Urogynecology and Reconstructive Pelvic Surgery

Urogynecology, also known as Female Pelvic Medicine, is a specialized field within gynecology and obstetrics that evaluates, diagnoses, and treats pelvic floor disorders. A female’s pelvic floor is a collection of muscles, ligaments, and tissues that support the bladder, reproductive organs, and bowel. These disorders arise when the muscles of the pelvic floor become weak, overactive, or torn. Depending on the problem and its severity, reconstructive pelvic surgery may be necessary.

All too often, we see women embarrassed to seek help for the problems they are experiencing. We hope that by educating and enlightening them about the problems and associated treatments, they realize how common pelvic floor dysfunction really is.

Important facts about pelvic floor disorders

If you are experiencing some level of pelvic floor dysfunction, you are not alone! According to a study from the National Institute of Health, 1 in 4 women faces pelvic floor dysfunction at some point in their life. For women 60 years and older, that number reaches closer to 1 in 2.

The prevalence of pelvic floor disorders varies with the number of times a woman has given birth.

Pelvic floor dysfunction is not just something you need to live with as you age. These disorders are medical conditions that have treatments!

Health conditions or injuries that affect the nerves (such as diabetes, Parkinson’s disease, stroke, back surgery, spinal stenosis, or childbirth) can weaken the pelvic floor muscles.

What pelvic floor disorders do we treat?

  • Urinary incontinence including stress and urgency urinary incontinence
  • Pelvic organ prolapse
  • Recurrent urinary tract infections
  • Overactive bladder
  • Interstitial cystitis/bladder pain syndrome

 

What procedures do we perform for pelvic floor disorders?

  • Office cystoscopy for bladder evaluations
  • Bladder instillation and hydrodistension for interstitial cystitis
  • Pessary fitting for prolapse and stress incontinence
  • Midurethral slings for stress incontinence
  • Peripheral tibial nerve stimulation (PTNS) for overactive bladder
  • Peripheral nerve evaluation (PNE) for overactive bladder
  • Sacral neuromodulation (SNM) for overactive bladder
  • Bladder BOTOX injections for overactive bladder

 

Meet your provider

Dr. Chang is an ABOG Board Certified Obstetrics & Gynecology physician with sub-specialty fellowship training in Female Pelvic Medicine and Reconstructive Surgery who is passionate about providing quality and compassionate care to women with urologic and gynecologic issues.

Dr. Eric S. Chang, MD, MEng, FACOG

Meet your provider

Dr. Chang is an ABOG Board Certified Obstetrics & Gynecology physician with sub-specialty fellowship training in Female Pelvic Medicine and Reconstructive Surgery who is passionate about providing quality and compassionate care to women with urologic and gynecologic issues.

Dr. Eric S. Chang, MD, MEng, FACOG

FAQ

What is urogynecology?

Urogynecology, or female pelvic medicine & reconstructive surgery is a specialty of medicine that specifically deals with “pelvic floor disorders”. These are conditions affecting women’s urinary, reproductive, and other pelvic organs. These conditions can include but are not limited to difficulty in controlling bladder or bowel movements, hernias or bulges from the vagina, chronic bladder discomfort, urinary tract infections, and muscle-related pelvic pain.

What does a urogynecologist or female pelvic reconstructive surgeon do?

A urogynecologist is a surgeon with sub-specialized training in the evaluation and treatment of pelvic floor disorders. These surgeons typically have at least 7 years of post-medical school training, with at least 2-3 years purely dedicated to the study of urogynecology. A urogynecologist with an obstetrics & gynecology background is comfortable in providing women-centric care, and should be able to provide full-spectrum medical and surgical treatment options for pelvic floor disorders.

What are pelvic floor disorders?

Pelvic floor disorders are conditions affecting women’s urinary, reproductive, and other pelvic organs. Specific conditions can include leakage of urine with coughing, sneezing, laughing (stress urinary incontinence), the constant feeling of urinary urgency and frequency with or without leakage of urine (overactive bladder and/or urgency urinary incontinence), accidental leakage of bowel movements (fecal incontinence), or the presence of a vaginal bulge (pelvic organ prolapse), to name a few. The good news about these conditions is that they are mostly quality-of-life issues that rarely would cause serious harm to your health, and they are very treatable.

Why do women develop pelvic floor disorders?

In many cases, there is not one single reason why a woman will develop a pelvic floor disorder. Sometimes, it can be caused by stress to the support structures of the pelvis such as from past pregnancies or prior pelvic surgeries. In other cases, conditions that cause straining or additional pressure on the pelvic floor such as constipation or chronic coughing can also result in the development of these conditions. If other women in your family have experienced pelvic floor disorders, you may be more likely to develop a pelvic floor disorder in the future. However, there are times where there is no identifiable cause for a pelvic floor disorder. In any case, it is important to recognize if you have a treatable condition and seek the appropriate help from a urogynecologist.

How common are pelvic floor disorders?

Much more common than you may think! Prior studies have shown that up to 60% of women may develop a pelvic floor disorder at some point in their life. Being that these are oftentimes embarrassing problems to talk about or even bring up to your doctor, many women never present to care of these conditions. If you think you may be experiencing a pelvic floor condition, know that you are not alone, and that many treatment options exist to improve your quality of life. We encourage you to take the first step by making an appointment with our urogynecologist to discuss which treatment options are right for you.

What is pelvic organ prolapse?

Pelvic organ prolapse is a pelvic floor disorder that involves the “falling” of the vagina resulting in a bulge in the vagina. This can be thought of like a hernia in the vagina. Prolapse can be caused by weakening of the support structures of the pelvis, causing pelvic organs like the bladder, bowel, cervix, and uterus to push on the vagina resulting in the bulge. In some cases, the bulge does not cause any symptoms. However, if large enough, the bulge can cause feelings of discomfort, difficulty with walking or sitting, difficulties with urination or defecation, and the presence of a protrusion beyond the vaginal opening. It is important to know that pelvic organ prolapse is rarely a serious condition, but treatment is available to improve the quality of life for a woman with prolapse.

What treatment options are available for pelvic organ prolapse?

Treatment options for pelvic organ prolapse include conservative therapy, medical management, and surgery. Your urogynecologist may recommend a trial of pelvic floor physical therapy to strengthen the pelvic floor muscles. A pessary is an intravaginal device that can be inserted to keep the prolapse from protruding out of the vagina. Surgical options are varied but are the most permanent fix, are minimally invasive, and mostly same-day procedures. If you would like to discuss your treatment options for prolapse, or are ready to discuss what surgery may be right for you, we encourage you to make an appointment with our urogynecologist today.

What is stress urinary incontinence?

Stress urinary incontinence is the accidental leakage of urine associated with a forceful action such as coughing, sneezing, laughing, or exercise. This condition can develop due to loss of support around the urethra which can happen from pregnancy and childbirth and prior pelvic surgery among other causes, as well as from the normal aging process. It is important to know that stress urinary incontinence is rarely a serious condition, but treatment is available to improve the quality of life for a woman with this type of urinary leakage.

What treatment options are available for stress urinary incontinence?

Treatment options for stress urinary incontinence include conservative therapy, medical management, and surgery. Your urogynecologist may recommend a trial of pelvic floor physical therapy to strengthen the pelvic floor muscles. A pessary is an intravaginal device that can be inserted to restore some of the lost support around the urethra and prevent urinary leakage. Surgical options are the most permanent fix, are minimally invasive, and are outpatient procedures. If you would like to discuss your treatment options for stress urinary incontinence, or are ready to discuss if surgery may be right for you, we encourage you to make an appointment with our urogynecologist today.

What is overactive bladder?

Overactive bladder is the constant feeling of urinary urgency and frequency, the need to awaken multiple times a night to urinate, and is sometimes associated with urgency-related leakage of urine. Sometimes, overactive bladder can be the result of bladder irritants in the diet, from bladder stones, or from foreign bodies such as suture or mesh left in the bladder from prior surgeries. In evaluating this condition, your urogynecologist may recommend a cystoscopy to look inside the bladder, or urodynamic testing to evaluate the function of your bladder. It is important to know that overactive bladder is rarely a serious condition, but treatment is available to improve the quality of life for a woman with this type of urinary problem.

What treatment options are available for overactive bladder?

Treatment options for overactive bladder include conservative therapy, medical management, and surgery. Your urogynecologist may recommend a trial of pelvic floor physical therapy to improve your bladder control. Various medications can be trialed to decrease the “squeezing” of your bladder to minimize the sensation of urinary urgency and frequency. Advanced treatment options can be provided by your urogynecologist and can include bladder nerve stimulation and BOTOX injections to the bladder. If you would like to discuss your treatment options for overactive bladder, we encourage you to make an appointment with our urogynecologist today.

Why do I keep getting urinary tract infections and what can I do about them?

Urinary tract infections or UTIs involve the presence of an invasive organism in the urine, most commonly bacteria, that can result in uncomfortable symptoms such as urinary burning, frequency, and urgency. UTIs are more common in women than men, and up to 50-60% of women report at least one UTI in their life. Women who notice they are experiencing repeated UTIs may warrant further evaluation of their urinary tract to determine if there are any underlying conditions that may be causing these infections. Your urogynecologist may recommend a cystoscopy to evaluate your bladder anatomy, and run urine tests to confirm the presence of infection. Your urogynecologist will also discuss the many treatment options that are available for women with recurrent UTIs to help decrease infection frequency. If you would like to discuss your treatment options for recurrent UTI, we encourage you to make an appointment with our urogynecologist today.

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