Sunday, September 28, 2008

Women's Health Urogynecology Pelvic Floor Disorders

By Natalie Piekos

Emory healthcare focuses on both innovation as well as high quality patient care. At Emory, advanced technology goes hand in hand with compassionate doctor care. What puts Emory above other medical institutions is that it provides up-to-date procedures in addition to personalized care.

When it comes to Women's Health Services, Emory understand that this balance of expertise and individual care are especially critical and this unique dynamic is one of the reasons why women use Emory's services. Women want to know they will be guided and supported throughout their treatment and procedures. Yet, they still want current technology and renowned doctors. A developing area in Obstretrics and Gynocology is Urogynecology.

Urogynecologists specialize in caring for a woman's specific urology and pelvic problems. This niche area is needed; a woman's internal make-up is unique and complex. Urogynecologists are sub-specialists that can be thought of as an Ob/Gyn or Urologist who concentrates on caring for a woman's urology and pelvic problems.

Urogynecologists are unique in that they have completed not only a four year residency in Obstretrics and Gynecology, but they also have additional training in the evaluation and treatment of conditions that affect the female pelvic organs and the muscles and connective tissues that support the organs. This training allows them to help women with non-cancerous gynecologic problems that often result due to childbirth, menopause or aging.Urogynecologists primarily treat women with pelvic floor disorders such as urinary or fecal incontinence and prolapse (bulging or falling) of the vagina, bladder and/or the uterus. Statistics show that urinary incontinence (leakage of urine) is very common affecting 10-20% of women under age 65 and up to 56% of women over 65.

The most common problems that a urogynecolegist may treat is pelvic floor disorders such as urinary or fecal incontinence and prolapse (bulging or falling) of the vagina, bladder and/or the uterus. Prolapse is when female organs fall down into the pelvic area; a gradual procedure that occurs over the course of many years. This problem is often accompanied by incontinence because both conditions are believed to result from damage to the pelvic floor that occurs after childbirth. However, while delivering a child is often a factor, other possible factors can lead to these conditions. For example, very heavy lifting on a daily basis (as some paramedics and factory workers might do) chronic coughing, severe constipation and obesity may all play a role in developing prolapse or incontinence.

Treatment usually involves behavioral, pharmacological, or surgical methods. Behavioral and pharmacological methods are usually attempted before surgery is tried. Behavioral changes include diet and exercise modification. Highly acidic foods and beverages, such as citrus fruits and vinegar can irritate the bladder and so patients with inconsistence are advised to avoid these and other similar foods. If a non-acidic diet helps, no other treatment is then pursued. Pelvic Muscle Exercises are included in behavioral changes because they strengthen a woman's sphincter muscles thereby reducing incontinence.

In addition, surgical treatments for these conditions may also be used. A fairly common surgical procedure is called Interstim Therapy and this is used to treat incontinence. In this procedure, a tined-lead is placed through the S3 foramen, and the lead is then attached to a small medical device call an implantable pulse generator or IPG (which is also use in cardiac pacemakers) which sends small electrical impulses to the sacral nerve. This helps to decrease the symptoms of urgency, frequency, urinary retention and most importantly, urge incontinence. In addition, there are ongoing studies involving injecting Botox into the bladder wall; more information on this procedure is still needed before it is recommended.

As mentioned above, Emory is a leader in medicine because it is not simply research oriented but listens to patient needs and responds with a caring team of doctors, and nurses. Women's Health Services at Emory now includes The Emory Center for Pelvic Reconstructive Surgery & Urogynecology. This newer facility exemplifies yet again how Emory manages to continue as a leader in its medical endeavors; Emory is dedicated to its patients and is not afraid to embark on new challenges, tasks, and complex conditions.

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