Pelvic floor conditions can cause a variety of symptoms, such as urinary urgency, urinary frequency, leakage of urine, painful urination, difficulty in passing urine or stool, pelvic pressure, protrusion of a mass through the vagina (prolapse) and involuntary loss of stool. DISORDERS OF PELVIC FLOOR SUPPORT AND FUNCTION ARE COMMON AND TREATABLE. The office provides comprehensive diagnostic and treatment services for women who suffer from disorders associated with the female pelvic floor, including: Stress urinary incontinence (SUI) Overactive bladder Prolapse Recurrent urinary infections Interstitial cystitis / Painful bladder syndrome (IC/PBS) Pelvic floor dysfunction (PFD) / Levator muscle spasm Voiding dysfunction Fistulas Defecatory dysfunction Fecal incontinence Rectal prolapse

Did you know…. Approximately 11 million women are affected by urinary incontinence (1 in 4 women over age 40), but less than 10 percent seek medical treatment. The vast majority of them can improve dramatically with exercises, behavioral management, medications, or minimally invasive procedures.

Identifying the Problem

Early detection and treatment is critical to obtaining positive results. For an accurate diagnosis and to identify the cause of pelvic floor disorders, our office provides comprehensive diagnostic testing.

Brief Overview of Specific Conditions

Stress urinary incontinence (SUI) is involuntary leakage of urine that occurs during exercise or other physical activity, coughing, laughing or sneezing. This is usually due to either an intrinsically weak urethra or a poorly supported urethra, which often occurs as a result of childbearing. Treatment focuses on different methods to strengthen and support the urethra to help control leakage. Sling procedures, minor vaginal surgeries, are very effective for treating stress urinary incontinence. Other treatment options include medications to increase urethral pressure, physical therapy to improve muscular support of the pelvic floor and urethra, and periurethral injections.

Overactive bladder. When a patient experiences an unstoppable urge to urinate, it is referred to as an overactive bladder. Women with overactive bladder can have such urinary frequency that it hinders quality of life or nighttime frequency so that it interferes with sleep. It can result in a small or large amount of urine leakage while trying to get to a toilet. The condition is NOT a normal part of aging and there are behavioral, pharmaceutical and rehabilitative therapies that have proven successful in treating the condition. In refractory cases, Sacral Nerve Stimulation (SNS) or BoTox injections into the bladder muscle are proven effective treatments.

Recurrent urinary infections. This is extremely common in women due to a urethra (the canal carries off the urine from the bladder) of only three centimeters in length and its proximity to the vagina and rectum. Occasional urinary infections (burning with urination, urinary frequency, and pain as the bladder fills) are easily treated with antibiotics for 3–7 days. RECURRENT urinary infections often need to be treated with urinary antiseptics, prophylactic antibiotics and/or vaginal hormones in post menopausal women. Diagnostic procedures may include a cystoscopy and renal ultrasound or a computed tomography (CT) scan to exclude other causes.

Interstitial cystitis / Painful bladder syndrome (IC/PBS). Patients often have symptoms of urinary tract infections (such as burning with urination, severe urinary frequency, bladder pain and pressure), but these patients have negative cultures and minimal improvement with antibiotics. Treatment for IC/PBS may include dietary modification, the use of herbal remedies, medications such as neuromodulator drugs (such as gabapentin or nortriptyline) or pentosanpolysulfonate and pelvic floor physical therapy. Installations of medications into the bladder periodically is also an effective treatment, which avoids systemic side effects. IC/PBS often is associated with vulvodynia (pain in the vulvar area) with resultant pain with intercourse as well as Pelvic Muscle Spasm.   If you have this condition, Dr. Hall may refer you to other practitioners who have dedicated staff to serve your special needs.

Pelvic floor dysfunction (PFD) / Levator muscle spasm. The Levators are a bowl-shaped group of muscles that support the pelvic organs including the rectum and when they go into spasm (an involuntary and abnormal contraction of muscle), it can be extremely painful. It can also lead to trouble urinating or defecating, or painful intercourse. Treatment usually involves a combination of physical therapy, lifestyle changes, muscle relaxant medications, and other non-invasive methods for relieving the spasm. Sacral Nerve Stimulation can be useful for voiding dysfunction associated with PFD.

Voiding dysfunction. Voiding dysfunction describes the inability to completely empty the bladder. Once the underlying cause of the dysfunction is identified, appropriate treatment measures can be taken. This can include physical therapy, surgery if the reason is a prolapse which is partially kinking and obstructing the urethra, Sacral Nerve Stimulation, or intermittent catheterization.

Fistulas. A fistula is a hole or pathway between two organs of the body or an organ and skin. Genitourinary fistulae are found between the vagina and the urinary tract; rectovaginal fistulae are found between the rectum and the vagina. In the United States, most fistula are a result of surgical trauma, constant inflammation (as in the case of inflammatory bowel disorders), and/or radiation therapy for cancer. Generally painless, fistulae let urine or feces pass between the organs causing constant urine leakage or embarrassing soiling problems or foul-smelling discharge or gas coming from the vagina. Dr. Hall travels to Africa every year to help fix fistulas there, which are a result of childbirth trauma. Fistulas in Africa tend to be much bigger, more scarred, and much more difficult to fix than the fistulas encountered in first-world nations.

Defecatory dysfunction. This term refers to difficulty in evacuating stool from the rectum. It can be caused by spastic pelvic floor muscles or by stool trapping in a rectocele. Accurate diagnosis of the problem either by physical exam and/or Defecography (a special X-ray similar to a Barium enema) leads to appropriate treatment.

Fecal incontinence. This is uncontrolled leakage of stool from the anus which can be very disturbing to patients. The cause of fecal incontinence may be anatomic (torn sphincter muscle), neurologic, both, or due to irritable bowel syndrome overcoming even the best of sphincters. A treatment plan is developed based on the etiology (cause) of the problem and may include dietary management, use of medications, biofeedback, surgery and other modalities.

Rectal Prolapse. This term refers to weak support of the rectum so that it protrudes from the anus. Rectal Prolapse can either cause or be caused by constipation and trouble with bowel movements. Rectal Prolapse and Pelvic Organ Prolapse often occur together and if surgery is contemplated, both problems can be corrected at the same time. Dr. Hall works very closely with Colorectal Surgeons and Gastroenterologists to formulate a customized, joint treatment plan to best serve women with these disorders.