Urogynecology Services in Carrollwood

The pelvic floor is a group of muscles that act like a hammock to support pelvic organs, such as bladder, uterus, vagina and rectum. A properly functioning pelvic floor may prevent pelvic floor muscle dysfunction, which occurs when the muscles become weak or overactive.

Pelvic floor disorders include:

• Chronic or functional constipation
• Dyspareunia (pain with intercourse)
• Endometriosis
• Erectile dysfunction
• Fecal incontinence
• Fecal urgency
• Fistulas
• Interstitial cystitis (chronic pelvic pain)
• Overactive bladder
• Pelvic organ prolapse
• Pelvic pain
• Pre- and post-prostatectomy issues
• Postpartum disorders
• Post-surgical soft tissue pain
• Rectal prolapse
• SI joint dysfunction
• Urinary incontinence
• Urinary retention
• Urinary urgency
• Vaginismus (pelvic floor spasms)

Since different people experience pelvic disorders in different ways, an accurate diagnosis is essential in creating a personalized treatment plan. Your urogynecologist will begin with a medical history and physical examination. To more precisely diagnose the issue, additional tests will be performed to help determine the most effective treatment.

Testing for bladder or bowel control problems focuses on visualizing the organ and testing and monitoring its function along with the muscles that control it.

Bladder and bowel testing procedures include:

• Cystoscopy
• Ultrasound
• CT scan
• Urinalysis
• Urodynamics and video urodynamics
• Anal manometry
• Anoscopy
• Colonoscopy or sigmoidoscopy
• Dynamic defecography
• Biofeedback

Pelvic floor physical therapy is designed to strengthen and retrain pelvic floor muscles. Pelvic floor therapy treatments include strengthening of pelvic floor musculature, core muscle stabilization, scar tissue release and pain management. A physical therapist who is specially trained in addressing the pelvic floor works with patients in one-on-one sessions to improve muscle coordination.

Treatments may include:

• Strengthening exercises - Strengthening exercises, also known as Kegels, involve squeezing and relaxing the pelvic floor muscles. If performed correctly and routinely, these exercises may improve the symptoms of prolapse.
• Biofeedback - Biofeedback is a nonsurgical technique that uses special sensors to monitor the pelvic floor muscles as the patient attempts to relax or contract them.
• Relaxation techniques - Relaxation techniques such as breathing strategies, yoga and stretching exercises can alleviate some symptoms.

In most cases, pelvic floor disorders can be managed with conservative treatments. In rare cases of pelvic organ prolapse or uncontrolled incontinence, the following surgical options may be considered:

• Mid-urethral sling – A mesh sling is created and placed to support the urethra and the neck of the bladder to reduce urinary incontinence.
• Sacral nerve stimulation (SNS) – A small device that sends mild electrical signals to the sacral nerve, which controls the muscles of the pelvic floor. This therapy is effective for both urinary and fecal incontinence.
• Surgical pelvic organ prolapse repair – There are many options available to surgically correct pelvic organ prolapse, including minimally invasive and robot-assisted procedures.
• Vaginal hysterectomy - A vaginal hysterectomy is the surgical removal of the uterus through the vagina, which may be performed for uterine prolapse.