Pelvic Floor Disorders

What are Pelvic Floor Disorders?

Bladder and pelvic floor disorders, also known as urogynecologic disorders, include any pain or dysfunction in the area of the uterus, cervix, vagina, bladder or rectum. The primary types of bladder and pelvic floor disorders are:

• Urinary incontinence - two main types of urinary incontinence are:
  • Stress Incontinence - Tiny leaks that occur when motion stresses the bladder. These motions may include coughing, sneezing or laughing.
  • Urge Incontinence - Also called "overactive bladder," this is the urgent need to go to the bathroom followed by an involuntary loss of urine.
• Fecal incontinence - the involuntary loss of solid or liquid stool that can result in impaired quality of life for an individual
• Pelvic organ prolapse - described as a fallen bladder, uterus, vagina or rectum
• Fistulas - vesicovaginal or rectovaginal - an opening between the wall of the vagina and the wall of the bladder or rectum which can lead to urine leakage
• Complex benign conditions of the vagina and urethra such as vaginal cysts, absence of vagina, and urethral diverticulums
• Other problems with urination or pelvic floor

Diagnosis of Pelvic Floor Disorders

Our goal is to provide diagnostic and therapeutic options tailored to your urogynecologic needs. Our approach is to efficiently complete your evaluation in a comfortable and friendly environment. We keep you informed of your condition, enabling you to make educated decisions and take control of your situation.

Your evaluation may include:

• History and physical examination – The first office visit consists of an interview and consultation followed by a physical exam and pelvic exam. Following the exam, the doctor may recommend specialized testing.
• Urine examination – A urine analysis and culture are performed to detect infection, inflammation, blood or other underlying kidney problems.
• Cystoscopy – This in-office test enables the physician to look directly inside the bladder through a small camera inserted through the urethra. It is a common test used to detect inflammation, stones or tumors.
• Multi-channel urodynamics – Urodynamic testing evaluates the bladder's function. These in-office tests are particularly useful for women with urinary incontinence or urinary frequency.
• Electrodiagnostic testing (EMG) of the pelvic floor – This testing evaluates nerve function of the pelvic floor. EMG determines the pelvic floor's muscle response to a series of small electrical impulses.

Depending on your condition, additional tests such as anal manometry, defecography, anal ultrasound and pelvic magnetic resonance imagery (MRI) may be performed. We strive to evaluate your problem, offer a diagnosis, and recommend the best treatment options for you.

Treatment at Penn

The Division of Urogynecology at Penn offers comprehensive, efficient, state-of-the-art services for a variety of bladder and pelvic floor disorders. Our specialists are amongst the best in the nation and are dedicated to the evaluation and treatment of urogynecologic conditions in women. We conduct national and international clinical trials, providing our physicians access to the most progressive therapies available.

Behavioral Therapy

Behavioral therapy is safe, easy to learn, and does not have side effects. Examples of behavioral therapy are:

• Pelvic Muscle Training – Regularly practicing pelvic muscle (Kegel) exercises to help muscle control and manage leakage
• Bladder Training – Lengthening the time between trips to the bathroom to train the bladder to help women with urge incontinence
• Relaxation Exercises – Breathing slowly and deeply when the urge strikes
• Fluid and dietary modification – For example, decreasing daily caffeine intake to help reduce or eliminate urine leakage

Devices and Medications

Pessaries and other devices can be used to treat some conditions as a safe alternative to surgery. Medications are available to treat a variety of urogynecologic problems.

Surgery

Surgeons specialize in a variety of surgical treatment options that range from minimally invasive surgery (including robotic gynecologic surgery), vaginal surgery and abdominal surgery.

• Minimally invasive surgery for stress incontinence – This surgery includes transvaginal slings ("tapes"), fascial slings and collagen injections.
• Minimally invasive surgery for urge incontinence: Sacral Nerve Stimulation – This technique electrically stimulates the sacral nerves that influence the behavior of the bladder, urinary sphincter and pelvic floor. It is an outpatient procedure, performed in two stages and is highly effective, safe and well tolerated.
• Laparoscopic surgery – A surgery performed via small incisions using specially designed surgical instruments and viewed through a laparoscope, or surgical telescope. This surgery can be used to treat a prolapsed uterus.
• Pelvic reconstructive surgery – If your condition permits, urinary incontinence or pelvic organ prolapse can be repaired through the vagina with no visible abdominal incisions. For advanced conditions, abdominal surgery may be recommended.

Our surgeons use advanced techniques and materials such as biologic grafts and synthetic meshes to minimize the chance of recurrence after surgery. Surgeons also can perform vaginoplasty operations for women who do not have a vagina.

Penn Programs & Services for Pelvic Floor Disorders