Services & Treatments

Bladder drills

As part of a program to get in control of your bladder, you may have been asked to void by the clock rather than by urge. Learning to control your bladder is easier than you may realize.

Read more about bladder drills.

Dietary modifications

Although there is no particular “diet” that can cure bladder control, there are certain dietary suggestions you can use to help control the problem.

Read more about dietary modifications.

Integrative Medicine Modalities

In an effort to provide a complement to our medical services, we provide the following integrative medicine techniques:

• Herbal consultation: The discussion of herbal therapies for conditions such as menopause, pelvic pain, chronic urinary tract infections, insomnia, adrenal gland stress, fatigue, and others.
• Stress reduction strategies/lifestyle counseling: We will discuss guidelines on how to bring balance into your overactive life, for health maintenance, disease prevention, treatment of chronic conditions, and for longevity.

Pelvic floor physical strengthening

Specially-trained physical therapists treat women’s health issues including urinary urgency and frequency, urinary incontinence, bowel incontinence, pelvic floor dysfunction and pelvic pain. They use biofeedback and other techniques to improve your outcomes with Kegel exercises and other non-surgical treatments. Exercises taught are used to strengthen your pelvic floor muscles. If they are performed routinely, they can help you control your urine loss and support your bladder, vagina and rectum. They may also be done for childbirth preparation and may improve your sex life.

It is important that you know how to perform these exercises correctly. Read additional information that details the exercises.

Pelvic floor physical therapy

Specially-trained physical therapists treat women’s health issues including urgency/frequency of urination, urinary or fecal incontinence, and/or pain in the pelvic region. Physical therapists rehabilitate the musculoskeletal system and have a variety of methods to treat and teach you how to improve pelvic floor function. Physical therapists work closely with physicians to support improved quality of life for each client. We frequently send patients to be seen by physical therapists as an alternative or adjunct to pelvic surgery.

Sacral nerve stimulator, interStim therapy

A sacral nerve stimulator uses low amplitude electrical stimulation in the lower-half of the body to send signals to the sacral nerve. This is a treatment for urgency-frequency and urgency-incontinence as well as fecal (bowel) incontinence.

Improvement or cure rates of 70-80 percent are seen for both of these conditions, even in patients who have not responded to other treatments.

Burch procedure

Burch Procedure is used to correct urine loss that occurs with coughing, sneezing, laughing or activity (stress incontinence). We also offer this procedure to women who don’t complain of incontinence but do show loss of urine when their pelvic relaxation is replaced during urodynamics (bladder testing) and require other abdominal surgery for prolapse (pelvic relaxation).

Read more about what you can expect.

Colpopexy

• Abdominal sacral

  Abdominal Sacral Colpopexy (ASC) is a procedure is typically done to correct slippage of the top of the vagina and/or uterus and cervix. A hysterectomy can be done first if it is needed with this procedure. If a hysterectomy is done, the cervix may remain after removing the uterus so that more tissue is available to attach our supports (mesh) to. In some patients a Burch procedure or suburethral sling is performed to support the bladder neck as associated urinary stress incontinence is common. This entire procedure can also be performed through minimally invasive laparoscopic surgery in some patients. Read more about what you can expect.

• Laparoscopy/robotic sacral

  Laparoscopic or Robotic procedures are minimally invasive technologies that can be utilized to perform this specialized surgery, which is considered the most durable for appropriate candidates and is done to correct uterine and vaginal prolapse. Only small incisions are needed to complete the procedure so that patients have less pain, a shorter hospital stay, and a quicker recovery.

  This procedure is typically done to correct prolapse of the top of the vagina and/or uterus and cervix. A hysterectomy is done first if it is needed. If a hysterectomy is done, the cervix may remain after removing the uterus so that more tissue is available to attach our supports to. Read more about what you can expect.

Hysterectomy

A hysterectomy is the surgical remove a woman's uterus or womb and can be performed by a variety of minimally invasive procedures such as a laparoscope-assisted vaginal hysterectomy/ robot-assisted laparoscopic hysterectomy, laparoscopic supracervical hysterectomy or a vaginal hysterectomy.

Learn more about the various surgical hysterectomy techniques.

Laparoscopy/gynecologic surgery

Laparoscopy is a procedure used to examine the organs of the abdominal cavity. Laparoscopy utilizes a laparoscope, a thin flexible tube containing a video camera. The laparoscope is placed through a small incision in the abdomen and produces images that can be seen on a computer screen. A similar procedure can be used to look at the organs of the pelvis (gynecologic laparoscopy or pelviscopy).

Learn more about laparoscopy.

Paravaginal repair of cystocele

Paravaginal repair is typically done to correct bulging of the front wall (anterior wall) of the vagina that has resulted from lateral detachment of the supports of the bladder. This is typically done through a bikini incision in the abdomen, but can be done laparoscopically (minimally invasive) as well.

Learn more about what you can expect.

Pessary

A Pessary is a device that is placed into the vagina to support the uterus, bladder and rectum to relieve prolapse and urinary incontinence. They are made in a variety of shapes and sizes. Pessaries are an alternative to surgery. Some people wear them until they are able to have surgery. Others may choose to wear them the rest of their life.

Read more information detailing the exercises.

Urethral bulking

Urethral bulking is a type of therapy used for stress urinary incontinence. It is a minor office procedure to treat some patients with stress urinary incontinence. This procedure, done in the office under local anesthesia, is FDA approved for certain types of stress incontinence.

Urgent PC/neuromodulation

Urgent PC is a non-surgical, non-drug treatment for overactive bladder. The procedure is done in the office and is designed to provide percutaneous tibial nerve stimulation for the treatment of overactive bladder and associated symptoms of urinary urgency, frequency, and urge incontinence.

Vaginal cystocele repair

Vaginal cystocele repair is typically done to correct bulging of the front wall of the vagina. This bulging can cause symptoms such as the sensation of sitting on a ball, incomplete emptying of the bladder, overactive bladder symptoms, recurrent urinary tract infections, and pelvic discomfort.

Learn more about what you can expect.

Vaginal mesh removal

Some women may have had adverse reactions to implants (vaginal mesh) placed for repair of prolapse or incontinence. These reactions may include erosion or exposure of the implant material, pelvic pain, pain with sex, incontinence, or voiding problems. Treatment options include surgical removal, medical therapy and physical therapy.

Vaginal rectocele repair

Vaginal rectocele repair is typically done to correct bulging of the bottom wall of the vagina. This bulging can cause symptoms such as the sensation of sitting on a ball, incomplete emptying of the rectum, and pelvic discomfort.

The surgery is usually done through a vaginal approach, but in some circumstances a combined abdominal and vaginal approach to the repair is made.

Learn more about what you can expect.

Botox bladder injections

In 2013, the U.S. Food and Drug Administration expanded the approved use of Botox (onabotulinumtoxinA) to treat adults with overactive bladder who cannot use or do not adequately respond to a class of medications known as anticholinergics. Clinical studies have demonstrated Botox’s ability to significantly reduce the frequency of urinary incontinence. Botox injections into the bladder provide an important additional treatment option for patients with overactive bladder, a condition that affects an estimated 33 million men and women in the United States.

Overactive bladder is a condition in which the bladder squeezes too often or squeezes without warning. Symptoms include leaking urine (urinary incontinence), feeling the sudden and urgent need to urinate, and frequent urination.

When Botox is injected into your bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence. Injecting the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder while Botox is being injected.

Suburetheral sling

A suburethral sling is a surgical procedure for patients with severe incontinence that occurs with activity, coughing, sneezing, or laughing. Specifically, slings are for patients with a damaged urethral sphincter or failures of other surgery for incontinence. Slings act as a backstop underyour bladder neck and urethra to prevent urine leakage during activity, coughing, laughing, etc. The success of the surgery is between 85 to 90 percent in most cases. The surgery usually involves a small incision above the pubic bone in your hairline that is 4 to 8 cm long. To place the sling, a 2 to 4 cm incision is then made in the vagina overlying the bladder. The sling is placed in the vagina and wrapped under the urethra and bladder neck, and attached or tied over the fascia overlying the muscles in the abdomen. Most commonly; we use a piece of fascia (strong tissue) from your own body as the sling material. This fascia may come from your leg or your abdominal incision. The long term success of this procedure is over 80 to 85 percent for curing stress urinary incontinence.

Learn more about what to expect.

Tension free transobturator tape sling

TOT sling placement includes surgery for patients with stress incontinence that occurs with activity, coughing, sneezing, or laughing. This may be a safer alternative the regular TVT because it does not come as close to structures that can be injured (bladder, bowel, blood vessels, etc.). All slings act as a backstop under your bladder neck and urethra to prevent urine leakage during activity, coughing, laughing, etc..

The sling material is made of a permanent material called prolene so it should last forever. Because it is not a natural material, there is a risk of mesh erosion through the vagina skin—less than 1-2 percent.

Learn more about what to expect.

Tension free vaginal tape sling

A Tension Free Vaginal Tape (TVT) Sling is surgically placed in patients with stress incontinence that occurs with activity, coughing, sneezing, or laughing. Specifically, slings are for patients with a damaged urethral sphincter or failures of other surgery for incontinence. Slings act as a backstop under your bladder neck and urethra to prevent urine leakage during activity, coughing, laughing, etc. The cure rate of the surgery is between 85 percent, with another 5-10 percent improved significantly. To place the sling, a 2 cm incision is then made in your vagina overlying the bladder. Two incisions less than a centimeter are also needed to place the sling and are located above your pubic bone below the hair line. The sling is placed in through the vagina under the urethra. At the end of the procedure your bladder is filled and cystoscopy is performed to ensure the procedure has been successful.

Learn more about what to expect.