Specialists at the Pelvic Floor Center at the George Washington University Hospital can help diagnose and treat the following conditions: 

Pelvic Organ Prolapse 

When the uterus, bladder or rectum lose elasticity and descend or bulge into the vagina, women can feel pressure in the lower abdomen. Also, they actually may see something falling out of the vagina, experience urinary or fecal incontinence, become constipated and/or have diminished sexual function. This condition, known as pelvic organ prolapse, occurs when the muscles and ligaments supporting the pelvic organs weaken or break. Learn more about pelvic organ prolapse and how it can be treated with robotic surgery >

Rectocele 

When the area between the rectum and vagina, known as the rectovaginal septum, becomes thin and weak, the rectum may bulge into the vagina during bowel movements. Constipation, a difficult childbirth and hysterectomy can cause this weakness of the pelvic structures. If a rectocele becomes a problem, the doctors at the GW Pelvic Floor Center can offer multimodality management options for treatment.

Cystocele 

Like rectocele, cystocele is common among women with weak pelvic floor muscles. When the muscles at the base of the bladder become too thin and weak, the bladder can fall down into the vagina. This may affect urination. GW’s Pelvic Floor Center can offer multimodality management options for treatment.

Urinary Incontinence 

Stress urinary incontinence causes urine to escape when a person laughs, sneezes, coughs or strains in any way. The embarrassment caused by urinary incontinence frequently prevents people from getting timely help from their doctors. Although many people regard this condition as a natural part of aging, it is not natural and can affect people of all ages, particularly those women who have experienced vaginal delivery of their children.

Following surgery or radiation treatment for prostate, bladder and colorectal cancers, men sometimes experience the unpleasant side effect of urinary incontinence.

The GW Pelvic Floor Center is able to accurately diagnose the problem and offer many different modalities for treatment.

Overactive Bladder  

The bladder is made up of muscle and sometimes this muscle can contract spastically and cause feelings of urinary urgency and frequency. Sometimes this may be associated with incontinence and discomfort. This may cause distress and inconvenience to men and women with this problem. People with severe overactive bladder will change or limit their daily activities because of the embarrassment and discomfort that is caused by overactive bladder.

The doctors at the GW Pelvic Floor Center are experts at the diagnosis and treatment of overactive bladder. Treatments for this problem include medications, minimally invasive surgeries and for severe or refractory cases, the doctors in the Pelvic Floor Center offer technologically advanced treatment options and surgery.

BPH (Benign Prostatic Hyperplasia) and Urinary Retention 

An enlarged prostate could cause many urinary symptoms such as frequency of urination, awakening through the night to urinate and an inability to empty the bladder completely. This can significantly affect a man’s quality of life. The GW Pelvic Floor Center offers minimally invasive treatments to relieve BPH symptoms.

Neuropathic Bladders 

Neurological conditions like Parkinson’s disease, stroke, multiple sclerosis and spinal disorders can affect the bladder. The GW Pelvic Floor Center is able to evaluate these patients and offer nonsurgical and surgical treatment options.

Fecal Incontinence

Affecting people of all ages, fecal incontinence is the inability to control the bowels. More common in women, fecal incontinence is not a normal part of aging. People who suffer with this condition also are reluctant to socialize because they are afraid to have an “accident” in public.

Causes of fecal incontinence include: constipation, damage to the anal sphincter muscles or the rectum, loss of storage capacity in the rectum, diarrhea and pelvic floor dysfunction. Physicians practicing at GW’s Pelvic Floor Center treat fecal incontinence with recommended dietary changes, medication, bowel training or surgery. Regaining fecal continence may require more than one treatment.

Constipation 

Infrequent bowel movements (less than three times per week), the need to strain more than fifty percent of the time when having bowel movements, bloating and abdominal pain are symptoms of constipation. The GW Pelvic Floor Center provides patients with bowel management procedures, surgical repair and pelvic floor rehabilitation to correct these abnormalities.

Pelvic floor disorders are treatable and controllable. However, successful therapy requires active patient participation both for diagnosis and therapy. Treatment typically depends on the severity of the condition and many times, the best success comes from using several treatment options together.

Treatment Options

Pelvic floor disorders are treatable and controllable. However, successful therapy requires active patient participation both for diagnosis and therapy. Treatment typically depends on the severity of the condition and many times, the best success comes from using several treatment options together.

Nonsurgical Options

  • Kegel muscle-building exercises can be extremely helpful for pelvic floor conditions of a mild degree. Biofeedback can help train and strengthen the pelvic muscles.
  • A pessary can be inserted in the vagina. This ring-shaped device and can stay in the body all day to help give support to the pelvic floor organs. This custom device helps slow the deterioration of the pelvic muscles for several years and is a good option for women who still want to have children or those who are not good candidates for surgical repair.
  • Electral impulses can be sent through the rectum or vagina to help control and stimulate the pelvic floor muscles. This treatment must be done several times over a few months.
  • A bowel management program and stimulated defecation (enemas, suppositories, medications). 

Surgical Options

Transvaginal Pelvic Floor Repair

These procedures treat pelvic prolapse through incisions in and around the vagina to restore the normal anatomy of the pelvic floor.

Laparoscopic Pelvic Floor Repair

In this procedure, surgeons insert a tiny telescope (laparoscope) through a small incision. The laparoscope is attached to a camera-television setup, giving the surgeons a magnified view of the pelvic floor. After making several "keyhole" incisions in the abdomen, the surgeons use specially designed instruments to lift and attach the prolapsed organs back in their normal positions with permanent sutures. There are numerous benefits to having pelvic floor defects treated laparoscopically, such as:

  • Providing an accurate identification of the pelvic floor defects because of the laparoscope's excellent view of the pelvic floor from above
  • Minimizing the need and extent of vaginal repair, thus reducing the risk of painful internal scars
  • Avoiding or deferring hysterectomy for uterine prolapse
  • Allowing the patient to enjoy a shorter recovery time and to experience less postoperative discomfort

Urinary Incontinence

Nonsurgical Options

Depending on the reason for a person's incontinence, behavioral changes may help with some of the urinary symptoms. Bladder training and scheduled urination can help to rid the bladder continuously instead of waiting for the feeling of having to go. Llessening alcohol and caffeine intake, as well as acidic foods and liquids, can also help. Finally, medications can be prescribed to help control the bladder: antimuscarinicsc (for overactive bladders); imipramine-an antidepressant to relax the bladder muscle; antibiotics-when your condition is related to a urinary tract infection; Alpha blockers and other medicines to relax your urinary sphincter muscle or shrink the prostate.

Surgical Options

  • Overactive bladder or retention of urine can be treated by the placement of electrodes in the spinal region that sends electrical stimulation to the nerves of the bladder.
  • A "sling" can be inserted during a minimally invasive procedure in the urethra to support it into its natural position. This can be performed in patients with urinary incontinence or sphincter dysfunction.
  • The tissue surrounding the urethra can be surgically enhanced or "bulked" around the urinary sphincter to help tighten the sphincter.
  • Bladder neck suspension surgery can be performed by making an incision into the abdomen and securing the bladder to a ligament near the pubic bone.
  • An artificial urinary sphincter muscle may be inserted to help control the pelvic floor muscles. This doughnut-shaped ring is inserted around the urethra. It stops the flow of urine, and when pressed manually, will release it.
  • Sacral nerve stimulation: electrodes placed to stimulate spinal nerves.

Fecal Incontinence

Surgical Options

Most people with fecal incontinence will not be candidates for surgical correction, but some individuals may benefit. A variety of surgical procedures and techniques exists for the treatment of fecal incontinence:

  • Sphincteroplasty: direct repair of a muscle defect.
  • Artificial bowel sphincter: an implanted inflatable donut placed around the anal muscles.
  • Sacral nerve stimulation: electrodes placed to stimulate spinal nerves.
  • Colostomy or ileostomy.
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