Women's Pelvic Wellness Clinic: Frequently Asked Questions
The UW Health Women's Pelvic Wellness Clinic in Madison, Wisconsin, offers a multidisciplinary approach to comprehensive care for pelvic floor disorders. Here are questions that we are asked frequently:
Q: What is a Female Pelvic Medicine and Reconstructive Surgeon?
A: A Female Pelvic Medicine and Reconstructive Surgeon is one who specializes in the care of women with pelvic floor disorders. The pelvic floor is a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that provides support for a woman's internal organs, including the bowel, bladder, uterus, vagina and rectum.
Q: Why should I see a Female Pelvic Medicine and Reconstructive Surgeon?
A: Female Pelvic Medicine and Reconstructive Surgeons are board-certified specialists with additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs. In addition to a four year residency in OB/GYN or a five year residency in urology, specialists have completed an additional two to three year fellowship that focuses on the surgical and non-surgical treatment of gynecologic and urologic problems.
Q: What is the pelvic floor?
A: The pelvic floor is a bowl-shaped part of the body consisting of muscles and other non-muscular soft tissues located in the lower pelvis. It supports the abdominal organs, facilitates urinary and bowel continence and aids in sexual satisfaction.
Q: What is pelvic organ prolapse?
A: Pelvic organ prolapse occurs when the pelvic floor muscles and ligaments are stretched or become too weak to hold organs in the correct position in the pelvis. As it progresses, women can feel bulging tissue protruding through the opening of the vagina.
Q: What are the symptoms of pelvic organ prolapse?
A: Symptoms of pelvic organ prolapse include:
- Pressure and heaviness in the pelvic area
- Bulging (feeling a lump in the vagina)
- Urinary problems (difficulty starting to urinate or slower stream of urine)
- Bowel problems (chronic straining or pushing to have bowel movements)
Q: What is urinary incontinence?
A: Urinary incontinence affects women of all ages, from young to elderly. It is the inability to control the flow of urine and involuntary urination. There are two types of urinary incontinence. Stress incontinence is common in younger women. It is characterized by urine leakage that happens with coughing, laughing, exercising or other vigorous activities. The other type of incontinence is urge incontinence, also known as overactive bladder. It is the sensation of strong urge to urinate all of a sudden. Often the ''urge” is so strong that individuals are not able to make it to the bathroom resulting in small leakage or complete urine loss.
Q: What are the treatment options for urinary incontinence?
A: There are many treatment options available depending on the severity of incontinence. Treatment options include:
- Pelvic floor physical therapy: This can include Kegel exercises to strengthen the pelvic floor and bladder muscles.
- Biofeedback: This is the use of vaginal devices placed in the vagina temporarily to track and improve pelvic floor/bladder muscle strength.
- Pessary fitting: A pessary is a device that is inserted into the vagina that can improve symptoms of prolapse and urinary incontinence.
- Peri-urethral bulking agents
- Urethral sling surgery
- Posterior tibial nerve stimulation
- Intravesical injection of Botox®
- Sacral neuromodulation: This is used for urge incontinence that doesn't respond to behavioral treatments or medications. This involves stimulation of the nerves to the bladder via an implanted device.
Q: What is the benefit of pelvic floor physical therapy?
A: When the pelvic floor weakens or carries undue stress, individuals may experience urinary or bowel urgency, incontinence, constipation and pelvic pain or pain with intercourse. Physical therapy can break into those dysfunctional cycles. Education about normal anatomy and function, behavior modification therapy, as well as exercises all work to restore normal coordination of the pelvic floor muscles.
Q: What is accidental bowel leakage?
A: Accidental bowel leakage is also known as fecal incontinence. It is the impaired ability to control gas or stool and can range in severity from mild difficulty with gas control to severe loss of control over liquid or formed stools on a daily basis. It is not an uncommon condition and it often coexists with urinary problems.
Q: What are the treatment options for accidental bowel leakage?
A: There are medications and dietary changes that can help with accidental bowel leakage. Pelvic floor physical therapy is also an integral part of treatment. For people whose symptoms do not improve with these first line therapies, there are innovative approaches including nerve stimulation, bulking injections and surgery to repair muscle disruption.