incontinence & pelvic health

pelvic organ prolapse

Pelvic organ prolapse is a result from weakness or laxity in the ligaments, fascia, and muscles supporting the pelvic organs. The prevalence of pelvic organ prolapse is difficult to ascertain, and treatment is based on symptoms.

Common contributing factors include:

Childbirth (particularly vaginal delivery)
Obesity
Aging
Injury (eg, due to pelvic surgery)
Chronic straining

Less common factors include congenital malformations, increased abdominal pressure (eg, due to ascites, abdominal tumors, or chronic respiratory disorders), sacral nerve disorders, and connective tissue disorders.

Pelvic organ prolapse affects various sites and includes:

Anterior vaginal wall prolapse
Posterior vaginal wall prolapse
Apical prolapse (vaginal vault prolapse)
Uterine prolapse

Prolapse of the vaginal wall allows surrounding organs to protrude into the vaginal space; commonly used terms include cystoceles (bladder prolapse), urethroceles, enteroceles, and rectoceles (recto-vaginal wall prolapse), depending on the site. A prolapse may occur in multiple sites.

Risk factors for vaginal wall prolapse are:

Age
Obesity
Vaginal delivery

Severity of vaginal wall prolapse can be graded by the Baden-Walker system, which is based on level of protrusion:

Grade 0: No prolapse
Grade 1: Halfway to the hymen
Grade 2 : To the hymen
Grade 3 : Halfway past the hymen
Grade 4: Maximal possible

Although the Baden-Walker system is commonly used, it is an older classification system that is not reproducible; thus, professional organizations recommend the Pelvic Organ Prolapse-Quantification (POP-Q) system. The POP-Q system is a more reliable and reproducible classification system that is based on predefined anatomic landmarks:

Stage 0: No prolapse
Stage I: Most distal prolapse is more than 1 cm above the hymen
Stage II: Most distal prolapse is between 1 cm above and 1 cm below the hymen
Stage III: Most distal prolapse is more than 1 cm below hymen but 2 cm shorter than total vaginal length
Stage IV: Complete eversion

Pelvic or vaginal fullness, pressure, and a sensation of organs falling out are common. Organs may bulge into the vaginal canal or through the vaginal opening (introitus), particularly during straining or coughing. Dyspareunia can occur.
Mild cases may not cause symptoms until women become older.
Stress urinary incontinence can accompany pelvic organ prolapse.
Enteroceles may cause lower back pain. Rectoceles may cause constipation and incomplete defecation; patients may have to manually press the posterior vaginal wall to defecate.

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recurrent urinary tract infections (utis) / genitourinary syndrome of menopause

Recurrent urinary tract infections may be caused by hormonal changes that affect the tissue in the genitourinary tract such as: labia, clitoris, vulva, urethra, and the lower one-third of the bladder can greatly impact a woman’s quality of life. Instead of treating the bacteria with different antibiotic therapies, it is just as important to treat the environment (the vagina) which becomes a perfect medium for bacterial growth during menopause. Without treatment the problem will worsen and the pain may become intensified and affect sexual relations. However, there are treatment options, but first, a comprehensive evaluation is in order to rule out other urological conditions that can cause recurrent UTIs such as, kidney stones, urethral diverticulum, interstitial cystitis (IC), or cancer.

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interstitial cystitis (IC)

Interstitial cystitis (IC), also called painful bladder syndrome, is a chronic, or long-lasting, condition that causes painful urinary symptoms. Symptoms may vary between individuals. Some people experience mild discomfort, pressure, or tenderness in the pelvic area while others have intense pain in the bladder or suffer with urinary urgency or frequency.

Approximately four million Americans suffer from interstitial cystitis (IC), a recurring uncomfortable or painful condition of the bladder. IC symptoms are similar to a bladder infection, but IC does not respond to antibiotics. Approximately 3 in 8 million women and one in four million men suffer from IC.

IC is diagnosed by ruling out other conditions with similar symptoms. A lifestyle approach with diet, stress control, medications, and in some cases, rescue bladder treatments are utilized. Since IC may result from conditions that cause inflammation in the body, therefore, a lifestyle approach is fundamental in the treatment of this condition. Since severe IC symptoms may affect your quality of life, it is important to seek help for this condition early on.

A feeling of discomfort or pain and pressure in the bladder area – this may get worse as the bladder fills
Needing to go to the bathroom more often than normal during the day and night – as often as every 10 minutes
Feeling like you need to urinate right away, even just after you went
Pain, pressure or tenderness in the pelvic area and/or genitals o Pain during sex
In some people, IC symptoms come and go; but for others, the problem is constant

No one knows what causes IC.
IC seems to run in families. Physical or mental stress can worsen the symptoms of IC.
Smoking can make the symptoms of IC worse.
Cranberry products can trigger irritation in an IC bladder. Fruits considered to be more IC-friendly include pears, mild sweet apples and blueberries.

Diet changes, such as avoiding citrus fruits (oranges, grapefruits, lemons or limes) or spicy foods, and limiting caffeine, carbonated drinks and alcohol can help control symptoms.
Wear comfortable, loose clothing.
IC-friendly activities including yoga, Pilates and walking.
Physical therapy to relax pelvic muscles can help improve IC.
Train yourself to urinate less often once you have your pain under control.
Learn ways to control your stress, such as relaxation methods, meditation and massage.
Explore methods such as acupressure, acupuncture and biofeedback to relieve symptoms.
Oral prescription medications, nerve stimulation therapy and surgery may also help relieve symptoms of IC.

At this time there is no cure for IC. However, there are many available treatment options to help relieve your symptoms of bladder pain, urgency, and frequency. A combination of treatments is the best approach in managing your IC. Finding your optimal treatment plan may also require a period of trial and error. The following is a list of treatment options for IC, starting with the least invasive treatments and ending with the most invasive treatments. Only when less invasive treatments fail to control your symptoms or improve your quality of life should you and your healthcare provider consider more invasive treatments.

• Avoiding diet triggers (lifestyle changes) can help to control your IC symptoms (coffee, tea, soda, alcohol, citrus juices, and cranberry juice).
• Timed-urination and not waiting until your bladder tells you (bladder retraining), managing your stress, and developing healthy sleep habits.
• Over-the-counter products such as neutraceuticals, calcium glycerophosphates (Prelief), Pyridium (phenazopyridine) are available without a prescription at drug stores and pharmacies and are helpful for mild to moderate pain.
• Complementary and alternative medicine (CAM) refers to health care systems, practices, and products that are not part of the conventional medicine treatment approaches. CAM therapies most often used to treat IC symptoms include biofeedback, herbal remedies, massage, yoga, and Pilates.
• Physical therapy can treat pelvic floor muscle dysfunction.
• Your Augusta Anti-Aging Medicine healthcare provider will prescribe medication that may include antidepressants, antihistamines, pentosan polysulfate sodium, H2 blockers, and more. You may also be prescribed bladder instillations—medicine your healthcare provider puts directly into your bladder via catheter.
• Removal of Hunner’s ulcers (also known as Hunner’s lesions) can reduce symptoms significantly.
• Cystoscopy with hydrodistention under anesthesia may reduce pain and discomfort in some IC patients, which can last 3 to 6 months. However, not everyone benefits from this procedure, and it may take up to several weeks to notice any symptom improvement.
• Neuromodulators, also known as electrical nerve stimulators, send mild electrical pulses to nerves in the lower back and help manage urinary function. Neuromodulators have been helpful for IC patients who don’t get enough relief from other therapies.
• Cyclosporine (an immunosuppressant) may be used when other treatments haven’t helped enough or you and your provider agree your symptoms justify it.
• Botulinum toxin A (Botox) injections into the bladder muscle are only considered when other treatments haven’t helped enough or you and your doctor agree your symptoms justify it.

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Body Remodeling & Tightening

Aviva–more information coming soon!

Morpheus8 Body is the newest innovation in fractional micro-needling and radio frequency. This treatment is great for someone who wants to shape areas of their body without surgery. We can tighten skin, melt fat, and improve surface irregularities all with one treatment! After numbing, the microneedles penetrate the skin and emit radio frequency energy that targets fat and the fibro-septal network. With Burst technology, we can treat three different depths on the same pass, shrinking the treatment time by two-thirds!

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Morpheus8V is the latest innovation in women’s health. With this technology we are able to apply radio frequency bulk heating inside the vagina and under the vaginal mucosa to help alleviate a wide range of issues, from stress urinary incontinence to pain during intercourse.

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VTone is a gentle FDA-cleared technology designed to provide intravaginal electrical muscle stimulation (EMS) and neuromuscular re-education to rehabilitate weak pelvic floor muscles for the treatment of stress, urge, and mixed urinary incontinence in women.

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Revitalize your skin! Tighten skin, reduce scarring, and remove fine lines and wrinkles with Morpheus8 by InMode. This revolutionary technology combines micro-needling with radio frequency. The microneedles penetrate the skin to stimulate your body’s natural healing process, returning a fresh, youthful look to your skin. The radio frequency heats the deeper layers of the skin to precise temperatures that cause the fibroseptal network to contract and pull your skin tight.

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We’re excited to now offer FormaV from InMode. It is a revolutionary radio frequency technology that has multiple uses. It can help with anything from laxity, stress urinary incontinence, pain with sex, to dryness.

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Sometimes diet and exercise alone won’t get you the muscle definition you’re looking for. Seek perfection in your body with EvolveTone from InMode Aesthetics. Tone uses electrical signals to stimulate muscle contractions. You can do the equivalent of 1,000 sit-ups in just 30 minutes.

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