Urogynaecology

The field of Urogynecology (a subspecialty within Obstetrics and Gynecology) is dedicated to the treatment of women with pelvic floor disorders such as urinary or fecal incontinence and prolapse (bulging) of the vagina, bladder and/or the uterus.

We specialize in the treatment of a wide range of urogynecological conditions including:

  • Urinary incontinence
  • Interstitial cystitis and bladder pain syndromes
  • Overactive bladder
  • Pelvic prolapse
  • Pelvic floor dysfunction
  • Post-surgical complications
  • Urogynecologic fistula

The uterus is held in position by pelvic muscles, ligaments and other tissues. If the uterus drops out of its normal position, this is called prolapse. Prolapse is defined as a body part falling or slipping out of position. Prolapse happens when the pelvic muscles and connective tissues weaken. The uterus can slip to the extent that it drops partially into the vagina and creates a noticeable lump or bulge. This is called incomplete prolapse. Complete prolapse occurs when the uterus slips to such a degree that some uterine tissue is outside the vagina.

Pelvic prolapse is usually accompanied by some degree of vaginal vault prolapse. Vaginal vault prolapse occurs when the upper part of the vagina loses its shape and sags into the vaginal canal or outside the vagina. Pelvic prolapse may also involve sagging or slipping of other pelvic organs, including the bladder, the urethra which is the tube next to the vagina that allows urine to leave your body, and rectum

Anatomy of the Vagina

The vaginal vault is the “ceiling” or the inner, upper end of the vagina. The vaginal vault has four “compartments”: an anterior compartment, closest to the front of the body; the vaginal wall; a middle compartment consisting of the cervix; and a posterior compartment consisting of the vaginal wall at the back of the body.

Signs & Symptoms

Women with mild cases of pelvic prolapse may have no noticeable symptoms. However, as the uterus falls further out of position, it can place pressure on other pelvic organs—such as the bladder or bowel — causing a variety of symptoms, including:

  • Sensation of sitting on a small ball
  • Heaviness or pulling in the pelvis
  • Pelvic or abdominal pain
  • Pain during intercourse
  • Protrusion of tissue from the opening of the vagina
  • Repeated bladder infections
  • Vaginal bleeding or an unusual or excessive discharge
  • Constipation
  • Frequent urination or an urgent need to empty your bladder

Symptoms may worsen with prolonged standing or walking due to added pressure placed on the pelvic muscles by gravity.

Causes and Risk Factors

Pelvic prolapse is fairly common and the risk of developing the condition increases with age. It can occur in women who have had one or more vaginal births. Normal aging and lack of estrogen after menopause may also cause pelvic prolapse. Chronic coughing, heavy lifting and obesity increase the pressure on the pelvic floor and may contribute to the condition. Although rare, pelvic prolapse can also be caused by a pelvic tumor. Chronic constipation and the pushing associated with it can worsen pelvic prolapse.

Screening & Diagnosis

Diagnosing pelvic prolapse requires a pelvic examination usually performed by a gynecologist. The doctor will ask about your medical history and perform a complete pelvic examination to check for signs of pelvic prolapse. You may be examined while lying down and standing. Imaging tests, such as ultrasound or magnetic resonance imaging (MRI), may be performed to further evaluate the pelvic prolapse.

Stress incontinence is a leakage of urine that happens when you are active or when there is pressure on your pelvic area. Walking or doing other exercise, lifting, coughing, sneezing, and laughing can all cause stress incontinence. You had surgery to correct this problem. Your doctor operated on the ligaments and other body tissues that hold your bladder or urethra in place.
You may be tired and need more rest for about 4 weeks. You may have pain or discomfort in your vaginal area or leg for a few months. Light bleeding or discharge from the vagina is normal.

You may go home with a catheter (tube) to drain urine from your bladder.

There are several different kinds of surgeries to correct stress incontinence, which occurs when weakened pelvic floor muscles allow the bladder neck and urethra to drop. These surgeries seek to lift the urethra, the bladder, or both into the normal position. This makes sneezing, coughing, and laughing less likely to make urine leak from the bladder.

Surgery works to cure stress incontinence better than any other treatment. If other treatments (like pelvic floor muscle exercises) haven’t worked to control your incontinence, surgery may be your best option. What kind of surgery you have depends on your preference, your health, and your doctor’s experience.

Stress incontinence in women can cause frequent involuntary release of urine during activities that put pressure on your bladder, such as coughing or laughing. The tension-free vaginal tape (TVT) procedure is designed to provide support for a sagging urethra so that when you cough or move vigorously or suddenly, the urethra can remain closed with no accidental release of urine.

In TVT surgery, a mesh tape is placed under your urethra like a sling or hammock to keep it in its normal position. The tape is inserted through tiny incisions in your abdomen and vaginal wall. No sutures are required to hold the tape in place.

TVT surgery takes about 30 minutes and may be done under local anesthesia so you can cough at the surgeon’s request to test the tape’s support of your urethra.
Other sling surgeries are done in a way that is similar to TVT surgery. Transobturator tape (TOT) surgery is done almost as often as TVT in a slightly different way.

Why It Is Done

Tension-free vaginal tape is used to correct stress incontinence caused by sagging of the urethra. It is a relatively simple procedure that can be done with minimal hospitalization and recovery time.

How Well It Work

Tension-free vaginal tape surgery works as well as the Burch colposuspension surgery to cure stress incontinence. About 8 out of 10 women are cured (“dry”) in the year after TVT surgery. Long-term success rates are not known.

Surgery time, hospital stay, and recovery time are all shorter for women who have TVT compared to women who have retropubic suspension surgery.

Transobturator tape (TOT) surgery seems to work almost as well as TVT to cure women who have stress incontinence, although the evidence is not as strong.