Diagnosis and Treatment of Pelvic Health Disorders
A Urogynecologist can diagnose and treat a variety of pelvic health disorders. With a comprehensive medical history and physical examination, which emphasizes the woman's gynecological and urinary systems, your physician will help to identify the right treatment plan for you.
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Diagnosing a pelvic health condition
A focused physical examination will assess the vaginal area including the support of your pelvic organs. After your initial exam, your physician may recommend specialized testing or medical treatment if appropriate.
Testing may include:
- Cystoscopy: Cystoscopy uses a lighted flexible telescope to look at the inside of your bladder. The test allows Avista Pelvic Health Center experts to see if your bladder is inflamed or has other abnormalities that may be causing problems.
- Urodynamic testing: Urodynamics tell us about the bladder, its nerves, its sphincters and the pelvic floor muscles. These are simple tests done in the office that involve filing your bladder with water while specialized equipment monitors the response of your nerves and muscles. These tests are the key to understanding the cause of your symptoms.
Treating a pelvic health condition
There are a wide range of treatment options available to treat pelvic health conditions.
Nonsurgical Treatment Options
You may be a candidate for these non-surgical treatments:
- Biofeedback: Biofeedback is a technique where a patient will learn to control specific physiological processes. This non-painful, non-surgical strategy provides improvement for many patients with pelvic floor disorders. During biofeedback, electrical activity in the muscle is recorded and displayed for the patient. The therapist can then provide feedback to help the patient improve their muscle coordination. When used in conjunction with Kegel exercises, biofeedback techniques help women gain awareness and control of their pelvic muscles.
- Botox bladder injections: When Botox is injected into the bladder muscle, it causes the bladder to relax, increasing the bladder’s storage capacity and reducing episodes of urinary incontinence. Injecting the bladder with Botox is performed using cystoscopy, a procedure that allows a doctor to visualize the interior of the bladder while Botox is being injected.
- Medications: Medications may be prescribed and work by relaxing the bladder muscles and decreasing the amount of abnormal spasms in the bladder. They may increase the interval between voids, and help alleviate symptoms of urgency and urinary frequency.
- Pelvic floor physical therapy: Pelvic floor rehabilitation is achieved through an individualized program of treatments aimed at improving the strength of the pelvic floor, restoring function and eliminating pain or restriction in the perineum. Therapy may include pelvic muscle exercises (Kegels) and core exercises, manual therapy, biofeedback, electrical stimulation and others, depending on each patient’s individual condition. After several treatments, effective symptom relief can often be achieved.
- Peri-urethral bulking: Peri-urethral bulking agents can effectively relieve symptoms of stress incontinence by increasing tissue bulk and tightening the urethra to prevent urine from flowing out unexpectedly. The bulking agent is injected directly into the peri-urethral tissue as a liquid, which then solidifies to add the desired bulk to the insufficient urethral wall.
- Pessaries: A pessary is a device that is placed into the vagina to support the uterus or bladder and rectum. It is a firm ring that presses against the wall of the vagina and urethra to help decrease urine leakage. The type and size of the pessary should be fitted to meet your individual needs and anatomy. A properly fitted pessary is not noticeable when it is in place.
Surgical Treatment Options
Your surgeon will work with you determine which treatment option is best for you.
Before choosing which technique to use, our specialists will factor in your wishes, past medical history, previous surgeries and overall health status. You may be a candidate for these surgical treatments:
- Minimally invasive laparoscopic surgery: This surgery is done through one or more small incisions, using small tubes and tiny video cameras and surgical instruments.
- Vaginal or pelvic reconstructive surgery: The goal of all reconstructive pelvic floor procedures is to restore normal pelvic floor anatomy and give the patient her best chance at maintaining a normal quality of life, including sexual intercourse if desired.
- Robotic surgery: Robotic surgery provides a magnified, 3-D view of the surgical site, which gives the surgeon great precision, flexibility and control.
Lifestyle & Behavioral Changes to Improve Pelvic Health
You can help control pelvic floor disorder symptoms by making lifestyle and behavioral changes like these:
- Diet and fitness. For many women, a healthy diet and fit lifestyle really makes a difference in controlling their pelvic health disorder symptoms
- Lose weight if you are overweight. Weight loss can help improve urine leakage along with pelvic muscle strengthening and other behavioral changes. If you are overweight, as little as a 5 to 10 percent reduction in your weight will reduce weekly incontinence episodes by more than half. In addition to stressing the pelvic floor, obesity affects the normal functioning of the nerves and muscles in your genital tract. This further increases your risk for pelvic floor disorders.
- Manage fluid intake. The specific recommendation for fluid intake relates to your specific symptoms. For urinary incontinence, not overdoing the fluids can translate to less trips to the bathroom. Also, restricting drinking after dinner can help reduce the number of trips to the bathroom at night. For women struggling with constipation, increasing fluids is often recommended.
- Be diet savvy. Women with urinary incontinence find it helpful to reduce bladder irritants, including caffeine found in coffee, tea, chocolate, cola and some energy drinks and artificial sweeteners. These foods may cause bladder muscle spasms, which can make you suddenly feel like they have to urinate.
- Eat plenty of fiber daily to avoid constipation. You may also need to use a stool softener if you continue to struggle with constipation to avoid excessive straining with bowel movements.
- Adjust physical activity. Regular physical activity helps keep bowel movements normal. Being active also helps with maintaining a normal body weight, decreasing your risk for urinary incontinence. However, high-intensity exercises (e.g., CrossFit) can put pressure on your pelvic floor and increase your risk for incontinence problems.
- If You Smoke, Quit Now. The risk for pelvic floor disorders doubles for women who smoke.