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Focus of Care
Female pelvic floor disorders – such as incontinence, bladder and bowel problems, and pelvic prolapse – are not uncommon. Yet, women will seldom report these disorders because they are embarrassed and uncomfortable. Many women believe that these disorders are part of aging and must be accepted as part of life. That is not true. There are effective, durable treatments for these disorders and women do not need to live with them provided they seek help from medical professionals who understand the complex nature of these disorders. As trained urogynecologists, Drs. Ryan R. Stratford and Ronald C. Burton focus exclusively on treating women with pelvic floor disorders.
Click on any of the icons below to learn more about our approach to each of these disorders:
Urinary Incontinence
Urinary incontinence is widespread. More than 11 million women in the United States suffer from urinary incontinence and as much as 50% of all women will experience some form of incontinence in their lifetime.1 Those with severe incontinence spend an average of $900 a year to purchase hygiene products. In fact, it is projected that more money is spent on hygiene products in the United States for urinary incontinence than monthly menses. Urinary incontinence is debilitating and costly.2
Female urinary incontinence can cause embarrassment, loss of self-esteem, social isolation and depression. Incontinence will often alter a woman’s lifestyle, decreasing her willingness to go out and reducing her interest in physical activity. Read Olympic speed-skater, Bonnie Blair’s experience.
Fortunately, there are excellent treatments for urinary incontinence. Because of the complexities and interdependent nature of the female pelvic floor, many women who suffer from incontinence will receive treatments that might overlook or ignore other pelvic floor disorders that contribute to their bladder function. At The Woman’s Center for Advanced Pelvic Surgery, our approach to your incontinence is thorough, scientific and comprehensive, including advanced urodynamic testing and cystoscopy. Once we have diagnosed the cause of your incontinence, we can offer the most appropriate individualized treatment the first time, reducing the risk of future recurrence. As specialists in female pelvic floor disorders, we offer a multidimensional approach to treatment that includes minimally invasive surgery, bowel and bladder retraining, physical therapy, diet counseling, biofeedback, medications, neuromodulation and more.
Overactive Bladder
Overactive bladder can cause anxiety and apprehension. Some women with overactive bladder will even plan their activities around proximity to a restroom. Symptoms of overactive bladder include: urinary frequency, urgency, and nighttime wakening. Most women will void every 3-4 hours during the day. Frequent voiding is defined as over 10 voids within 24 hours. It can cause tremendous social problems especially if it causes frequent nighttime wakening. Women will complain of feeling tired and fatigued because they cannot obtain adequate sleep.
Leakage associated with urgency and frequency compounds the problem and in some cases the leakage may be so severe that high volumes of leakage will occur without much warning. Fortunately, overactive bladder can be readily diagnosed, treated and often cured. Often, treatment for overactive bladder, if discussed with a physician, is temporarily treated with medication but the condition will either worsen or not improve. At The Woman’s Center for Advanced Pelvic Surgery, we specialize in treating overactive bladder and will work with patients until their symptoms have resolved. Most often treatment begins with the most conservative therapies such as medications and bladder retraining. If the problems persist, then more aggressive and comprehensive treatments such as sacral neuromodulation (Interstim) can be offered. Ultimately, overactive bladder can be treated and lifestyles can be restored.
Pelvic Organ Prolapse
Over time, the effects of childbirth, straining, genetics and other health issues contribute to the development of hernias in the pelvic floor. When this occurs, surrounding structures like the uterus, bladder, rectum or bowel can herniated (bulge) into the vagina, even pushing the vagina outside of the body. This type of herniation or bulging from the vagina is called prolapse. Commonly, prolapse is accompanied by other pelvic floor disorders such as urinary and fecal incontinence, overactive bladder, urinary urgency and frequency, and difficulty emptying the bladder or rectum. The bulging will also commonly give women the sensation of pressure or fullness in the pelvis and may cause lower back discomfort.
At The Woman’s Center for Advanced Pelvic Surgery, we offer conservative treatment as well as surgery. A device called a pessary can be used to hold up the prolapse and relieve the symptoms caused by the prolapse. Alternatively, we can reconstruct the pelvic floor and restore the normal anatomy. Because prolapse is due to a hernia, surgical reconstruction for prolapse has been met with variable success in the past and many surgeons have stopped repairing prolapse because the problem will recur very readily. Highly specialized surgical techniques that require advanced training can be performed so that the prolapse does not come back. These technically advanced surgical procedures are not performed by most physicians but are routinely performed by Drs. Stratford and Burton.
Minimally Invasive Gynecologically Surgeries
Pelvic floor disorders like urinary incontinence and pelvic prolapse are surprisingly common among women. One out of nine women will undergo surgery to correct a pelvic floor disorder. One third of these women will require more than one operation.
The Woman’s Center for Advanced Pelvic Surgery is a recognized leader in today’s most advanced surgical procedures for treating female pelvic floor disorders. We hope to reduce the rate of re-operation by offering more durable repairs through advanced surgical techniques.
- Vaginal uterosacral vault suspension
Vaginal uterosacral vault suspension is a highly specialized reconstructive repair of prolapse through the vagina. Because of technical difficulty, only a select group of surgeons in the United States routinely perform this operation. Both Dr. Stratford and Dr. Burton perform this surgery routinely. Historically, prolapse repairs were performed vaginally but were met with little success and high recurrence rates. Further understanding of pelvic floor anatomy through research has proven this repair to be much more successful and durable than traditional repairs. The procedure can be performed with an overnight stay in the hospital and recovery is less painful and quicker than traditional repairs. Because of the high success rates, long-term durability, less health risk and easier recovery, this procedure offers patients, particularly elderly patients who may have other complicating health conditions, a wonderful surgical alternative for permanently repairing prolapse.
- Tension-free Vaginal Tape (Mid-urethral sling)
Midurethral sling or tension-free vaginal tape (TVT) is a minimally invasive surgical procedure appropriate for some women with stress urinary incontinence. The procedure can be performed under local anesthesia and takes only 30 minutes to complete. The recovery period is 1-2 days and patients experience few complications. There are many mid-urethral slings available on the market, but we follow scientific data that supports a specific type of mid-urethral sling with excellent long-term outcomes.
- Laparoscopic Uteropexy
Laparoscopic uteropexy is performed with a small telescope-like instrument called a laparoscope that works like a video camera along with other thin surgical instruments inserted through two incisions in the abdomen. Using these surgical instruments, the surgeon can attach the uterus to existing ligaments in the pelvis or to a ligament on the tail bone to provide support and lift up the uterus back into the pelvis. This procedure allows women the option of keeping their uterus rather than having a hysterectomy, which is the traditional way of treating prolapse.
- Laparoscopic Hysterectomy
Laparoscopic hysterectomy (removal of the uterus) is performed with a thin, lighted telescope-like instrument called a laparoscope that works like a video camera while other thin surgical instruments are inserted through two to three tiny incisions on the abdomen. Using these surgical instruments, the surgeon carefully removes the uterus. Because the procedure does not require the surgeon to make a large incision on the abdomen, recovery time is less painful and shorter. This approach to hysterectomy also causes less stress to the body than traditional “open” hysterectomy and was developed to reduce pain, minimize scarring and shorten recovery time. The procedure can be done as an outpatient, meaning you can be home resting comfortably within 24 hours of surgery and back to normal activities in a few weeks.
Chronic / Recurrent Cystitis
Cystitis, or infection in the bladder, is a common problem for women. Symptoms of cystitis include urinary urgency, frequency and burning with urination. Infections occur when bacteria enter the bladder and infect the urine. Fortunately, most urinary tract infections, such as cystitis, disappear spontaneously within 24 to 48 hours by the body’s own immune system. Other times, cystitis requires treatment with urinary antibiotics. However, when cystitis keeps recurring (more than twice in six months) or does not resolve with treatment or lasts longer than two weeks, specialized evaluation is needed.
Middle-aged and elderly women are more susceptible to cystitis. Dropping of hormonal levels after menopause contributes to recurrence of cystitis. Other contributing factors include incomplete bladder emptying, lack of enough fluids, bowel incontinence, decreased mobility, placement in a nursing home, and poor hygiene.
If you suffer from recurrent or chronic cystitis, our physicians can help you evaluate and treat the disorder to restore your quality of life.
Fecal Incontinence
Fecal incontinence is the inability to control the bowels. Leakage can occur when attempting to rush to the bathroom or can occur without warning. More than 5.5 million Americans have fecal incontinence. It affects people of all ages, including children as well as adults. Fecal incontinence is more common in women than in men, but it is not a part of normal aging.
Involuntary leakage of stool can be very debilitating. People with fecal incontinence may feel ashamed, embarrassed or humiliated. Some will not leave the house out of fear that they might have an accident in public. Most try to hide the problem as long as possible, so they begin to withdraw from family and friends. Ultimately, fecal incontinence can lead to depression and social isolation. Fortunately, there are treatments that can improve bowel control and make incontinence easier to manage.
Treatment depends on the cause and severity of fecal incontinence. It may include dietary changes, medication, bowel training, or surgery. More than one treatment may be necessary for successful control since continence is a complicated physiologic process.
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