Overview

Overview

In the Section of Urogynecology and Reconstructive Pelvic Surgery, our physicians have been performing a number of innovative techniques for the diagnosis and treatment of urinary and fecal incontinence, pelvic organ prolapse and other pelvic floor disorders. Our department was one of the first in the country to establish a fellowship in the board approved specialty of Female Pelvic Medicine and Reconstructive surgery. This rigorous fellowship has trained many leaders in the field.

Our division provides both basic and advanced urodynamic testing to evaluate women with urinary disorders. Our physicians are further specialized in evaluating and treating pelvic floor disorders. There are many different treatments available for urinary and fecal incontinence, pelvic floor dysfunction and pelvic organ prolapse. Our physicians perform numerous procedures for the treatment of incontinence and prolapse. For urinary incontinence, different types of outpatient procedures performed include the tension free vaginal tape (TVT) procedure, transobturator vaginal tapes and sacral neuromodulation. To treat pelvic organ prolapse, common short stay procedures performed include laparoscopic and robotic-assisted sacral colpopexy, vaginal reconstruction with native tissue repair or mesh implantation, and explantation of vaginal mesh.

Our physicians also provide innovative office procedures including peripheral nerve electrode placement and Botox intramuscular (bladder) injections for severe urge incontinence, trigger point injections for pelvic pain, and transurethral bulking agent injections for stress incontinence. As of July 2015, we will offer vaginal laser therapy for vaginal atrophy.

For more information about women's pelvic health issues, please visit the American Urogynecologic Society's website.

What We Treat

What We Treat

Incontinence

What is incontinence?

Incontinence is the inability to control the passage of urine or stool. Current figures indicate that 25 to 45 percent of American women suffer with involuntary loss of bladder control (urinary incontinence) and that 10 percent of these people also have problems with bowel control (fecal incontinence).

Often, embarrassment and the stigma associated with incontinence prevent the person from seeking treatment, even when incontinence threatens his or her quality-of-life and that of his or her family.

Urinary and fecal incontinence can be cured or significantly improved once the underlying cause has been detected. However, it's important to recognize that incontinence is a symptom and not a disease. Its cause may be quite complex and involve many factors. Your physician should complete an in-depth evaluation before beginning treatment.

What can I do to address this problem?

Getting help means taking the first step. See your doctor. Diagnostic tests for incontinence can be completed in the outpatient setting and are not painful. Once these tests have confirmed the cause of your incontinence, your physician can make specific recommendations for treatment, many of which do not require surgery. No matter how serious the problem seems, incontinence is a condition that can be significantly helped and, in most cases, cured.

Pelvic Organ Prolapse

Pelvic organ prolapse is a downward descent of female pelvic organs, including the bladder, uterus and the small or large bowel, resulting in protrusion of the vagina, uterus, or both. Prolapse development can be attributed to several factors, including vaginal child birth, advancing age and obesity. Vaginal delivery, hysterectomy, chronic straining, normal aging and abnormalities of connective tissue or connective-tissue repair predispose some women to disruption, stretching or dysfunction of the connective-tissue attachments of the vagina, resulting in prolapse.

Get the FAQs on Pessaries

What Is A Pessary?
A pessary is a silicone disk which comes in multiple styles and sizes. The style/size is chosen based on the patient’s medical needs and individual anatomy. A pessary is fit in the office with no procedure necessary.

What Purpose Does A Pessary Serve?
A pessary is typically used for pelvic organ prolapse. In some cases it may also be used to decrease urinary incontinence. It may be used temporarily if a patient desires surgery or as an alternative to surgery. Its purpose is to alleviate vaginal pressure and aid in bladder emptying.

How Do I Manage/Care For A Pessary?
Depending on the style, a pessary may be taken out and cleaned by the patient or the healthcare provider. Women who remove their own pessary typically do so twice weekly. The removal schedule is discussed at the office visit and altered based on individual needs. Once removed you may choose to leave the pessary out overnight or even a few days. Other women will remove, clean and immediately replace their pessary. This is based on patient choice and comfort.

Vaginal Health Treatment: MONALISA TOUCH® Laser Therapy

What is the MonaLisa Touch? 
The MonaLisa Touch procedure is an office-based laser treatment for vaginal health. It is used to treat symptoms of vaginal atrophy, such as vaginal dryness and painful intercourse. 

Does the treatment hurt?
The procedure is virtually painless and requires no anesthesia. Some patients may experience some discomfort when the vaginal probe is inserted into the vagina, but the actual treatment is not painful. A numbing ointment is applied to the vaginal opening prior to the treatment, to help ease any discomfort from the probe insertion. 

How many treatments are recommended?
A series of three treatments over 18 weeks is typically recommended for the initial therapy. However, some patients have sufficient results after just one to two treatments. As time goes on, some patients may benefit from additional maintenance treatments, which can be done every 6 to 12 months or as determined by the treating provider.

How much does the treatment cost? 
Treatment cost may be dependent on your particular insurance. Please call the Cleveland Clinic Ob/Gyn & Women’s Health Institute financial counseling office for costs.

Patient Education

Patient Education

Preparing for Elective Gynecologic Surgery

Eating Well

Preparing your body prior to surgery can have a profound impact on your recovery. Nutrition plays a big role by helping you heal better and fight infection. Eating enough calories, protein, vitamins and minerals will all help speed your recovery.

  • Eating to Heal: Choose foods that will help your body heal. Good choices are protein-rich foods, whole grains, fruits, vegetables and dairy products.
  • Eat at least three times a day. Don’t skip meals.
  • Include protein-rich foods with each meal. Lean, quality proteins can be found in fish, poultry, beans, eggs, cheese, nuts, tofu, milk, cottage cheese, yogurt and protein drinks.
  • Drink at least 6 to 8 eight-ounce cups of fluid each day to stay well hydrated.
  • Add a daily protein drink if you cannot eat enough food.

For more information or to schedule an appointment to see a Registered Dietitian at the Cleveland Clinic Section of Nutrition Therapy, call (216) 444-3046.

Managing Your Weight

Achieving a healthy weight before surgery can improve your chances of having a better outcome after surgery.

Excess weight can put you at risk for certain side effects and complications in surgery, such as prolonged surgery time and increased risk for infections, heart or lung issues and blood clots.

Many women who want to start losing weight can understandably find it challenging to know how to start.

The Women’s Weight Management Program at the Ob/Gyn & Women’s Health Institute is specifically designed to help women lose weight and decrease risks associated with obesity. Ask your doctor if you are interested in a referral to accomplish your weight loss goals.

Quitting Smoking

Smoking causes serious harm to your health, but did you know that it can also increase your risk for many problems after surgery? These include:

  • Greater likelihood of breathing problems or lung infections (pneumonia)
  • Higher risk of your wound (incision) getting infected
  • Increased chance of having a heart attack

The Cleveland Clinic Smoking Cessation Program is a comprehensive program that can be tailored to your individual needs. We offer a variety of services designed to help you throughout the process, including office visits, virtual visits, shared medical appointments, smoking classes, our eCoach program and pharmacy consultations. Call (216) 448-8247 to schedule an appointment.

Controlling Blood Sugar

If you have diabetes, you know good blood sugar control is important. Having surgery puts stress on your body, and stress can affect your blood sugar level.

Blood sugar that is too high or too low can cause serious problems. Proper blood sugar control can:

  • Lower your risk of developing an infection
  • Help you heal better after surgery
  • Decrease your risk of fluid, electrolyte or kidney problems
  • Shorten your length of stay in the hospital

Your doctor will need to know what your recent blood sugar test results have been. On the day of your surgery, your doctor should check your blood sugar before your operation. Talk to your doctor to see whether there is anything else you can do to manage your diabetes.

Resources:

Nutrition Therapy at the Cleveland Clinic

  • Appointments: 216.444.3046

Weight Loss:

Cleveland Clinic Smoking Cessation Program

  • Appointments: 216.448.8247

Stop Smoking

Strong for Surgery

Our Doctors

Our Doctors

Appointments

Appointments

Make an Appointment

To make an appointment call us at 800.223.2273 ext. 4-6601. To arrange a same-day visit, call 888.223.CARE (888.223.2273).

Traveling from a distance?

For information about lodging, parking, directions and other details regarding your visit to Cleveland Clinic, please visit our Visitors Information site or contact the free Medical Concierge service available to all out-of-state and international patients at medicalconcierge@ccf.org or 800.223.2273 Ext. 55580.

Urogynecology and Female Pelvic Reconstruction is available at the following locations: