David Rahn, M.D. Answers Questions On: Urogynecology

Urogynecology is the intersection of benign gynecology with urologic concerns for women. We treat female pelvic floor disorders such as urinary incontinence and pelvic organ prolapse.

Some of the complaints common with pelvic floor disorders are dysparenunia, which is pain during intercourse; dysuria, or pain during urination; and nocturia, which is bothersome nighttime urination.

We are a specialty clinic, but we also treat common gynecologic concerns.

Pelvic organ prolapse is a hernia in the vagina. Weakened connective tissue can cause the bladder, uterus, bowels, or rectum to protrude. Patients may feel as if they are sitting on a bulge and often have trouble urinating comfortably or having normal bowel movements.

Pelvic organ prolapse can lead to recurrent bladder infections if the patient has obstructed urinary flow. It generally is not painful but can be very bothersome.

Most can be treated or managed with non-surgical solutions including strengthening of the pelvic floor muscles, changes in diet, medications, and some office-based procedures.  When these conservative measures do not suffice, most disorders can be treated with minimally invasive procedures, but others may require a longer surgery and hospital stay.

We use the minimally invasive sling procedure to treat, for example, stress urinary incontinence, which is leakage during physical stress such as lifting or exercise. A sling procedure involves putting a hammock-like fixture under the urethra to support it.  The procedure takes about 30 minutes, patients can go home the same day, and they experience quick relief from their symptoms.

Prolapse surgeries generally are not minimally invasive, but some can be done laparoscopically. We commonly treat patients who’ve had unsuccessful prolapse surgery elsewhere and those who are experiencing complications from transvaginal mesh placement.

Patients bothered by persistent pelvic floor disorders that have not been successfully managed by their general physician should seek a specialist who has had additional training beyond regular obstetrics and gynecology. Everyone in our division has had additional training in urogynecology.

Patients should also determine if their physician is comfortable with multiple modalities to treat, for example, overactive bladder beyond just a pill. He or she should be able to tailor the treatment to the patient.