The pelvic floor is a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that supports a woman’s internal organs, including the bowel, bladder, uterus, vagina and rectum. Weakened pelvic muscles or tears in the connective tissue can occur when excessive strain is put on the pelvis through childbirth, repeated strenuous activity or pelvic surgery. Other factors that can increase the risk of pelvic floor disorders include repetitive heavy lifting, menopause, chronic disease, tobacco use and family history.

What conditions can a urogynecologist treat?

• Pelvic organ prolapse: One or more of the organs in the pelvis drops down causing a sense of pressure or a bulge in the vagina. It may also cause urinary incontinence, pain or constipation.
• Stress urinary incontinence: Leakage of urine with coughing, sneezing, laughing or any other activity that increases the pressure on the bladder and/or the supporting tissue.
• Overactive bladder syndrome: Frequency, urgency (a sudden and strong desire to urinate that is bothersome) and nocturia (waking up more than once at night to void) with or without urge incontinence (accidental urine loss associated with a sudden and strong desire to urinate).
• Anal and fecal incontinence: Involuntary leakage of gas and/or stool.
• Fistulas: An abnormal connection between two organs (i.e. bladder and vagina or vagina and rectum)
• Complications from third and fourth degree tears following vaginal childbirth

What treatment options are available?

There are a variety of non-surgical approaches as well as surgical options that can help relieve the symptoms associated with pelvic floor disorders. After consultation, you and your physician will work together to find the solution that works best for you, your lifestyle and your overall health.

Why should I see a urogynecologist?

While many of the symptoms and conditions listed above are very common, it is important to know that these are not a normal part of aging or something that women need to put up with. Consulting with a urogynecologist will provide you with specialized expertise to help determine the best way to relieve your symptoms and restore your quality of life.

At Virginia Women’s Center, we are excited to welcome our first urogynecologist, Dr. Tovia Smith. Dr. Smith will work with female urologist Dr. Lonny Green and gynecologists Dr. Elizabeth Roberts and Dr. Louis Thompson to care for women whose qualities of life are being affected by bladder and pelvic health issues.

About Virginia Women’s Center
Since 2006, Virginia Women’s Center has been dedicated to helping women with urinary incontinence and other bladder problems find solutions to restore their quality of life. For more information, visit www.VirginiaWomensCenter.com, or find us on Facebook, Pinterest and Twitter.

In an earlier blog post, I reported that I was fortunate to be able to attend the American Urological Association annual meeting in early May. Attendees traveled to San Diego from around the globe to learn about the latest scientific breakthroughs for various urologic conditions. It was a stimulating conference with many new findings and reports. In this part two, I will present information on Botox for overactive bladder and the safety of slings done for stress urinary incontinence.

Botox is the most exciting new treatment for overactive bladder in years and data on its effectiveness was presented at the meeting by Dr. Victor Nitti. Patients who were part of an initial study on Botox could then enroll in an extension study. During this extension study, patients could receive repeat Botox injections over the course of a number of years, if needed. Analysis of large numbers of patients showed very positive results. Not only was Botox extremely effective in decreasing urgency, frequency and leakage, it also remained effective for a long time. Further, when repeat injections were done, the results were just as good and just as long lasting as when they were done for the very first time.

Botox injections can be performed right in our office in a few minutes. Numbing medicine is put into the bladder and there is very little discomfort. While the effects of Botox wear off over time, many patients see dramatic improvement for six to 18 months before noting a decline. At that time, the procedure may be repeated. Read patient testimonials from our own VWC patients who have had Botox for overactive bladder.

Another update from the AUA looked at the safety of slings done for stress incontinence. Stress incontinence is leakage related to exertion, such as a cough, sneeze or exercise. Dr. Anne Suskind and other investigators reviewed 6,698 mesh sling procedures done between 2006 and 2008, as well as 445 non-mesh procedures. They found that complications were extremely uncommon. Many other studies have confirmed the long-term safety and effectiveness of slings for treating urinary incontinence. This is in line with our experience here at Virginia Women’s Continence Center. The sling procedure – done as an outpatient – is minimally invasive. Patients are up and about and driving the very next day. The improvement in quality of live can be enormous – read what some of our own patients are saying.

There are many TV advertisements warning against the danger of vaginal mesh. It is important to understand that the sling procedure, done strictly for urinary incontinence, is not the same as the surgeries that were done with large pieces of mesh for “bladder tacking” or fixing pelvic prolapse. In fact, the sling does not sit under the bladder at all – it is completely under the urethra. In 2011, the FDA declared that manufacturers of the larger mesh kits had to do new studies and get new approval before being allowed to proceed. At the same time, the FDA said that companies did not have to do new studies on slings, with the exception of ongoing studies of the newest design modification of one of the slings. Further information on this can be found here.

These are just some of the new developments in the ongoing diagnosis and treatment of bladder problems. No matter the type of bladder problem you are experiencing, we are ready and willing to find a solution that will restore your quality of life. Make an appointment with Virginia Women’s Continence Center by calling 804.288.4084 and find out for yourself.

An estimated 17 to 53 million Americans are affected by overactive bladder. Frequent urination – the main symptom associated with overactive bladder – is defined as having to use the restroom more than eight times in 24 hours. Other symptoms may include waking up more than two times per night to urinate; urgency, or a sudden and strong desire to urinate; and urge incontinence, or accidentally wetting yourself due to not getting to a bathroom in time.

There are a variety of treatment options for patients who suffer from overactive bladder including exercises, diet and lifestyle modifications, medications, in-office procedures and the newest option: Botox injections.

Botox works by reducing bladder contractions and possibly decreasing the nerve signals that travel from the bladder to the brain, telling the brain that the bladder is full. The result is that the number of leakage episodes decreases and bladder capacity increases; thus increasing the amount of time between going to the bathroom.

Dr. Lonny Green

Dr. Lonny Green, urologist and director of Virginia Women’s Continence Center, was involved in the clinical trials that led to the FDA approval of Botox. Now, Dr. Green performs the injections in a couple of minutes at our John Rolfe Commons location. While some patients feel a slight pinch – the procedure is not considered to be painful.

In the clinical trials, most patients noted some improvement in their symptoms as soon as one to two weeks after the Botox treatment. The frequency of treatment varies from patient to patient, depending on how quickly symptoms return. Patients must wait at least three months between treatments, but most patients are re-treated between six and 18 months.

Just like any medical procedure, there are potential side effects from this treatment option. Some of the side effects that were reported during clinical trials include urinary tract infections, decreased bladder emptying (the inability to empty your bladder completely), blood in the urine, fatigue and insomnia.

Scheduling an appointment with Dr. Green is the first step in determining whether Botox is an appropriate treatment solution for your overactive bladder. If you’re interested in learning more about Botox or the other treatment options for incontinence, we recommend that you schedule an appointment with Dr. Green through our secure patient portal or by calling 804.288.4084.

Additional Resources:

To learn more about the types of urinary incontinence as well as other treatment options available, visit our Web site.

To read the recent article from the Richmond Times-Dispatch on Botox treatment for urinary incontinence, visit their Web site.

Virginia Women’s Center is an advertiser on Richmondmom.com

There are four types of urinary incontinence: stress, urge, mixed and overflow. Depending on the type of urinary incontinence you have, the treatment options can range from non-invasive therapies to minimally invasive surgical procedures. The InTone device is a new treatment option for women who suffer from stress, urge or mixed incontinence. By combining gentle muscle stimulation with pelvic floor training exercises, the InTone device can stop bladder leakage without medication or surgery. The InTone device is used on a regular basis in the comfort and privacy of your own home.

The InTone device helps strengthen your pelvic floor in two ways: gentle muscle stimulation and voice-guided pelvic floor exercises.Gentle muscle stimulation strengthens the pelvic floor by helping stop the spasms of the bladder muscle. If you have a strong pelvic floor, you can do things like cough, sneeze, laugh or run without leakage. Calming spasms of the bladder muscle allows you to “hold it” longer and avoid frequent trips to the bathroom.

The muscle stimulation will be customized under your physician’s supervision to ensure proper muscle activation. The muscle stimulation delivers a gentle electrical current directly to your pelvic floor muscles and has been proven to be an effective treatment for bladder leakage.

The InTone device also features voice-guided pelvic floor training exercises. The InTone device will talk you through your entire 12 minute session. The pelvic floor exercises are performed by contracting your muscles as directed. The InTone device uses an illuminated bar graph so that you know the strength of your contractions. The bar graph will also help guide you toward doing your exercises correctly.

Dr. Lonny Green, urologist and director of Virginia Women’s Continence Center, specializes in treatment for urinary incontinence and he is also a Certified InTone Specialist. Scheduling an appointment with Dr. Green is the first step in determining whether the InTone device is an appropriate treatment solution for your incontinence. If you’re interested in learning more about the InTone device or the other treatment options for incontinence, we recommend that you schedule an appointment with Dr. Green through our secure patient portal or by calling 804.288.4084.

Virginia Women’s Center is an advertiser on Richmondmom.com