The Center for Women's Continence and Pelvic Health treats many pelvic floor conditions common to women. Often, these conditions interfere with a woman's quality of life and require medical or surgical intervention. The expert physicians at Cedars-Sinai are trained to provide high quality care.
Some conditions treated at the center are:
- Stress urinary incontinence: Stress urinary incontinence is an 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. Treatment focuses on different methods to strengthen or support the urethral sphincter to better help control urination. Sling procedures (a minor vaginal surgery) are very effective for treating stress urinary incontinence. Other treatment options include medications to increase urethral pressure, physical therapy to improve support of the pelvic floor and urethra, and periurethral injections.
- Pelvic organ prolapse: Prolapse is the falling down or slipping of a body part from its usual position. When prolapse occurs in the pelvis, it is referred to as pelvic organ prolapse of which there are several types: cystocele (the bladder), rectocele (the rectum or large bowel), enterocele (the small bowel), uterine prolapse (the womb) or "vaginal vault prolapse" which can occur after hysterectomy. Treatment includes the use of pessaries or various surgical options including laparoscopic or vaginal reconstructive operative procedures.
- Overactive bladder: When a patient experiences an unstoppable urge to urinate, it is generally referred to as an overactive bladder. Women with overactive bladder can have such urinary frequency that it hinders quality of life or experience a nighttime frequency that interferes with sleep. 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, the Sacral Nerve Implant ("Interstim" or bladder pacemaker) is a proven effective treatment.
- 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 the muscle), it can be extremely painful. It can also lead to trouble urinating or defecating or painful intercourse. Treatment can involve physical therapy, lifestyle changes, muscle relaxant medications, and other non-invasive methods for relieving the spasm. The sacral nerve implant 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, the sacral nerve stimulator, or intermittent catheterization.
- Defecatory dysfunction: This term refers to difficulty in evacuating stool from the rectum. It can be caused by spastic pelvic floor muscles or more often by stool trapping in a rectocele. Accurate diagnosis of the problem either by physical exam or defecography (similar to a barium enema, which is a special X-ray) leads to appropriate treatment.
- 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. Generally painless, fistulae let urine or feces pass between the organs causing constant urine leakage, embarrassing soiling problems or foul-smelling discharge or gas coming from the vagina.
- Interstitial cystitis/Painful Bladder Syndrome)(IC/PBS): Patients often have symptoms of urinary tract infections but these patients have negative cultures or minimal improvement with antibiotics. The symptoms include urinary frequency and suprapubic pain. Treatment for IC/PBS may include neuromodulator drugs such as gabapentin or nortriptyline, dietary modification, the use of herbal remedies as well as pelvic floor physical therapy. IC/PBS often is associated with vulvodynia or pain in the vulvar area with resultant pain during intercourse.
- Recurrent urinary infections: Recurrent urinary infections are 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 three to seven days. Recurrent urinary infections often need to be treated with either 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.
- Fecal incontinence: Fecal incontinenence is an uncotrolled 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 or both, or it may be 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: Rectal prolapse refers to a weak support of the rectum so that it protrudes from the anus. It often accompanies pelvic organ prolapse and can be treated at the same time as vaginal prolapse. Treatment by a gynecologist or urologist and a colorectal surgeon, usually involves surgery as well as steps to avoid constipation.