Women's Health

Urogynecology & Pelvic Floor Disorders

Pelvic floor disorders such as pelvic organ prolapse, urinary incontinence, and fecal incontinence can significantly impact a woman’s quality of life. While pelvic floor disorders are more common in older women, they are not a normal part of aging. Fortunately, many pelvic floor disorders are easily treatable. At NewYork-Presbyterian Brooklyn Methodist Hospital, our women’s health team includes board-certified urogynecologists — physicians who specialize in female pelvic medicine and reconstructive surgery. These urogynecologists provide the most advanced and comprehensive care to women with pelvic floor disorders that are tailored to a woman’s unique needs to maximize health and well-being. With office locations in Brooklyn, you receive the care of a leading academic center close to home.

What are Pelvic Floor Disorders?

Pelvic floor disorders are problems that affect women’s pelvic organs, including the uterus, vagina, bladder, urethra, and rectum, and the muscles of the pelvic floor that surround and support them. These disorders occur when the muscles or connective tissue of the pelvic area weaken or are injured. One out of three women will experience a pelvic floor disorder in her lifetime. Childbirth, obesity, heavy lifting, surgery, or chronic disease can cause pelvic floor damage.

Many women are reluctant or embarrassed to talk with their clinicians about their pelvic floor symptoms or think they are part of the normal aging process. Pelvic floor disorders are very common problems that can be successfully treated.

At NewYork-Presbyterian Brooklyn Methodist Hospital, we understand how upsetting and disruptive pelvic floor disorders can be. Our urogynecologists listen carefully to each patient to understand her symptoms and concerns. We counsel and educate each patient about her condition and treatment options, which may include nonsurgical and surgical treatments. We use the least invasive therapies to minimize complications and recovery times for the best outcomes.

Signs & Symptoms

Symptoms of a pelvic floor disorder include:

• Heaviness, fullness, pulling, or aching in the vagina that gets worse by the end of the day
• Feeling a “bulge” or “something coming out” of the vagina
• Difficulty starting to urinate or emptying the bladder completely
• Leaking urine when coughing, laughing, or exercising
• Urgent or frequent need to urinate
• Pain while urinating

Our Approach to Care

Women may experience one or several pelvic floor disorders as they transition through life stages, including pregnancy, post-partum, and menopause. At NewYork-Presbyterian Brooklyn Methodist Hospital, we combine the expertise of doctors across multiple specialties to address pelvic floor issues for women of every age. Our urogynecologists closely collaborate with specialists in General Obstetrics and Gynecology, Urology, Gastroenterology and Colorectal Surgery to formulate a comprehensive plan tailored to each woman’s specific condition and treatment goals. We also work closely with specialists in Pain Management, Physical Therapy, and Integrative Medicine to treat all aspects of a woman’s health and well-being affected by the pelvic floor disorder, including other conditions that commonly occur together. Treatments range from nonsurgical approaches such as pelvic floor behavior modification and exercises to the latest cutting-edge, minimally invasive surgery approaches.

Conditions We Treat

We treat all types of pelvic floor problems in women, including:

• Pelvic organ prolapse (when an organ, such as the bladder, uterus, or cervix, sags into the vagina)
• Cystocele and rectocele
• Bladder problems: urinary incontinence (trouble holding urine), urinary retention (trouble emptying bladder), overactive bladder, pain, urinary tract infections (UTIs)
• Fistulas (abnormal openings between two organs, including urogenital fistula)
• Vaginal and urethral cyst/mass or atrophy
• Urethral diverticulum (a pocket that forms under the urethra, where urine can collect and lead to infections)
• Bowel problems and complications from pelvic mesh surgery

How We Diagnose Pelvic Floor Disorders

Clinicians can often detect pelvic floor disorders during a physical exam. Depending on the exam’s findings or the symptoms’ severity, additional tests may be ordered to help with diagnosis or treatment planning.

Tests that may be offered to identify bladder control problems include:

• Cystoscopy: Examines the insides of the bladder to look for problems, such as bladder stones, tumors, or inflammation.
• Urinalysis: Detect bladder infection, kidney problems, or diabetes.
• Urodynamics testing: Evaluates the function of the bladder and urethra.

Treatments We Offer

Our urogynecologists offer a full range of nonsurgical, minimally invasive and surgical treatments for pelvic floor conditions that meet each woman’s needs and goals. The selection of treatment may include one or more of the following approaches:

Nonsurgical treatments

• Pelvic floor behavioral modification therapy (for urine or accidental bowel leakage)
• Medical therapy (for overactive bladder, vaginal dryness, or recurrent urinary tract infections)
• Cystoscopic Botox procedure (to treat overactive bladder)
• Bulking agents (for management of stress urinary incontinence)
• Pelvic floor injections/nerve blocks
• Percutaneous tibial nerve stimulation (an office procedure to treat overactive bladder)
• Sacral neuromodulation (to treat certain bladder and bowel problems)
• Pessary fitting (the placement of a device into the vagina to support the uterus and vaginal walls in women with prolapse)
• Management of accidental bowel leakage/fecal incontinence

Minimally invasive surgery treatments

Minimally invasive surgical approaches include cystoscopic, vaginal, laparoscopic, and robotic procedures:

• Vaginal reconstructive surgery to repair vaginal prolapse (cystocele, rectocele, and uterine prolapse)
• Laparoscopic and robotic surgery to repair vaginal prolapse (cystocele, rectocele, and uterine prolapse)
• Surgical management of stress urinary incontinence
• Vaginal Fistula repair
• Urethral diverticulum and vaginal cyst excision

At NewYork-Presbyterian, our experienced urogynecologists collaborate with our highly skilled staff to provide the highest level of care before, during and after surgery.

Long-term management

Our team is committed to giving patients with pelvic floor disorders ongoing care that will enable them to improve their quality of life. Depending on her individual needs, long-term care may include periodic evaluations to review symptoms and to monitor the condition with pelvic examinations. Our compassionate specialists strive to meet each woman’s changing needs throughout her lifespan.

Why Choose Us

Expertise in the Diagnosis and Treatment of Pelvic Floor Disorders

NewYork-Presbyterian urogynecologists have expertise in diagnosing and treating pelvic floor disorders in women in every stage of life, from post-partum through menopause. After a careful assessment of a patient’s symptoms, life stage, and needs, our physicians devise a treatment plan that draws from a wide range of nonsurgical and surgical treatments to address a patient’s unique needs.

Leaders in Minimally Invasive Surgery Techniques

Our urogynecologists are all fellowship-trained in female pelvic medicine and reconstructive surgery. They have expertise in the latest minimally invasive surgical approaches, such as laparoscopy, robotic-assisted surgery, and vaginal surgery, to treat the most complex and challenging pelvic floor conditions. Compared to “open” surgery, minimally invasive surgery, including vaginal approach results in faster recovery, less pain, less scarring, fewer complications, and shorter hospital stays.

Providing the Latest Therapies Through Collaboration and Research

At NewYork-Presbyterian, our clinician-investigators actively participate in urogynecology clinical research networks and are leaders in the professional national and international organizations that establish patient care guidelines, such as the Collaborative Research in Pelvic Surgery Consortium. Our patients benefit from treatments and therapies based on the latest advances in urogynecology research. You may be eligible to participate in a clinical trial that examines new therapies for your condition.