Urogynecology is a subspecialty of Obstetrics and Gynecology focused on pelvic floor disorders. Urogynecologists are specifically trained to treat conditions such as urinary and fecal incontinence, pelvic organ prolapse (displacement or falling of uterus or vagina walls), difficulty with emptying one's bladder, pelvic pain, pain with intercourse, and constipation. Some common risk factors for pelvic floor disorders are vaginal delivery, repetitive straining, heavy lifting, obesity, chronic cough, genetics, and severe constipation.

The two most common conditions are pelvic organ prolapse and urinary incontinence which frequently occur together.

Approximately 30% of the female population suffers from some form of urinary incontinence. By the time a woman reaches 60 years of age, this number increases to 50%.

There are many possible causes of urinary incontinence. The key to treatment is identifying the specific type(s) of incontinence that a woman has through a careful medical interview and focused physical exam. It may be necessary to perform a special test called urodynamics to diagnose the problem.

The two most common types of urinary incontinence are stress incontinence and urge incontinence.

Stress incontinence is urine leakage that happens during activity that causes pressure (or "stress") on the bladder such as laughing, lifting, coughing or sneezing.

Urge incontinence is urine leakage that occurs before a woman has an urge episode and does not get a chance to make it to the bathrooom before leakage occurs
 

Stress incontinence: This can be can be effectively treated with pelvic floor exercises or surgery.   CLICK HERE for non-surgical treatment of stress incontinence, and CLICK HERE to view a description of the surgical management for stress urinary incontinence.

Urge incontinence: This is treated with dietary changes, pelvic floor physical therapy, and medications.  There is even a treatment for urge incontinence that involves placement of an electrical stimulator under the skin (similar to a pacemaker). The most important thing to remember is that there is a wide variety of non-surgical and surgical treatment options available for all kinds of urinary incontinence.  CLICK HERE for these options.  CLICK HERE to view a description of the electrical stimulator which can be used to treat urinary urge incontinence.
 

Over the years, many different procedures have been used to treat stress urinary incontinence. Research studies have identified two kinds of surgical procedures that are most effective: the retropubic urethropexy and the suburethral sling. There is no surgery for incontinence that has a 100% cure rate, but either the retropubic urethropexy or suburethral sling should permanently cure 75-95% of women with stress incontinence. The current “gold standard” treatment for stress incontinence is a surgery known as the TVT (Tension free vaginal tape). These slings are made from polypropylene mesh, and are placed through a small vaginal incision. The TVT procedure can be performed on an outpatient basis under local anesthesia plus IV sedation (much like the kind of sedation given for a colonoscopy). Although rare, some potential complications of surgery for incontinence include difficulty emptying the bladder and development of urge incontinence.

Some sling material that were used in the past did cause some problems for patients and those slings have been removed from the market. The current synthetic slings are made of a loosely woven polypropylene mesh designed especially for placement under the female urethra. Biomedical engineers have worked to create materials that will provide the necessary support while allowing excellent tissue in-growth. While problems with this tissue in-growth can occur, they are very rare. Feel free to ask Dr. Shariati about what type of sling he uses and why?

Pelvic muscle exercises (Kegel exercises ) have been shown to be helpful in prevention. Unfortunately most people do no do them and if they are they are not doing them correctly. 

Which are the right muscles?
During your pelvic exam, your doctor or nurse will place two fingers in your vagina and a hand on your abdomen. Then your doctor or nurse will ask you to contract the muscles of your vagina around her fingers as if you were stopping the flow of urine or if you are trying to prevent yourself from passing gas. These are the muscles you will exercise.

How to exercise pelvic muscles?
Pull in the pelvic muscles and hold for about 5 seconds, then rest for 5 seconds. Do 3 to 4 sets of 10 contractions per day. Over time increase the holding time and resting time to 10 seconds.

Be patient. Your goal is to improve muscle tone, and just as it takes time to improve muscle tone in your arms, legs, or abdomen, it takes time to tone the pelvic muscles. You may not feel your bladder control improve until after 6 to 8 weeks. Still, most women notice an improvement after a few weeks.

If the exercises work, continue to do them, just like any other exercises.

 

This means that one or more of the pelvic organs (bladder, rectum , uterus, vagina) have been displaced and are falling down.

Some common risk factors are vaginal delivery, repetitive straining, heavy lifting, obesity, chronic cough, genetics, and severe constipation.

Definitions and pictures of the various types of prolapse (cystocele, rectocele, uterine prolapse and enterocele) may be found by clicking on the GLOSSARY section...or click the VIDEOS link at the top of the page for videos that demonstrate individual types of prolapse.

The symptoms depend on which type of prolapse you have. Since prolapse usually occurs slowly over time, the symptoms can be hard to recognize. The most common symptom is pressure. Also prolapse may lead to difficulty emptying one’s bladder or bowel. If one does not empty her bladder appropriately, she may develop urinary tract infections. Some women with severe prolapse even have to push stool out of the rectum by placing their fingers into the vagina during bowel movements.

This is based on the individual’s symptoms.  A pessary may be worn - CLICK HERE to view a picture of different types of pessaries.  Dr. Shariati or one of his nurses will fit you with the appropriate pessary for you.  Pessaries have about a 50% chance of working.  This means that it prevents the prolapse from coming outside the vagina without causing any urinary or bowel problems.  Also depending on one’s symptoms, nothing may need to be done at all.

The ideal way to use a pessary is to insert it every day as part of your morning routine, and take it out for cleaning every evening. When this is not possible, we recommend that it is checked every 2-3 months to make sure that it is not causing any vaginal abrasions or ulcerations and for pessary cleaning. Even if you are taking out your own pessary daily, there is still a risk of vaginal infections. This risk is less, however, if you are removing your pessary on a daily basis. CLICK HERE for a picture of the various pessaries available.

It would probably get worse over time. Some times this may occur quickly but usually it is a slow process. The treatment of prolapse should be based on your symptoms. In rare cases, severe prolapse can cause urinary retention that progresses to kidney damage or infection, When this occurs, prolapse treatment is considered necessary. In most other cases, patients should be the ones to decide when to have their prolapse treated based on the symptoms they are having.
 

This is dependent on the type of surgery that you have. All the surgeries are performed either through very small vaginal incisions or small laparoscopic incisions abdominally. In either case, you will be in the hospital overnight. The catheter is generally removed before you leave the hospital. Even though you will have minimal pain and discomfort, we expect you not to strain or lift anything heavy (greater than 10 Lbs) for 4-6 weeks after the surgery. For more information, please CLICK HERE to review post-op instructions after incontinence surgery and CLICK HERE to review instructions after prolapse surgery.

This is dependent on the type of surgery performed. None of the surgeries are successful 100% of the time. According to the medical literature, failures with these types of surgeries occur 5-15% of the time. This is usually a partial failure and only a minor procedure is necessary to fix the remaining defect. Patients who follow that appropriate restrictions after surgery are less likely to have a failure.

Please ask Dr. Shariati about the success and failure rates of the specific procedure that you are having.

This is not exactly true. In 2008 the FDA did issue a warning about the use of vaginal mesh. While it is true that vaginal mesh placement can result in problems such as "erosion" and pain, we feel that the benefits of mesh need to be considered as well. If Dr. Shariati is considering the use of synthetic mesh to reinforce your prolapse repair, you will be informed about all the risks and benefits of doing so. Ultimately the choice will be yours to make.

The daVinci robot is a surgical tool that is designed to allow performing laparoscopic and minimally invasive surgeries more easily. Dr. Shariati has been using the daVinci robot since it’s inception for Gynecologic and Urogynecologic surgery. He also has performed hundreds and laparoscopic Gyencologic and Urogynecologic surgeries. The decision to use the Robot is dependent on your type of prolapse, your age, medical history and sexual activity. If he thinks that it would be best to perform your surgery vaginally, the daVinci robot would not be used.