
- Urethral diverticulum and other vaginal masses
- Urinary incontinence including stress incontinence, overactive bladder, urinary frequency, nocturia and urgency urinary incontinence
- Urinary or anal fistulas
- Urinary retention
St. Joseph’s Health’s Female Pelvic Medicine & Reconstructive Surgery Program focuses exclusively on women’s pelvic medicine and reconstructive surgery. Always working at the leading edge of medicine, offering minimally invasive pelvic surgery to treat pelvic-organ-prolapse repair, rectovaginal and vesicovaginal fistulas, incontinence and other urogynecologic conditions.
Procedures and surgeries we perform:
- Office cystoscopy for bladder evaluations
- Trigger point injections, bladder instillations and hydrodistension for pelvic pain
- Pessary fitting for prolapse and incontinence
- Percutaneous tibial nerve stimulation (PTNS) for overactive bladder
Our dedicated team will determine what is causing your symptoms and develop a comprehensive treatment plan. At St. Joseph’s, we believe in treating the whole person, not just your illness, which is why your care team may include surgeons, physical therapists, and nurses.
How Are Urogynecology and Pelvic Floor Conditions Diagnosed?
Accurate diagnosis is essential to successful treatment. St. Joseph’s Health’s team has vast experience in treating all urogynecological disorders.
Childbirth, age and other factors can weaken or damage the muscles, ligaments or nerves in the pelvic floor, leading to many of the pelvic floor conditions, such as leakage of urine and symptoms of a vaginal bulge.
Your doctor will take a detailed medical, surgical and family history and conduct an examination. Depending on your condition, your doctor may request imaging and tests, including: .
- Blood test
- Bladder function tests (urodynamic)
- CT scan
- Cystoscopy
- Laboratory tests
- MRI (magnetic resonance imaging) scan
- Ultrasounds
- Urine analysis and cultures
What Nonsurgical Treatments Are Available for Pelvic Floor Disorders?
Pelvic floor disorders can affect many aspects of everyday life. It can affect you physically, socially and emotionally. Most importantly, pelvic floor disorders interfere with intimacy and impede physical activities, both of which are vital to overall health and well-being. For women with these life-changing problems, St. Joseph’s Health offers life-changing solutions.
We take the time to listen to our patients and find out what is important to them. We assess how pelvic floor problems are affecting our patient's daily life and discuss their preferences and goals for treatment. Our physicians will explain the available treatments, both surgical and nonsurgical, and what to expect from each approach.
Together we devise a treatment plan that will provide a better quality of life and share that plan with our patient's medical team, including gynecologists and primary care physicians.
Whenever possible, we recommend conservative or nonsurgical interventions. Some of the treatments we offer include:
- Diet and behavior modification – Bladder retraining for urinary incontinence, and eating more fiber in the case of fecal incontinence, are examples of diet and behavior modification therapies that can lead to notable improvements.
- Injections – Bladder and urethra injections may be used to relieve urinary symptoms.
- Pelvic floor physical therapy – Pelvic floor problems sometimes require specialized physical therapy. The pelvic floor muscles play an important role in supporting abdominal organs, such as the bladder, bowel and uterus. They also are important in sexual health and childbirth. Pelvic floor physical therapy treatments can help strengthen pelvic muscles, which may reduce pelvic and bladder pain, bladder spasms, leakage and the sudden urge to urinate.
- Medications – Medications can provide symptomatic relief for conditions such as pelvic pain, frequent trips to the bathroom or urine leakage.
- Nerve stimulation – With this advanced therapy, neurostimulators are used to send electric signals to your nerves, easing or eliminating bladder symptoms. This therapy can be done through weekly visits or by implanting a neurostimulator.
- Pessaries – These devices can help control symptoms of pelvic organ prolapse and urinary incontinence.
What Surgical Treatments Are Available for Pelvic Floor Disorders?
If nonsurgical treatments are no longer providing relief or cannot manage your condition, your doctor may recommend surgery.
Our team is nationally recognized for its expertise in vaginal, laparoscopic and robotic-assisted surgery. These minimally invasive procedures offer a more satisfying experience for our patients with less pain and blood loss, a shorter recovery time, fewer complications and reduced scarring.
Your healthcare team will develop a surgical treatment plan tailored to your individual needs, with procedures that may include:
- Bulking agent therapy – For patients experiencing urinary incontinence, this procedure may provide relief by reducing urinary leakage from coughing, laughing and exercise. This therapy works best for women who do not lead a physically active lifestyle.
- Colpocleisis – For women who experience chronic discomfort from pelvic organ prolapse and are in poor health, this procedure can provide significant relief. This procedure is not intended for women who are currently sexually active or will engage in future sexual activity.
- Colporrhaphy – For women with vaginal prolapse, including cystocele and rectocele, this surgical technique provides relief by returning the vagina to its normal position in the pelvis. This can be done vaginally and typically involves using a woman's own tissues.
- Cystoscopy – For women who have blood in their urine, their doctor may require this procedure to look inside the bladder and urethra.
- Fistula repair – Fistulas are connections that may arise between the bladder and the vagina or the rectum and the vagina. There are many other types of fistula that may also develop. These can be repaired through your vagina or through your abdomen.
- Sacral nerve stimulation (neuromodulation) –Your doctor may recommend sacral nerve stimulation for the treatment of urinary incontinence, overactive bladder, fecal incontinence or other pelvic floor disorders. This technique is used to stimulate the nerves that control bladder function and bowel movements through the use of a small device that is implanted under the skin.
- Sacrocolpopexy or Sacrohysteropexy – Sacrocolpopexy and sacrohysteropexy are abdominal procedures used to treat prolapse. Both procedures are typically done in a minimally invasive manner through the abdomen using laparoscopy or physician-guided robotic surgery.
- Sacrospinous fixation – For women with vaginal vault prolapse, this procedure can support the vagina by attaching the vaginal vault to a ligament in the pelvic area.
- Sling placement – To prevent urinary leaks and stress incontinence, your doctor may place a sling to provide support for the bladder neck and urethra.
