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Conditions & Treatments

Female Pelvic Medicine

With a division devoted entirely to female pelvic medicine, Einstein Healthcare Network’s specially trained physicians, nurses and physical therapists offer compassionate and comprehensive treatment of urologic conditions specifically affecting women, including pelvic organ prolapse, incontinence and pelvic pain. The nationally renowned MossRehab, part of the Einstein network, offers specialized physical therapy for pelvic floor conditions.

Our team of caring and compassionate experts - led by Joshua A. Cohn, MD -  offer the latest diagnostic and treatment options for a full range of conditions, including:

One out of seven women has overactive bladder, one out of three experiences urinary leakage, and one in eight will undergo treatment for urinary leakage or vaginal prolapse at some point in her lifetime. The involuntary leakage of urine may be caused by either stress and activities or a sudden urge to urinate. Depending on the causes and the severity of the case, Einstein’s experts in female pelvic medicine may recommend nonsurgical or minimally invasive surgical options, including:

  • Dietary and lifestyle changes
  • Physical therapy to strengthen the bladder and pelvic muscles
  • Medications to relax the bladder
  • Inserts that prevent leakage in the vagina or urine channel
  • A specialized bulking agent placed in the urine channel using a minimally invasive procedure
  • A thin strip of mesh called a synthetic sling, or a sling created from the woman’s own tissue and placed beneath the urine channel to increase resistance to urine leakage
  • Botox injections to relax the bladder muscle
  • Electrical stimulation of a nerve in the lower leg, which can adjust the nerve signals to the bladder
  • An electrical implant in the lower back that delivers electrical stimulation of the nerve that controls the bladder, known as sacral neuromodulation

Pelvic organ prolapse is a common condition that occurs when pelvic organs drop below their normal position in the body. This descent is often caused by childbirth, and can result in painful pelvic pressure, difficulty with urination or bowel movements, urinary incontinence and a bulge near the opening of the vagina. Treatments include:

  • Physical therapy to strengthen the muscles of the pelvis
  • Placement of a removable ring that supports the vagina
  • Vaginal or abdominal surgery to treat dropped or bulging pelvic organs

Urinary tract infections (UTIs) are bacterial infections that can affect the kidneys, bladder and urethra. Symptom may include painful urination or a burning sensation, more frequent urination, constant urge to urinate, feeling the bladder is constantly full, abdominal discomfort, and cloudy, milky or bloody urine. Infections that have spread to the upper urinary tract and kidneys may cause symptoms such as fever, chills, general discomfort and pain between the ribs or in the abdomen or sides.

UTIs are more common in women, and women who have uterine prolapse, are postmenopausal or engage in increased in sexual activity are at higher risk for UTIs. UTIs are often preventable by drinking water and urinating when necessary, and women can prevent UTIs by wiping from front to back to reduce spreading bacteria, cleansing the vaginal region before intercourse, and avoiding vaginal hygiene products.

In most cases, UTIs can be successfully treated with antibiotics. However, if the infection is related to a kidney stone, enlarged prostate or other abnormality, further treatment may be necessary. In patients with recurrent urinary tract infections, non-antibiotic prescription medications and non-prescription supplements may be effective in reducing the frequency of symptomatic infections, reducing the need for antibiotics.

Some patients with symptoms similar to infection may actually have overactive bladder, urethral discomfort due to changes in the health of the vaginal tissues associated with aging, or bladder pain syndrome/interstitial cystitis which will not respond to antibiotic therapy.

Trouble urinating or the inability to urinate are known as voiding disorders, which are often caused by bladder infections, inflammation or neurologic or anatomic issues. Symptoms include urinary urgency, frequent urination, difficulty urinating or incomplete urination. Treatments include:

  • Physical therapy to train the pelvic muscles to relax during urination
  • An electrical implant in the lower back that delivers electrical stimulation of the nerve that controls the bladder, known as sacral neuromodulation
  • Self-catheterization to drain the bladder several times per day

Constant or intermittent pain or discomfort below the bellybutton and between the hips can be life-altering and stop you from enjoying daily activities. It may be sharp, dull or crampy, and is typically associated with urinary symptoms, bowel symptoms, pain during sex, disorders of the reproductive organs and pelvic muscle spasms.

While causes of pelvic pain may vary, Einstein’s team of experts in female pelvic medicine are specially trained to find the cause of your pain using the latest diagnostic tools and offer a full range of personalized treatments. 

An abnormal connection between the urinary tract and the reproductive organs known as a female genitourinary fistula can cause pain or discomfort and constant urinary leakage. This may be caused by removal of the uterus, complex labor and delivery, pelvic cancer radiation, or pelvic trauma and usually requires surgery to stop the leakage. Einstein offers minimally invasive approaches, including robotic-assisted surgery or surgery through the vagina to address this debilitating condition in a way that can accelerate recovery from surgery and return to life without leakage.

When a pocket or pouch called a urethral diverticulum forms along the urethra, it can become filled with urine, causing a painful vaginal mass, discharge, and/or frequent infections. Einstein has the latest imaging techniques available to diagnose urethral diverticula and specializes in treating this condition and any associated leakage with transvaginal surgery.

When scar tissue accumulates in the urine channel, it can cause straining or the inability to urinate. These urethral strictures in women often result from prior trauma, surgery, inflammation, infection or radiation. Urethral strictures are usually treated with vaginal surgery to repair the urethra and restore its function.

 

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Female Pelvic Medicine Specialists

Female Pelvic Medicine Resources

Pelvic Organ Prolapse: Causes and Treatments

Pelvic Floor Physical Therapy: An Overview


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