Areas of Expertise

A urogynecologist can recommend a variety of therapies to cure or relieve symptoms of prolapse, accidental bowel or bladder leakage, or other pelvic floor dysfunction symptoms. Conservative (non-surgical) or surgical therapy, depending on the patient’s wishes, condition severity, and general health may be advised.

Conservative options include medications, pelvic floor exercises, behavioral and/or dietary modifications and vaginal devices (also called pessaries). Biofeedback and electric stimulation are two newer treatment modalities that your urogynecologist may recommend.

Safe and effective surgical procedures are also utilized by the urogynecologist to treat leakage problems and prolapse. He or she will discuss all of the options that are available to treat your specific problem(s) before you are asked to make a treatment decision.

Areas we treat include:

• Overactive Bladder - A frequent need to void, bladder pressure, urgency, urgency incontinence or difficulty holding back a full bladder.
• Recurrent Urinary Tract Infections
• Voiding Dysfunction - Difficulty urinating potentially resulting in urinary retention.
• Pelvic Pain - Discomfort, burning or other uncomfortable pelvic symptoms, including bladder or urethral pain.
• Genital Tract Fistula - A communication or hole between the bladder and the vagina, the urethra and the vagina or the rectum and vagina. This usually occurs as a complication from prior surgery and results in a continuous loss of urine or stool from the vagina.
• Pelvic Organ Prolapse
  • Bladder Prolapse - A condition where the front wall of the vagina sags downward or outward, allowing the bladder to drop from its normal position. This may be referred to as a “dropped bladder.”
  • Posterior Vaginal Wall Prolapse - A condition where the back wall of the vagina sags outward, allowing the rectum to bulge into the vagina.
  • Uterine Prolapse - A condition where the upper supports of the vagina and uterus/cervix are weakened, allowing the uterus and cervix to bulge downward and outward.
  • Vaginal Vault Prolapse After Hysterectomy - A condition where the upper supports of the vagina are weakened, allowing the vagina to bulge downward and outward even after the uterus has been previously removed.
• Urinary Incontinence
  • Stress Urinary Incontinence - Accidental leakage of urine with physical activity or motions such as laughing, coughing, lifting, or with exercise.
  • Urge Urinary Incontinence - Accidental leakage of urine that is accompanied by a sudden sense of needing to get to the bathroom to urinate. A common description is “not being able to make it to the bathroom in time” or “not getting your clothes off fast enough before the urine begins to flow out”.
• Fecal Incontinence - Accidental loss of stool that can be associated with pelvic floor injury following childbirth or as a result of bowel motility issues.

Specialized Services

• Cystoscopy - Cystoscopy is a way to look at the inside of your bladder. Numbing gel maybe placed in the urethra, which is the tube between your bladder and the outside world. After this, a tiny telescope is passed into the bladder. Sterile fluid is then used to fill the bladder, so that your doctor can see inside. This allows your doctor to make sure that there are no abnormalities or other problems which might be causing your bladder symptoms. The test generally takes between 10 and 30 minutes.
• Sacral neuromodulation - At the University of Cincinnati, we offer sacral neuromodulation (Interstim, Medtronic, Minneapolis, MN, USA) for multiple different types of pelvic floor disorders. Please ask your doctor more about this minimally-invasive technique.
• Urodynamics - Urodynamics are a way of testing the functions and behaviors of the bladder and the urethra (the tube that leads from your bladder to the outside).  The test involves the placement of a very small catheter, or tube, in the bladder, and another small tube in the vagina or the rectum. Sterile fluid is then used to fill the bladder, so that your doctor can tell how the bladder behaves as it is getting full.
• Electrical Stimulation - A form of biofeedback that is typically done under the supervision of physical therapists familiar with technology. Electrical stimulation of pelvic floor muscles and nerves is used to assist women in finding and contracting their pelvic muscles.
• Minimally-Invasive Surgery - Minimally-invasive surgery includes both laparoscopic and vaginal approach and both are used within our division.  Traditional laparoscopic surgery has been demonstrated to be faster and less painful than open and even robotic surgical approaches.  Overall, with minimally-invasive surgery patients benefit by having their prolapse corrected with less blood loss, shorter hospitalization time and quicker return to activities of daily living as compared to open surgical procedures.
• Pelvic Floor Rehabilitation
• Biofeedback - A technique that uses different types of devices to give information on how well pelvic muscles are contracting. The message or “feedback” can help improve awareness and control of pelvic floor muscles. These techniques are added to a pelvic muscle exercise program for women who have not reached their goals of symptom improvement. Biofeedback can be given through:
  • A therapist who touches the muscles that are being contracted.
  • A computer screen that shows through sounds or pictures, if the pelvic muscles are contracting and the other muscles groups are relaxed. This is done by connecting the computer to small sensors in the vagina or rectum and on the skin of the abdomen and legs.
  • Vaginal weights are cone shaped plastic objects of increasing weight that can be used at home. They are placed in the vagina for a short time (15-30 minutes). By gripping or hugging the cones to keep them in place, women are contracting their pelvic muscles.