The physicians at the Good Samaritan Women’s Center for Specialized Care and at Cincinnati Urogynecology Associates regularly treat these urogynecological conditions:  

• Urinary incontinence, stress incontinence, overactive bladder, functional incontinence;
• Pelvic support problems, cystocele, rectocele, urethrocele, uterine prolapse, vault prolapse;
• Female sexual disorders, including painful intercourse and other sexual function problems;
• Bladder pain
• Pelvic pain
• Emptying disorders

Urinary Incontinence

Urine leakage is a sign that you have a medical problem that needs to be treated. Treatments depend on the type of incontinence you are experiencing. To properly diagnose, your doctor will ask about your symptoms and medical history including your pattern of urinating. You may be asked to complete a bladder diary for a few days. Depending on your type of incontinence, tests may be recommended. These may Dr. Kleeman with patientinclude a simple bladder filling study, complex urodynamics or cystoscopy.

Stress Incontinence

If certain everyday activities cause your urine to leak, you likely have stress incontinence. It can occur when you stress the bladder with a sudden increase in pressure such as:

• Sneezing
• Coughing
• Standing up
• Exercising
• Lifting heavy objects
• Laughing

Your doctor will help determine the reason for your stress incontinence. Treatment depends on the severity of your symptoms. Options include exercises, lifestyle changes, medications and surgery.

Overactive Bladder

If you have sudden urges to urinate that can be difficult to suppress, you probably have an overactive bladder. This occurs when your bladder muscles contract without warning, causing you to urinate more frequently than normal. This may or may not be associated with urge incontinence (frequent, sudden urges to urinate followed by leakage).

Symptoms include:

• Sudden urge to urinate followed by urine leakage
• Urinating more than eight times a day
• Frequent nighttime urination

If an overactive bladder disrupts your daily routine, talk to your doctor. Treatments are available that can help considerably. They may include bladder training, exercises and/or medication.

Functional Incontinence

Functional incontinence is most common among elderly patients with arthritis, Alzheimer’s or Parkinson’s disease. It occurs due to limitations in moving, thinking or communicating.

Pelvic Support Problems

If you experience problems with pelvic organ support, you are not alone. This can be described as a sensation of bulging, or pressure in the vagina, or the feeling of “falling down” in the vagina. The problem often begins after childbirth and may get progressively worse during the aging process. You may hear health care professionals refer to pelvic support problems as prolapse or herniation.

Symptoms of pelvic support problems depend on the organ involved. Symptoms can range from
mild to severe. They can include:

Feeling of pressure, pelvic heaviness, bulging sensation or something falling out of your vagina

• Achy low back pain
• Bulge of the pelvic organs outside of your vagina
• Difficulty with bowel movements
• Difficulty emptying your bladder
• Urinary incontinence

Your symptoms of pelvic support problems may be worse at certain times, (for example, at the end of a long day, especially after standing for long periods, or just prior to menstruation.) Conditions may occur separately or in conjunction with other types of prolapse.

Types of Pelvic Support Problems

Specific pelvic support problems are designated by the organ bulging into the vagina:

• Cystocele (bladder) – A cystocele occurs when your bladder bulges into the top part of the vagina. Some problems associated with a cystocele may include:
  • A bulge from your vagina
  • Incomplete emptying of your bladder (occurs if the cystocele is large enough to cause the urethra to bend)
   
• Rectocele (rectum) – A rectocele is a bulging of the rectum into your vagina. You may have difficulty with complete evacuation during bowel movements, and therefore, may have small, frequent bowel movements. Your doctor may do a rectal exam to help accurately diagnose a rectocele.
• Urethrocele (urethra) – A urethrocele is a protrusion of your urethra into your vagina. It may or may not be combined with a cystocele or symptoms of stress urinary incontinence (see above.)
• Uterine prolapse (uterus) – Uterine prolapse occurs when your cervix and uterus are pushing down into the vagina.
• Vault prolapse (top of the vagina) – If you have had a hysterectomy, the top of your vagina can prolapse or fall into your vagina. This most often occurs in conjunction with an enterocele (a bulge of the small intestines into the top of the vagina.)

Your health care provider will do a complete history and physical exam. A pelvic exam will be performed while you are lying down and again while standing. If you have problems with leaking urine or voiding completely, bladder function tests may be necessary.

Treatment

Treatment of pelvic support problems may include:

• Diet – If you have problems with urinary leakage, decreased intake of caffeine and limiting fluid intake to approximately 64 oz. per day may help. Maintaining a healthy body weight may prevent pelvic support problems.
• Exercises – Kegel exercises, also called pelvic floor exercises, can help with pelvic support problems. The pelvic floor muscles are like a hammock, stretching from your pubic bone to your tailbone. These muscles support your internal organs including the bladder, intestines and uterus. Childbirth, repetitive lifting and chronic coughing can weaken these muscles.
• Pessary – A pessary is shaped like a ring and looks similar to a diaphragm. It is placed in your vagina to help support your bladder, rectum and uterus. The pessary can be used as a temporary measure to provide comfort until surgery takes place. You may elect to use a pessary long term to avoid surgery. It also is an alternative if you are not able to have surgery to correct your prolapse. Pessaries come in several sizes. Being fitted for a pessary takes less than 10 minutes and occurs during an office visit.
• Medications – Your doctor may suggest vaginal estrogen cream. After menopause, the support to your pelvic floor may weaken due to lack of estrogen. Estrogen cream may help to strengthen your vaginal tissue and improve symptoms of pressure in your vagina.
• Surgery – Surgery may be an option to correct pelvic support problems. It can be done through your vagina, abdomen or laparoscopically/robotically.

Female Sexual Disorders

Problems with sexual desire, arousal, orgasm, and pain that bothers you is considered sexual dysfunction. The causes are varied and may include:

• Menopause or hormonal alterations
• Relationship problems
• Certain medications
• Diseases like diabetes or high blood pressure
• Depression
• History of abuse

Painful Intercourse

If you experience pain during or soon after sexual intercourse (called dyspareunia) you are not alone. There are many possible reasons for the pain. Your doctor can help you pinpoint the cause. Possibilities include:

• Intercourse too soon after surgery or childbirth
• Vaginal dryness or infection
• Menopause
• Reaction from a latex condom or diaphragm
• Irritation from soaps, douches or other hygiene products
• Sexually transmitted diseases
• Urinary tract infections
• Painful bladder syndrome
• Vulvar vestibulitis/vulvodynia
• Endometriosis
• Involuntary contraction of the vaginal muscles
• Hemorrhoids
• History of sexual abuse
• Certain medications

Depending on the cause, your doctor may recommend treatments that you can administer at home. Other treatment options include medications and/or therapy. Be sure to notify your doctor if the pain is accompanied by bleeding, vaginal discharge, genital lesions or irregular periods.

Other Sexual Function Problems

Resolving sexual function issues begins by discussing them with your doctor. She can help you find the reason for your symptoms. Recommended treatment will depend on your specific problem.

Bladder Pain

Painful bladder is a syndrome of recurring discomfort in the bladder, urethra or the surrounding pelvic region. Symptoms include:

• Urgent or frequent need to urinate
• Pelvic pressure or pain

Your pain may increase as your bladder fills, and decrease as it empties. It may go away for weeks, then return for no apparent reason.

It is important to rule out other causes for your bladder discomfort, or urgency and frequency. Your physician visit will include a detailed history and physical exam. Other testing may include a urine sample, performing a simple bladder-filling study, or looking in the bladder with a camera (cystoscopy.) Following these procedures, your treatment may include bladder retraining, lifestyle changes, physical therapy or medications.

Pelvic Pain

Pain in a broad area below your abdomen is called pelvic pain. You may have it during your period, during intercourse or bowel movement or whenever you are seated. The pain can be intermittent or steady, severe or a dull ache. It can feel like a pressure deep within your pelvic area.

If the pain is severe enough to disrupt your day, you should see your doctor. Finding the cause of pelvic pain may be difficult. Once the reason for the pain is found, treatment will focus on eliminating the cause. In some situations where an obvious cause is not identified, treatment will focus on managing the pain.

Emptying Disorders

Sometimes your bladder may not empty completely. This can lead to symptoms of fullness or discomfort, as well as leakage of urine due to an overly full bladder. Causes can include:

• Obstruction to the flow of urine either by prolapse or following surgical repair
• Weak bladder muscles
• Nerve damage due to certain diseases or spinal cord injury
• Certain medications

In order to determine the cause, a complete history and physical exam is necessary. Urodynamic and other imaging testing with fluoroscopy may assist in understanding how your bladder is emptying, and likely will improve your diagnosis. Treatments may include physical therapy, surgical interventions or medications.