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Continence and Advanced Pelvic Surgery

Women have unique health care needs that deserve specialized care. All women are susceptible to problems that can be embarrassing or uncomfortable such as bladder control problems, a bulge in the vaginal area or bowel control problems. These problems can greatly affect your quality of life. At the Women's Health Center, we provide comprehensive care for women who suffer from a multitude of pelvic floor disorders. Whatever your specific needs, you can be assured that you will be treated with respect and compassion.

We treat:

Pelvic Organ Prolapse

Over time, the effects of childbirth, straining, genetics and other health issues contribute to the development of bulges in the pelvic floor, called prolapse. Nearly half of all women between the ages of 50 and 79 have some form of prolapse. Pelvic organ prolapse occurs when the normal support of the vagina is lost resulting in sagging or dropping of the bladder, urethra, cervix and rectum. The bulging also will commonly give women the sensation of pressure or fullness in the pelvis and may cause lower back discomfort.

Symptoms

  • Difficult bowel movements, constipation, liquid stools
  • Feels like having a tampon that is about to fall out or a lump outside the vagina
  • Lower backache
  • Painful intercourse
  • Pelvic pressure, pulling or stretching groin pain
  • Something bulging or falling out from the vagina
  • Urine leakage, frequency, chronic urinary tract infections, difficulty urinating

Women with pelvic organ prolapse can experience all, some or none of these symptoms. Each woman's experience depends on the type of prolapse, the severity of the symptoms and the individual herself.

Evaluation

  • Health history
  • Pelvic exam

Other tests and diagnostics

Your pelvic floor disorder is unique. Many times these disorders occur with some other problem that demands advanced diagnostic techniques to determine the cause. We have an experienced team of health care professionals and state-of-the-art technology to provide the most accurate diagnosis and most effective treatment of your condition. By using diagnostic tests, we can work with you to determine the best course of treatment.

Urodynamics

Urodynamic testing is a series of bladder tests that are done in order to observe how your lower urinary tract reacts under certain conditions. It is usually done to see if you have problems with loss of urine or to figure out what type of incontinence you may have.

Cystoscopy

Cystoscopy is a diagnostic procedure designed to examine your bladder and urethra. Cystoscopy may assist in identifying problems with the urinary tract such as early signs of cancer, infection, strictures (narrowing), obstruction and bleeding.

Ultrasound

Ultrasound imaging is a method of obtaining images inside the body through the use of high-frequency sound waves. A probe that emits sound waves is placed on the skin of the abdomen or within the vagina or rectum to obtain images of the pelvis. Ultrasound is a useful way of examining many of the body’s internal organs such as the bladder, bowel and uterus.

Treatments

Pessaries - A pessary is a small device made of plastic or silicone that is placed inside the vagina to hold the uterus or the walls of the vagina up and inside your body. These are especially useful for women who leak urine during specific activities such as exercise. Several types and sizes of pessaries are available. Identifying the right size and shape for your body makes the device’s use easy, comfortable and manageable.

Pelvic Floor Muscle Training (Kegels) - There are muscles around the vagina that help with pelvic support. It is possible to train and exercise these muscles. Pelvic floor muscle training can be used to stop a prolapse from getting bigger. It is usually more helpful in smaller prolapses.

Surgery - There are many different types of surgeries to correct pelvic organ prolapse. One out of nine women will undergo surgery to correct a pelvic floor disorder.

Urinary Incontinence

Female urinary incontinence may cause embarrassment, loss of self-esteem, social isolation and depression. Incontinence often will affect a women’s ability to live her life the way she wishes. The good news is there are excellent treatments for urinary incontinence. We have a comprehensive approach to treating incontinence.

Symptoms

  • Stress incontinence: loss of urine with coughing, sneezing, laughing or exercising
  • Urge incontinence: loss of urine that happens because you cannot make it to the bathroom in time or you have an urge to go very frequently
  • Evaluation
  • Health history
  • Pelvic exam

Other tests and diagnostics

Your pelvic floor disorder is unique. Many times these disorders occur with some other problem that demands advanced diagnostic techniques to determine the cause. We have an experienced team of health care professionals and state-of-the-art technology to provide the most accurate diagnosis and most effective treatment of your condition. By using diagnostic tests, we can work with you to determine the best course of treatment.

Urodynamics

Urodynamic testing is a series of bladder tests performed to observe how your lower urinary tract reacts under certain conditions. It is usually done to see if you have problems with loss of urine or to figure out what type of incontinence you may have.

Urinalysis

This test is done to determine if you have an infection or other substances found in the urine. It is usually performed at the beginning of any type of bladder test.

Bladder Diary

An important tool in guiding treatment for urine loss is to keep records during a three-day period of your bladder function. The diary will ask you to measure the volume voided with every void. You also will keep track of your fluid intake — what type, when and how much.

Treatments

  • Fluid management
  • Bladder training
  • Medications
  • Surgery
  • Pelvic Floor Muscle Training - There are muscles around the vagina that help with pelvic support. It is possible to train and exercise these muscles. Pelvic floor muscle training can be used to stop a prolapse from getting bigger. It is usually more helpful in smaller prolapses.
  • Pessaries - A pessary is a small device made of plastic or silicone that is placed inside the vagina to hold the uterus or the walls of the vagina up and inside your body. These are especially useful for women who leak urine during specific activities such as exercise. Several types and sizes of pessaries are available. Identifying the right size and shape for your body makes the device's use easy, comfortable and manageable.

Overactive Bladder

With overactive bladder, you have many strong, sudden urges to urinate during the day and night. You can get these urges even when you have only a little bit of urine in your bladder. You may not be able to hold your urine until you get to the bathroom. This can lead to urine leakage, called incontinence.

Even without incontinence, overactive bladder can make it hard to do the things you enjoy. The need to drop everything and race to the bathroom can disrupt your life. And if you leak, even if it's only a little bit, it can be embarrassing. Many people are too shy to talk about their bladder problems. But overactive bladder can get better with treatment. 

Symptoms

  • An urgent need to urinate.
  • The need to urinate often.
  • Waking up to urinate 2 or more times a night.
  • The need to urinate even if you have just gone to the bathroom.
  • Taking many trips to the bathroom only to urinate just a little bit each time.
  • Leaking urine when you have the urge to urinate.

How is overactive bladder diagnosed?

Your doctor will do a physical exam. He or she will ask what kinds of fluids you drink and how much. Your doctor will also want to know how often you urinate, how much, and if you leak. It may help to write down these things in a bladder diary(What is a PDF document?) for 3 or 4 days before you see your doctor.

Your doctor probably will also do a few tests, such as:

Treatments

The first step in treatment will be to try some things at home, such as urinating at scheduled times. This is called bladder retraining.

You can also do special exercises called Kegels to make your pelvic muscles stronger. These muscles control the flow of urine. Doing these exercises can improve some bladder problems. It may help to work with a physical therapist who has special training in pelvic muscle exercises.

There are other changes you can make that can help:

  • Cut back on caffeine drinks, such as coffee, tea, and sodas.
  • If it bothers you to get up at night to urinate, cut down on fluids before bed. But don't cut down on fluids at other times of the day. You need them to stay healthy.
  • At night, if you have trouble getting to the toilet in time, clear a path from your bed to the bathroom. Or you could put a portable toilet by your bed.
  • Get to and stay at a healthy weight.

Medicine

If your symptoms really bother you or affect your quality of life, your doctor may suggest that you try medicine along with bladder training and exercises. These medicines include:

  • Drugs that calm the bladder muscles, such as oxybutynin, solifenacin, and tolterodine. They may cause side effects like dry mouth and constipation.
  • Drugs that help the bladder store more urine, such as mirabegron. Side effects may include increased blood pressure, inflammation of the nose and pharynx, and urinary tract infections (UTIs).

Other treatments

For severe overactive bladder or severe urge incontinence that hasn't been controlled by exercises or medicine, treatments include:

  • Botox (botulinum toxin) injections. You may need to get a shot every 3 months. Side effects may include having pain when you urinate, not being able to urinate easily, and getting a urinary tract infection (UTI).
  • Electrical stimulation. Small electrodes send pulses to the nerves in the lower back.
    • Sacral nerve stimulation (SNS) affects bladder storage and emptying.
    • Peripheral tibial nerve stimulation (PTNS) affects bladder control and pelvic floor muscle strength.
  • Surgery to make the bladder bigger (augmentation cystoplasty) or to make another way to store and pass urine (urinary diversion).

Your First Visit

Things you should know about your first visit:

  • Parking is free. There is parking near the entrance to the clinic building.
  • Your first visit may take more than one hour. The physician will spend a significant amount of time with you at this visit.
  • Please arrive 15 minutes before your appointment if you bring your completed forms to your visit. Please arrive 45 minutes before your appointment if you plan to complete the forms at the clinic or have not completely filled out the forms.
  • Please bring your health insurance card with you. We accept most insurance, but if you wish to confirm we accept your insurance, please call 573-817-3165. You are responsible for your co-payment at the time of your visit. Payment may be made with cash, check or major credit card (Visa or MasterCard).
  • Please dress appropriately for your clinic visit as you will be ask to undress from the waist down before your evaluation. You will be provided a comfortable cloth wrap to wear and your examination will be performed with the highest degree of professionalism.

If you are unable to make it to your scheduled appointment, please contact us at 573-817-3165 at least 24 business hours before your appointment to reschedule.
Please feel free to contact us with any questions. We pride ourselves in being knowledgeable and attentive to your needs.

Additional Resources

Location

Female Continence and Advanced Pelvic Surgery
573-817-3165
Keene Medical Building
500 N. Keene Street, Suite 306
Columbia, MO 65201

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