Urogynecology

The BID Needham urogynecology team can treat many bladder and pelvic conditions, including:

• Fecal incontinence or loss of bowel control, often due to pelvic floor injury
• Frequent urinary tract infections (UTIs)
• Interstitial cystitis, or painful bladder syndrome
• Overactive bladder, or urinary frequency and urgency
• Pelvic organ prolapse, when organs in the pelvic cavity drop or slip out of place
• Urinary incontinence (involuntary urine loss), including stress incontinence (urine leakage associated with activity, such as coughing, sneezing or running) and urge incontinence (urine leakage associated with sudden urgency)
• Vaginal fistulas, which can either be an abnormal connection between the vagina and the urinary tract (a vesico-vaginal fistula) or an abnormal connection between the vagina and the rectum (a rectovaginal fistula)

Evaluations and Tests

The first step to helping you feel better is to learn what is causing the problem. Our urogynecologists provide you with an array of advanced diagnostic testing right in the office, including computerized, multichannel urodynamic testing and cystourethroscopy.

Urodynamic Testing

This is a computerized evaluation of how your bladder, urethra and sphincters are working. The test uses thin, flexible tubes called catheters. It is not a painful procedure, but it may be uncomfortable. Please come to the test with a full bladder and be prepared to spend at least one hour in the office. You will be able to drive after this procedure and do not need to be accompanied.

At the beginning of the study, you will empty your bladder into a machine that measures how fast your urine flows. Two small catheters will be placed: one vaginally or rectally, and one into the urethra. The catheters measure how much pressure is exerted on your bladder during the study. Your bladder will be slowly filled with sterile water. You will be asked to indicate fullness at various times during the filling process. You will also be prompted to cough and bear down to reproduce circumstances that provoke leaking. Once the bladder is full, you will be asked to empty your bladder into a special funnel with the catheters in place. Be prepared to spend at least 1 hour in the office for this procedure.

Cystourethroscopy

A cystourethroscopy is a procedure during which we insert a small lens into the urethra and bladder, looking for abnormalities that may contribute to your urinary symptoms. Your doctor will be inspecting the walls of your bladder and urethra and ureteral orifices. For your comfort, we apply an anesthetic gel to the inside of your urethra to numb the area. The procedure is usually not painful, but you may feel some discomfort. Be prepared to spend at least 30 minutes in the office for this test. You will be able to drive after this procedure and do not need to be accompanied.

Please keep this information in mind when you make an appointment:

• When you schedule an office visit, you may need to answer a few questions about your health and personal history.
• Before your first appointment, please forward your relevant medical records and the results of any medical tests you have had. Bring a list of your current medications, your insurance card, and any other materials requested by your doctor's office.
• Check with your insurance company to see if your policy includes care and treatment at BID-Needham. We can help if you have questions about your coverage. We can also work with your insurance company if the company has questions or needs more information to determine your benefits.
• Bring a list of any questions you have for your physicians, and a notebook so you can jot down information.
• We always encourage you to invite a family member or trusted friend to your appointment to help you as you gather information about your health and treatment.

The urogynecology specialists at BID–Needham recommend the following reputable online resources if you want to learn more about pelvic floor disorders:

• American Urogynecologic Society
• American Association of Gynecological Laparoscopists
• American Board of Obstetrics and Gynecology
• American Congress of Obstetricians and Gynecologists
• American Urological Society
• International Continence Society
• International Urogynecological Association
• Interstitial Cystitis Association
• National Association for Continence
• Simon Foundation for Continence
• Society of Gynecologic Surgeons

A pelvic floor disorder suggests there is a weakness or tear somewhere within the pelvic floor. This weakening or tear may cause an organ to shift out of place and improperly function.

Pelvic floor disorders create numerous symptoms. You may experience more than one at the same time:

• Problems controlling your bladder and bowels, including urine, bowel gas or stool leakage.
• Difficulty emptying your bladder or having a bowel movement.
• Problems controlling urinary frequency.
• Recurrent bladder or urinary tract infections.
• Feelings of heaviness, sagging, bulging or even dropping in the pelvic area.
• Feeling or seeing tissue coming out of the vagina.

Whatever symptoms you experience, we encourage you to see a specialist who is trained to diagnose and treat these types of conditions. There are good non-surgical and surgical treatment options available to improve your quality of life.

If your symptoms affect your daily activities, speak with your primary care provider about seeing a specialist. There are good treatment options available.

We understand these problems can be embarrassing. But neglecting them can make the symptoms worse. These aren’t life-threatening problems, but they can have a negative effect on your quality of life if they’re not treated. Although it’s unusual, in some cases, ignoring the problem can lead to serious health complications.

There are many contributing factors to pelvic floor disorders. Almost all of them are beyond your control. Although more common in women who have given birth vaginally, pelvic floor disorders can also affect those who have never been pregnant. They can affect you at any age. Other contributing factors include:

• Chronic constipation.
• Chronic cough.
• Excess weight.
• Genetics.
• Repetitive heavy lifting.
• Pelvic tumors.
• Weakening of the connective tissues over time.

Pelvic floor disorders are very common. One-third of all U.S. women will be affected by some type of pelvic floor disorder in their lifetime.

Although the frequency of pelvic floor disorders does increase with age, they aren’t a normal part of aging. No one should have to "just live with" these symptoms. By visiting a specialist trained to diagnose and treat pelvic floor disorders, you can learn about the many non-surgical and surgical treatment options available.

Urinary incontinence and pelvic organ prolapse are the most common kinds of pelvic floor disorders. The good news is that there are good treatment options available.

While some cases of pelvic organ disorder are unavoidable, the following suggestions may help decrease your chances of developing a condition:

• Strengthen your pelvic floor by doing regular Kegel exercises.
• Stay at a healthy weight through diet and exercise.
• Resolve constipation issues, because excessive straining can weaken the pelvic muscles. Speak with your physician about constipation, making dietary changes and increasing the amount of fiber in your diet.
• Quit smoking. Smoking may cause a chronic cough that weakens your pelvic muscles. Smoking also weakens the tissues that support your pelvic organs. If you smoke, ask your physician about strategies to quit.
• Limit the amount of heavy lifting you do. Speak with your specialist about lifting techniques that won't put as much stress on your pelvic muscles.

After graduating from medical school, urogynecologists complete their residency in Obstetrics and Gynecology. Next, they complete a fellowship in Female Pelvic Medicine and Reconstructive Surgery. This gives them additional training and experience in diagnosing and treating pelvic floor disorders. If you need a urogynecologist, ask your primary care physician for a referral. It is important that you find someone who is experienced and with whom you feel comfortable. At BID–Needham, our goal is to provide the best experience possible for our patients and their families.