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Pelvic Floor Disorders

Pelvic prolapse or vaginal vault prolapse is a very common condition characterized by the herniation of pelvic organs, bladder (cystocele), rectum, (rectocele), small intestine (enterocele), uterus, or vagina. These organs herniated due to weakness of support structures in the pelvis.

Patients may notice a bulge in the vagina, and may even have to reduce this bulge manually in order to urinate or defecate. Patients may also have urinary incontinence accompanying the prolapse. This may surprisingly may improve as the prolapse worsens.. Furthermore, patients can also complain of constipation, and dyspaurenia (painful intercourse), back pain and can have recurrent urinary infections.

Diagnosis begins with a thorough history and physical exam. A urinalysis is useful to evaluate blood in the urine or infection. A post void residual is obtained to ensure the patient is emptying. other important test that may be done include a cystoscopy and urodynamics which provide comprehensive evaluation of the bladder function and pelvic floor.

Treatment options may include conservative options such as pelvic floor retraining, biofeedback, and a placement of a Pessary. A vaginal pessary is a removable device that is designed to support the areas that may cause pelvic organ prolapse. Our staff is trained to place the pessaries in the office. Surgical treatment options include various procedures that address the pelvic floor defect. The da Vinci robot is used to repair pelvic floor defects.

Several advantages are noted utilizing this technique. These include shorter hospitalization stay, less blood loss, and return to normal function sooner. Our physicians are trained to deal with all types of pelvic floor prolapse.

Pelvic Pain

One of the most challenging urological disease conditions for patient and doctor alike is chronic pelvic pain. If you are frustrated by this problem you are not alone. Chronic pelvic pain includes the syndromes chronic prostatitis and interstitial cystitis/painful bladder syndrome. It can affect both men and women. Symptoms vary but usually include urinary frequency and urgency, pain and/or pressure perceived to arise from the bladder. Frequency usually involves urinating several times throughout the day and night, sometimes even several times an hour. At times, pain is associated with bladder filling and can be severe, and it may be relieved by voiding. Sometimes, a trigger can be identified. It can be a certain type of food or it can be a stressful situation. In women, it may be associated with the onset of a menstrual cycle. Patients may see several doctors before they are diagnosed. The diagnosis of this condition is usually made after excluding other identifiable causes such as a urinary tract infection, bladder cancer , prostatitis, and endometriosis. The proposed pathophysiology suggests that there may be an initial insult—possibly trauma or infection that sets up tissue injury in the bladder/prostate. This further promotes inflammation and release of cytokines and upregulation of pain fibers. Subsequently, this causes the bladder lining to be “leaky” and very sensitive to the urinary toxins and can causes over sensitivity with the pain fibers. Also of interest, many people may suffer with other chronic pain conditions such as fibromyalgia, irritable bowel syndrome, migraines and painful intercourse and pelvic floor spasm. Treatment should be based on a multidisciplinary approach. Pharmacology, behavior and lifestyle modification, and dietary changes are implemented. Of note, it is found that if patients exhibit myofascial pain or a hypertonic pelvic floor, then physical therapy is extremely beneficial. Pelvic pain syndromes require a multidisciplinary approach with realistic goals agreed on by the patient and doctor.

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