In the Section of Urogynecology and Reconstructive Pelvic Surgery, our physicians pioneered 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 specializes in minimally invasive techniques for the treatment of pelvic floor disorders, which includes urinary incontinence, accidental bowel leakage, pelvic organ prolapse (prolapsed bladder, uterus, or rectum), and pelvic floor dysfunction. For urinary incontinence, we offer the tension free vaginal tape (TVT), and transobturator (TOT) vaginal tapes, urethral bulking injections, as well as Botox bladder injections, and sacral neuromodulation for overactive bladder. To treat pelvic organ prolapse, we offer outpatient laparoscopic and robotic-assisted sacral colpopexy, vaginal reconstruction with native tissue repair or mesh implantation, and explantation of vaginal mesh. We also perform vaginal laser therapy for vaginal atrophy and for vulvar skin conditions such as lichen sclerosus.
The vast majority of our surgeries are performed on an outpatient basis, with no or minimal narcotics necessary, due to following evidence-based Enhanced Recovery After Surgery (ERAS) guidelines, which utilizes multi-modal analgesia and post-operative nausea/vomiting mitigating strategies.
For more information about women's pelvic health issues, please visit the American Urogynecologic Society's website.
What We Treat
What is incontinence?
Incontinence is the inability to control the passage of urine or stool. Current figures indicate up to 50% of women suffer with involuntary loss of bladder control (urinary incontinence) at some point during their lifetime and that 10% of these people also have problems with bowel control (fecal incontinence, or accidental bowel leakage).
Often, embarrassment and the stigma associated with incontinence prevent the person from seeking treatment, even when incontinence impacts her quality-of-life and that of her family.
Urinary and fecal incontinence can be cured or significantly improved with appropriate treatment. Your physician will 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 been performed, your physician can make specific recommendations for treatment, many of which do not require surgery. Incontinence is a condition that can be significantly helped and, in many cases, cured.
Pelvic Organ Prolapse
Pelvic organ prolapse is a downward descent of female pelvic organs, which can result in protrusion of the prolapsed bladder, uterus, or rectum. 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.
- Treatment options for pelvic organ prolapse
- Information on how pessaries are used for pelvic organ prolapse
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, as well as some vulvar skin conditions.
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?
Your provider can discuss with you how to arrange payment with Cleveland Clinic OB/Gyn & Women’s Health Institute financial counseling office.
Preparing for Elective Gynecologic Surgery
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.
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.
- Appointments: 216.444.3046
- CDC: Assessing Your Weight (Body Mass Index Calculator)
- Women’s Weight Management Program at the Cleveland Clinic
- Appointments: 216.444.6601
- Appointments: 216.448.8247
- Freedom From Smoking® Online - a program to help you quit smoking
- Diabetes Center at the Cleveland Clinic
- Appointments: 216.444.6568
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 [email protected] or 800.223.2273 Ext. 55580.
Urogynecology and Female Pelvic Reconstruction is available at the following locations: