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Urogynecology + Pelvic Reconstructive Surgery

Urogynecology is a medical specialty that combines urology and gynecology care to treat conditions like a weak bladder or pelvic organ prolapse. Our goal is to make it easier for women and people assigned female at birth (AFABs) to receive specialized care for the vagina, uterus, bladder and pelvic organs.

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What’s the difference between urogynecology and urology?

Urogynecology is dedicated to treating pelvic health concerns specifically for women and AFABs, whereas urology is a more general urinary medical practice that treats all people.

Since every body is different, we take a personalized approach to pelvic health care. Whether you seek relief from a urinary tract infection (UTI), stress incontinence or other conditions affecting your pelvic floor, we’re committed to alleviating symptoms for a more comfortable life.

Urogynecology patient talking with Diego S. Illanes, MD, FACOG, FACS who is explaining a procedure while using a prop for reference during a clinic appointment.
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Conditions

Urogynecological and pelvic floor disorders can take a toll on your day-to-day activities. Know that you can turn to our urogynecologists to treat the following conditions:

Bladder, bowel or vaginal fistulas (abnormal connection between body parts)
Fecal incontinence
Interstitial cystitis
Maternal birth trauma
Neurogenic bladder
Overactive bladder
Recurrent urinary tract infections (UTI)
Stress urinary incontinence
Urethral diverticulum
Urge incontinence

Stress urinary incontinence

Stress urinary incontinence is a type of bladder leakage that happens when you cough, laugh, sneeze, exercise or do anything that puts pressure or stress on your lower abdomen. It develops when the muscles and ligaments that support your urethra become weakened by conditions like:

  • Aging
  • Childbirth
  • Chronic constipation
  • Chronic cough
  • Genetic factors
  • Heavy lifting or straining
  • Obesity
  • Pregnancy

Stress urinary incontinence symptoms

Stress urinary incontinence affects 10–20% of women and AFABs. We encourage talking with your doctor if you experience any of these symptoms:

  • Bladder leakage or urinary incontinence
  • Bowel leakage or fecal incontinence
  • Feeling like you can’t empty your bladder well
  • Leaking with cough, laugh, sneeze or exercise
  • Leaking with orgasm or sexual activity
  • Limiting your physical activity to avoid leaking

Pelvic organ prolapse

Pelvic organ prolapse happens when weakened pelvic muscles cause one or more organs — bladder, rectum, uterus or vagina — to bulge or drop out of place. This condition can affect anyone. For women and AFABs, a prolapse occurs when organs bulge into or out of the vagina. This can be caused by:

  • Aging
  • Childbirth
  • Chronic constipation
  • Chronic cough
  • Connective tissue diseases
  • Heavy lifting or straining
  • Obesity
  • Pregnancy

There are different types of prolapses, depending on the body part is moving into your vagina:

  • Cystocele (bladder)
  • Enterocele (small intestine)
  • Rectocele (rectum)
  • Uterine prolapse  (uterus)
  • Vaginal vault prolapse (top of the vagina, in people who have had a hysterectomy)

Pelvic organ prolapse symptoms

Don’t delay in speaking with your doctor if you experience any of these symptoms:

  • A bulge in your vagina
  • Bladder leakage or urinary incontinence
  • Bowel leakage or fecal incontinence
  • Discomfort during sexual intercourse
  • Dullness, heaviness or significant pressure in your vagina
  • Feeling like you can’t empty your bladder well
  • Feeling like something is falling out of your vagina
stethescope

Testing

To learn more about your pelvic and reproductive organs, we may recommend 1 or several of the following tests:

  • Cystoscopy
  • Pelvic floor ultrasounds
  • Peripheral nerve evaluation for overactive bladder or accidental bowel leakage
  • Urodynamic test
hands-heart

Treatments

Urogynecologic treatment options range from simple pelvic floor exercises to surgical options. Not all people will require surgery to address their urogynecologic condition. We offer minimally invasive treatments you can complete from the comfort of your home or in-office procedures we can perform during a visit, like:

  • Bladder Botox® injections
  • Posterior tibial nerve stimulation
  • Trigger point injections in the pelvic floor muscles

When you turn to Tufts Medicine for care, you can expect a treatment plan that balances your preferences and goals with your health history.

Pelvic floor physical therapy + exercises 

Our physical therapists are invested in your recovery. We’ll work with you to reduce your symptoms using a range of pelvic floor physical therapy exercises like:

  • Bladder control training
  • Electrical stimulation
  • Ergonomics and body mechanics training
  • Pelvic floor and core exercises
  • Massage and myofascial release
  • Relaxation techniques

Pelvic floor exercises, or more commonly known as Kegel exercises, are simple squeeze-and-release actions that help strengthen pelvic floor muscles. You may not be able to see the difference Kegels make over time, but you can feel them.

These exercises are very helpful for people with stress urinary incontinence or pelvic organ prolapse. Consistency is key here, and we recommend doing these exercises regularly to manage your condition. If you need help performing these exercises, we can refer you to a physical therapist who will work with you to target and strengthen your Kegel muscles.

Pessary

A pessary is a soft, flexible device typically made of silicon that is placed into the vagina to support prolapsed pelvic organs or treat stress urinary incontinence. They’re also a good option for people who have a urogynecologic condition and want to delay or avoid surgery.

Pessaries come in all shapes and sizes. Our care team will work closely with you to find the right fit, and assist you with inserting or removing the pessary as needed.

Surgical options

To find out which surgery is best for you, we’ll talk to you about your preferences, goals, and medical and surgical history. We’ll also consider the severity of your conditions and symptoms.

  • Fistula surgery
  • Laparoscopic surgery
  • Mesh complication surgeries
  • Pelvic reconstructive surgery
  • Robotic-assisted laparoscopic surgery
  • Sacral neuromodulation
  • Sphincteroplasty
  • Vaginal surgery
Stress urinary incontinence surgery

The following procedures help treat stress urinary incontinence by supporting the bladder neck and urethra:

  • Mesh midurethral slings
  • Autologous fascia slings (non-mesh slings)
  • Laparoscopic Burch urethropexy (non-mesh laparoscopic surgery)
  • Urethral bulking
Pelvic organ prolapse surgery

Because a pelvic organ prolapse can affect one or multiple organs in your pelvic area, we’ll align the following surgical approaches with your body’s anatomy and needs:

  • Colpocleisis (vaginal closure)
  • Colporrhaphy (fixing the front or back walls of the vagina)
  • Hysterectomy (removal of the uterus)
  • Non-mesh surgery (native tissue)
  • Sacrocolpopexy (mesh-augmented)
  • Uterine sparing surgeries (hysteropexy)
Anasuya Gunturi MD, PhD talks with patient at Lowell General Hospital's Women's Wellness Center clinic appointment.
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