Treatments

Surgical, Non-surgical, Nerve Stimulation Treatments for Bladder and Pelvic Floor DisordersA variety of non-surgical treatments are available for certain situations. Depending on your specific issue, one or more of the following treatments may be advised by your physician.

Pelvic floor muscle exercises (Kegel exercises): The purpose if these excercises is to strengthen the pelvic floor muscles that help control urine leakage. Like any other form of exercise, improvement is a refection of good exercise technique and dedication to doing the exercises regularly. Your physician can help you identify the right muscles to exercise and give you and exercise schedule.

Dietary changes: There are certain dietary elements that can irritate the bladder and aggreviate your bladder symptoms. Your physician will give you a list of certain foods and drinks that you should avoid.

Weight loss: Maintaining healthy body weight is very important for normal pelvic floor function. As little as a 5% to 10% decrease in weight in women who are overweight or obese will reduce weekly incontinence episodes by more than half.

Bladder retraining: This means going to the bathroom on a set schedule. The interval between urination is extended every few days as long as leaking accidents are avoided. The goal of this exercise is to regain bladder control by emptying before the sudden strong urge comes.

Medications: Medications work by causing relaxation of the bladder wall and prevent abnormal bladder contractions or spasms that can cause symptoms of frequency, urgemcy and urinary leakage before reaching the bathroom. Patients who do need get the desired relief of symptoms with medications or who experience non-tolerable side effects from medications may be candidates from nerve stimulation therapy.

Pessaries: Pessaries are plastic devices, similar to vaginal contraceptive diaphragms, which are used to either lift the bladder. These devices are placed in the vagina to support the vaginal wall and lift up a prolapse.

Pelvic floor electrical stimulation: The treatment consists of intermittent electrical stimulation of the pelvic floor nerve and muscle tissues using a tampon-shaped exerciser inserted into the vagina, or a smaller exerciser inserted into the rectum.

Urinary Incontinence:

Midurethral sling procedure: This procedure is also known as tension-free vaginal tape procedure. This is an outpatient, minimally invasive form of sling surgery with a high success rate. The sling is a tape made of a synthetic material. The sling is placed under the urethra, where it acts as a hammock, compressing the urethra to prevent leaks that occur with activities of daily living.

Burch Colposuspension: The procedure involves placing sutures close to the urethra to lift the urethra upwards. The procedure is done through a small abdominal incision or laparoscopic. This procedure is not as famous as it was in the past after the development of the mid urethral slings.

Interstim: This is a minor outpatient procedure that involved placing a lead (wire) close to the back bone. This wire will be connected to a stimulation device to gently stimulate the sacral nerves that go to your bladder. Initially the stimulator will be outside your body and you can wear it around your waist (like a cell phone or a pager). If significant improvement of your bladder symptoms is seen a stimulator can be implanted under your skin like a pace maker instead of the external stimulator. This procedure is used to treat overactive bladder, urge urinary incontinence and bowel incontinence.

Botox Bladder injections: This is a minor procedure that can be done in the office or in a surgery center under sedation. It involves placing a camera in the bladder (i.e. cystoscopy) and injecting the bladder wall with Botox to help with overactive bladder symptoms including Urge urinary incontinence.

Posterior Tibial Nerve Stimulation (Uroplasty): This type of treatment involves putting a very small needle (similar to an acupuncture needle) close to the tibial nerve (above the ankle joint) and stimulating the nerve with gentle electrical impulses. The treatment session is 30 minutes. Multiple treatment sessions are needed to achieve the treatment goal. This is a very simple type of treatment that is done in the office.

Peri-urethral injections: This procedure involves injection of a bulking agent into the area around the bladder neck to tighten it. Bulking materials can be injected into the tissue around the urethra to add bulk and keep the sphincter muscles closed to stop urine from leaking. This procedure can be done in the office.

Fecal Incontinence(Accidental Bowel Leakage)

Pelvic Floor Physical Therapy & Biofeedback: See the section on Physical Therapy.

Interstim: As described above.

Anal Sphincter repair: The procedure involves repairing the injured anal sphincter muscles with sutures. The procedure is an outpatient procedure.

Prolapse:

Hysterectomy: The procedure is offered to patients with uterine prolapse or any other gynecologic disorder where removal of the uterus is necessary. Hysterectomy can be done either vaginally (i.e. without any abdominal incisions) or laparoscopic / robotic (i.e. with small abdominal incisions) or open (i.e. with an abdominal incision) depending on each case. Most of the time hysterectomy can be done vaginally or laparoscopic / robotic.

Cystocele repair (aka Bladder lift): Repair of a cystocele or “dropped bladder” is a procedure that involves repairing the support structures between the vagina and the bladder and placing the bladder upwards, restoring its normal position. The procedure is performed vaginally without abdominal incisions.

Rectocele repair: Repair of a rectocele or “bulging rectum” is a procedure that involves repairing the support structures between the vagina and the rectum and placing the rectum downwards, restoring its normal position. The procedure is performed vaginally without abdominal incisions.

Uterosacral vaginal vault suspension: This procedure involves attaching the top of the vaginal to the ligaments that goes to the sacral (back) bone. This procedure can be done vaginally, laparoscopic or robotic.

Sacrospinous ligament suspension: This procedure involves attaching the top of the vaginal to the sacrospinous ligaments using sutures. The procedure is performed vaginally.

Sacral colpopexy: This procedure involves attaching the top of the vagina to a strong ligament in the back bone using straps of graft material. This procedure can be done laparoscopically or robotically.

Colpocleisis: This procedure involves partial or complete closure of the vagina to correct a protruding vaginal bulge. This procedure is reserved for patients who elect not to maintain sexual function.

Vaginal vault prolapse and Enterocele repair: These defects often occur together high in the vagina, so surgery may be approached through the vagina or abdomen. Treatment options are: uterosacral vaginal vault suspension and sacral colpopexy.

The most common complications for vaginal meshes include mesh exposure (i.e. feeling a foreign body sensation in the vagina), vaginal pain, vaginal scarring, painful sexual intercourse and others. The treatment options for vaginal mesh complications depend on the type of complication which may include hormonal cream application, surgical removal of the mesh and / or pelvic floor physical therapy. Combination therapy of the options mentioned below is often used for maximum results.

Vaginal mesh Excision: Surgical removal of vaginal mesh can often be done vaginally (i.e. without abdominal incisions) with complete removal of all mesh in contact with the vaginal walls. Non mesh vaginal repairs can be done at the same time using sutures or biologic materials to correct or prevent recurrent prolapse after mesh removal. Often patients have improvement of vaginal and sexual pain after complete removal of the vaginal mesh.

Pelvic Floor Physical Therapy: A course of pelvic floor physical therapy can be used alone or in conjunction with surgical removal of mesh to help rehabilitate and relax the pelvic floor muscle spams participating in pelvic floor pain.

Vaginal Topical Medication Therapy: Some vaginal creams and vaginal suppositories to relax the pelvic floor muscles may help alone or in combination of the above mentioned options.

Interstitial cystitis (IC) is a bladder disorder that can cause varying degrees of pelvic pain, discomfort, burning or pressure and may be associated with urinary urgency (persistent urgent need to go to the bathroom), frequency (urinating too often) and painful sexual intercourse. Although symptoms of IC may resemble those of recurring urinary tract infections, urine test is usually free of bacteria. Symptoms can be so severe that it would have significant effects on quality of life. Current estimates indicate that IC affects 1 million Americans and is nine times more prevalent in females than males. The exact cause of IC is not fully understood however one of the most acceptable theories indicates that patients with IC have gaps in the protective lining of the bladder cavity which allows toxic irritants in urine to go into the bladder wall muscle and irritate it. When IC is suspected the patient is usually given a symptom questionnaire focused on bladder symptoms. Other confirmatory diagnostic tests can also be done at the physician’s office. IC is a chronic disorder that cannot be totally cured; however treatment is directed towards symptom relief to improvement the patient’s quality of life.

Bladder Diet: There are certain foods and drinks that may trigger IC symptoms. Dietary modifications often help prevent IC symptom flare ups. Our doctor will discuss with you in details these dietary changes.

Bladder Instillations / Treatments: This kind of therapy involves placing a soothing solution into the bladder to which has a calming effect on contact with the bladder walls. These bladder treatments may be done once weekly or more for a number of week. Each treatment takes about 5 minutes. This can give immediate relief of IC symptoms. The number of treatment may vary depending on each case.

Pelvic Floor Physical Therapy: Physical therapy may help in patient with pelvic floor muscle spams, vaginal and pelvic pain of muscular origin. Therapy is done in weekly sessions for 10 to 12 weeks each session takes about 45 minutes.

Medications: Often medications are used to help with IC symptoms including bladder analgesic agents , antispasmodic medications and / or vaginal suppositories. Also medications to help with frequent urination are often used depending on each case.

Hydrodistension: This procedure involves stretching the bladder walls by filling the bladder with a large amounts of distension fluid while looking inside the bladder with a camera (cystoscopy). The procedure is done under general anesthesia and takes about 20 to 30 minutes with minimal postoperative recovery time.

Interstim: The procedure involves placing a neurostimulator under the skin to act as a bladder pacemaker. This procedure helps with urinary urgency, frequency and bladder pain. The procedure is considered one of the more advanced options for IC in patients who fail the above mentioned options.

The pelvic floor is a group of muscles that attaches to the front, back, and sides of your pelvis and to the tailbone. These muscles support your pelvic organs, including the bladder, uterus and rectum, and wrap around the urethra, vagina and rectum. Coordinated contraction and relaxation of these muscles helps control bladder and bowel function Pelvic floor therapy is a type of physical therapy that focuses on these muscles. Studies have shown benefits of this therapy in patients with urine and bowel leakage, overactive bladder, interstitial cystitis, some types of constipation and obstructed defecation, pelvic floor tension/spasms, pelvic and sexual pain. Our physical therapy program consists of weekly treatment sessions for 8 weeks which can be extended to 12 weeks depending on the severity of each case, each session takes about 45 minutes to an hour.

Each session may include a combination of the following techniques:

Pelvic floor strengthening exercises: It involves teaching you how to perform the proper pelvic floor muscle exercises. Muscle contractions can be monitored by vaginal and rectal probes and EMG electrodes using computerized equipment to ensure the contractions or the proper group of bladder, rectal and vaginal muscles.

Pelvic floor relaxation techniques: This involves teaching relaxation techniques of abnormal spasms of the pelvic floor muscles guided by computerized pressure monitoring of the muscle contraction relaxation cycle. These techniques help in patients with pelvic floor muscle tension, interstitial cystitis, pelvic and sexual pain.

Electrical stimulation: stimulates the pelvic floor muscles directly through a small probe inserted into the vagina or rectum. This helps you to be more aware of the specific muscles you need to exercise to get maximal results for bladder and bowel control. This also may help desensitize nerves or even cause muscles to contract and relax.

Biofeedback: uses electrodes placed on your body and / or probes inserted in the vagina or rectum to sense how tense or relaxed your pelvic floor muscles are and display the results on a computer screen for you to watch in real time to determine how well you are contracting and relaxing your pelvic floor muscles.

Manual therapy: includes external pelvic muscle therapy and internal vaginal therapy involving trigger-point therapy to release tight spots or “knots” especially in patients with cystitis and pelvic pain.

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