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Urogynecology and Pelvic Floor Disorders

You are not alone.

Many women face personal health problems that can interfere with their daily living. Most of these conditions are unique to women—including urinary incontinence and pelvic floor disorders such as genital prolapse. These conditions are rarely spoken about outside the medical community.

Approximately 8 to 10 million women in the U.S. are seriously affected by urinary incontinence and pelvic floor disorders. Many women are unaware that help is available for these uncomfortable and frequently disabling conditions.

With proper diagnosis and treatment, women can return to a more pleasant, active, and independent lifestyle.

Contact Information

Women & Infants Hospital
Division of Urogynecology and Reconstructive Pelvic Surgery

101 Plain Street
5th Floor
Providence, RI 02903
Click here for directions >>

Mon - Thu 8 a.m. - 4 p.m.
Fri 7 a.m. - 3 p.m.
P: (401) 453-7560
F: (401) 453-7573

Additional Locations:

Care New England Center for Health
49 South County Commons Way, 2nd Floor
South Kingstown, RI 02879
Click here for directions >>

Care New England Medical Group Primary Care - East Greenwich
1050 Main Street
East Greenwich, RI 02818
Click here for directions >>

Care New England Medical Group Family Medicine- Lincoln
640 George Washington Highway, Building A, Suite 102
Lincoln, RI 02865
Click here for directions >>

For All Additional Locations
P:
 (401) 453-7560
F: (401) 453-7573

Please be advised that this location is a provider-based clinic and both a physician and facility fee will be assessed, which may result in a higher out-of-pocket expense.

We are here for you.

Many women face personal health problems that can interfere with their daily living. Most of these conditions are unique to women—including urinary incontinence and pelvic floor disorders such as genital prolapse. These conditions are rarely spoken about outside the medical community.

Approximately 8 to 10 million women in the U.S. are seriously affected by urinary incontinence and pelvic floor disorders. Many women are unaware that help is available for these uncomfortable and frequently disabling conditions.

With proper diagnosis and treatment, women can return to a more pleasant, active, and independent lifestyle.

Teaching the Next Generation of Caregivers

As an Alpert Medical School teaching hospital, Medical students listening sitting at desk at the universityWomen & Infants Hospital is involved in a variety of important medical education and research programs. Fellows, residents, medical students, and other learners are important members of our team. You will always be informed about the identities and roles of the members of your care team.

You may be asked to participate in research programs. All of the Women & Infants’ research programs are reviewed by the hospital’s Institutional Review Board to protect our patients’ rights. Each patient will be asked for permission before becoming involved in any research.

About our staff

Our entire staff is sensitive to the personal and emotional needs of each woman who visits our Center. All of the physicians at the Center for Women’s Pelvic Medicine and Reconstructive Surgery are specially trained to help women suffering from urogynecologic problems. We all hold full-time faculty appointments at The Warren Alpert Medical School of Brown University.

In addition, our full-time registered nurse practitioners are specially trained in the diagnosis and non-surgical management of urogynecological disorders.

Disorders Treated

Urinary Incontinence

Urinary incontinence is any time urine leaks out when you don’t want it to, something that happens to many women. There are different types of urinary incontinence, and treatment options can depend on the type of incontinence you have.

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Fecal Incontinence

Fecal incontinence, also called “accidental bowel leakage,” is when you accidentally pass solid or liquid stool or mucus from your rectum. This can happen when you feel the urge to go and cannot get to a bathroom in time, or you might pass stool in your underwear without knowing.

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Overactive Bladder

Overactive bladder is any combination of the following problems: Urinary urgency, an uncomfortably pressing need to get to the toilet. Urinary frequency, or having to urinate more often than you think you should.

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Painful Bladder Syndrome

Painful bladder syndrome (PBS) is a condition that causes bladder pain, pressure, or discomfort. Some people feel the need to urinate frequently or rush to get to the bathroom. The symptoms range from mild to severe and can happen sometimes or all the time.

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Pelvic Organ Prolapse (POP)

Pelvic organ prolapse (POP) is a common problem. Women with POP may notice a bulge coming from the vagina when they wash or wipe, or just going about daily activities. It usually isn’t painful, but can be very uncomfortable and can cause a feeling of pressure.

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Urinary Tract Infections

Although the urinary system is designed to keep bacteria that cause infection out, the body’s defenses sometimes fail. UTIs typically occur when bacteria get into the bladder through the urethra. When that happens, bacteria can multiply and develop into an infection in the urinary tract. 

Learn More

Tests and Treatment

About Urodynamics

Urodynamics is a test measuring the capacity of and pressures of your bladder and urethra (the tube that empties your bladder). In other words, it tests the function of your bladder. A numbing gel is used before the test. A small catheter is placed in the urethra through which sterile water is used to fill your bladder and to read pressures in both your bladder and urethra. A second catheter is placed either in your vagina or rectum for additional pressure readings. The test takes 30 minutes to one hour.

What is a cystoscopy?

Cystoscopy is a test used to look at the inside of your bladder. Numbing gel is put in your urethra (the tube that empties your bladder). A narrow scope ("straw size") is used to look at the inside of your bladder. This test takes approximately 15 to 20 minutes.

What is a pessary?

Basic facts about pessaries

  • A vaginal pessary is a simple device inserted into the vagina to support the pelvic organs which may have prolapsed (fallen).
  • A pessary is a non-surgical solution to pelvic organ prolapse.
  • It can be used prior to, or sometimes in place of surgical procedures to correct pelvic organ prolapse.
  • A properly fitted pessary can improve the quality of life for women.
  • Pessaries come in many shapes, sizes, and materials.
  • Some pessaries have metal components and should be removed before you have an MRI.
  • None of the pessaries will affect airport metal detectors.
  • Some pessaries can remain in place during sexual intercourse. Others cannot.
  • A pessary is NOT a contraceptive device. If you are sexually active and still fertile you will need to use contraception to avoid an unwanted pregnancy.

Pre-Op and Post-Op Instructions

Preparing for Surgery
AT YOUR PREOPERATIVE APPOINTMENT

Please bring:

  • A list of your medical conditions
  • A list of your current medications (including the dose and how often you take them)           
  • A list of your allergies
  • The completed enclosed form (pre-admission testing questionnaire)

Please inform your surgeon if you have a history of:

  • Tuberculosis (TB)
  • Methicillin-Resistant Staph Aureus (MRSA) infection n Hepatitis
  • Clostridium Difficile (C Diff)
  • Human Immunodeficiency Virus (HIV)
WHEN TO SEE YOUR PRIMARY CARE PROVIDER OR OTHER SPECIALIST BEFORE SURGERY

Some health problems require that you discuss your medications and upcoming surgery with your primary care physician (PCP) or other health care specialist. It is best to do this as soon as possible so you can discuss their recommendations with your surgeon at your preoperative visit.

Instructions for Taking Care of Yourself After Surgery
What to Expect:

Bleeding and Vaginal Discharge

  • You will have some vaginal discharge with an odor (pink, yellow, or brown) for up to six weeks after surgery as the stitches in the vagina dissolve.
  • Light vaginal bleeding and spotting are normal. This may come and go, so don’t be surprised if you have spotting again after a few days without bleeding.

Self Care Instructions

Patient Instructions After Bladder Testing
What can I expect after bladder testing?

For the next 24 hours, you may have some:

  • Burning
  • Mild pain
  • Blood in the urine
Is there anything I should do after the test?

You should drink at least 6 glasses of water over the next 24 hours.

When should I call the doctor?

Please call the doctor if:

  1. You have a fever of 101+
  2. You cannot urinate
  3. You have mild pain that lasts more than 24 hours
What number should I call with questions or concerns?

Please call the nurse line at (401) 453-7560, select your preferred language then option 2.

How to Use Vaginal Cream and Vaginal Jelly
Estradiol, Estrace, or Premarin vaginal cream

These estrogen-containing creams are frequently prescribed for women whose vaginal tissues need some extra hormonal support.

Estrogen vaginal creams may be prescribed in the following situations:

  • Women using vaginal pessaries
  • Before and after vaginal surgery
  • Women with urinary frequency
  • Estrogen helps the lining of the vagina to become thicker and healthier
Please tell your health care provider if you have had in the past, currently have, or develop any of the following conditions:
  • Breast cancer
  • Blood clots
  • Gynecological cancer
Follow the directions for use carefully:
  • Wash and dry your hands.
  • Uncap the tube of estrogen cream and screw the applicator onto the end of the tube.
  • Gently squeeze the tube to push the cream into the applicator until the plunger reaches the line corresponding to the correct dose.
  • Position yourself in one of the following ways, similar to inserting a tampon.
    • Squatting slightly
    • Sitting on the edge of a chair or the toilet
    • Standing with one foot on a stool
    • Laying in bed with a pillow behind your back
  • Hold the applicator in one hand. With the other hand, gently separate the folds of skin outside the vagina.
  • Place the tip of the applicator into the vaginal opening and gently advance the applicator into the vagina about 2 inches.
  • Press the plunger and dispense the cream into the vagina.
  • Gently remove the applicator from the vagina and wash it in warm soapy water. Keep it in a plastic bag or container until the next use.
Trimo-San Vaginal Jelly

This is a vaginal jelly recommended for some pessary users. It works to balance the pH (acid/base balance) of the vagina to decrease the risk of bacterial growth due to the presence of the pessary. It also reduces odor and the risk of irritation by lubricating the vagina. Please note that Trimo-San does NOT contain any hormones. It is safe for use by women who cannot (or prefer not to) use estrogen-containing vaginal preparations.

Directions for use of Trimo-San Jelly
  • Remove the cap from the Trimo-San tube.
  • Reverse the cap and place the puncture tip into the end of the tube.
  • Push the cap firmly until the tube end is punctured.
  • Screw the “Jel-Jector’ applicator (bulbed applicator) onto the tube.
  • Squeeze the tube from the bottom until the jelly reaches the correct dosage level.
  • Detach the applicator from the tube.
  • Gently insert the applicator approximately 1 to 2 inches into the vagina.
  • Squeeze the bulb vigorously once to dispense the jelly into the vagina.
  • KEEP THE BULB COMPRESSED until the applicator is removed from the vagina.
  • Wipe the threads of the tube and inside the cap. Recap the tube.
  • Clean the applicator by holding the end of the applicator in warm soapy water and compressing the bulb several times. Allow it to dry. Keep it in a plastic bag or another container until the next use.
Strengthening the Pelvic Muscles
What is a Kegel exercise?
  • It’s an exercise you can do to strengthen the small muscles that support the pelvic organs (uterus, bladder, and rectum).
  • These muscles are involved in supporting the organs, and help to open and close the openings of the bladder (urethra), the vagina, and the rectum.
  • There are two main muscles that are involved in the Kegel exercise. They form a type of muscular hammock that supports the pelvic organs.
  • These muscles attach in the front to the pubic bone, in the back to the sacrum (tailbone), and on the sides to the pelvic bones.
Why should I do Kegel exercises?
  • Over a woman’s lifetime, events such as pregnancy, childbirth, and the effects of gravity and age can weaken the muscles that support the pelvic area.
  • When these pelvic muscles are weakened, problems such as leaking urine and dropping of the pelvic organs can occur.
  • These small pelvic muscles are just like other muscles in your body – they will get stronger and healthier with exercise.
  • By exercising these small but important muscles, you will help your body improve or maintain its ability to hold urine and support the internal pelvic organs.
  • Kegel exercises increase the strength of the small support muscles and, with regular exercise, the muscles will develop better blood flow for the improved general health of those tissues.
How do I do the Kegel exercise?
A Kegel exercise is done by squeezing the muscles of the perineum (the area around the vaginal, bladder, and rectal openings). Imagine you are trying to hold back urine or gas that’s the type of squeeze you’ll need to do. When you’re contracting the right muscles, you’ll feel a lifting or pulling up within the vagina and around the perineum.
  • Squeeze for 3 seconds, then relax for 3 seconds.
  • Do 10 squeezes, 4 times each day.
  • Eventually, work up to 10 squeezes. You’ll find this easier as the muscles get stronger.
  • You can do Kegel exercises sitting or standing - practice doing both.
  • Keep at it.
Types of Kegel exercises

Quick Kegels:

  • Do 10 fast squeezes.
  • Hold the squeeze for only 1 second, then relax for 1-2 seconds.
  • This is the type of muscle contraction you might do to stop the urge to urinate.

Slow Kegels:

  • Do 5 s-l-o-w squeezes.
  • Hold each squeeze for 5 to 10 seconds, then relax for an equal amount of time.

Please remember:

  • Do not hold your breath or bear down while doing the Kegel exercises. You’re trying to lift the muscles up, not push them down.
  • Try not to use the muscles of your legs, stomach, or other muscles while doing your Kegel exercises. Concentrate on the pelvic muscles only.

Rhode Island Center for Pelvic Floor Disorders Services

The Rhode Island Center for Pelvic Floor Disorders (PFDs) at Women & Infants Hospital has been created to provide state-of-the-art diagnosis and therapy for women with pelvic floor disorders. The Center provides a comprehensive service that includes both clinical care and organizational oversight. Providers from urogynecology, women's gastrointestinal disorders, colorectal surgery, urology, pelvic floor physical therapy, and diagnostic imaging work collaboratively to provide multidisciplinary care for women with these conditions.

Services and Areas of Expertise:
  • Urinary incontinence
  • Fecal/anal incontinence
  • Pelvic organ prolapse
  • Sensory and emptying abnormalities of the lower urinary tract and bowel
  • Painful bladder symptoms
  • Musculoskeletal dysfunction of the pelvic muscles/ligaments
  • Gastrointestinal disorders, irritable bowel syndrome (IBS), constipation and diarrheal states

In addition to pelvic floor disorders, gastrointestinal disorders are very common in women and exacerbate PFDs. Irritable bowel syndrome (IBS), a multi-factorial gastrointestinal condition, and constipation, one of the most common gastrointestinal complaints, are often concurrent with PFDs.

Urogynecology FAQs

How common are urogynecological problems in women? Are they more common than in men?

Urinary incontinence is the most common urogynecologic problem, afflicting 13 million American men and women. The United States spends more than $12 billion annually on incontinence-related health care and products. Women are three times as likely as men to suffer from this disorder.

How common is urinary incontinence? What causes it?

Urinary incontinence affects 10-35 percent of all adults. Some studies have reported that up to 50 percent of women have occasional incontinence and as many as 10 percent have daily incontinence. Urinary incontinence increases with age, and by the age of 75 approximately 1 in 5 women will suffer from it. Continence is dependent upon a coordinated system of muscles and nerves surrounding the bladder. The brain constantly sends signals relaxing the muscles of the bladder while keeping the muscles surrounding the urethra strong. If the bladder muscles contract inappropriately or the muscles around the urethra relax or are not strong enough, incontinence occurs.

Why might someone leak urine only occasionally, like when she laughs?

During laughing, coughing, or with straining (like in exercise), pressure in the abdomen is transmitted to the bladder. Weakened pelvic muscles supporting the bladder and urethra may not be able to withstand the increased abdominal pressure. When those muscles are overcome, leakage occurs.

What can be done to help women with urogynecologic problems? Is surgery the only option?

Treatment options vary according to patient complaints and preferences. Although there are several surgical options for treating urinary incontinence and genital prolapse, surgery is not the only option. Specialized pelvic physical therapy may help strengthen the muscles surrounding the bladder and vagina. Sometimes, lifestyle modifications – such as decreasing caffeine and alcohol intake, stopping smoking, or losing weight - may alleviate some of the symptoms.

What sort of tests are done to determine the problem?

A complete physical exam by a gynecologist or urogynecologist is the first step in determining the extent of a urogynecologic problem. Your doctor may advise you to complete urodynamic testing. This specialized test looks at the ability of your bladder to hold urine.

Is there such a thing as recurrent bladder infections? What causes them and what can be done to prevent them?

Recurrent bladder infections are due to bacteria within the bladder that cause symptoms of painful urination more than two times in six months. Antibiotics are used to clear the bacteria from the bladder. Recurrent infections may be due to antibiotic-resistant bacteria. Incompletely treated infections may also lead to recurrent infections. Other causes of recurrent bladder infections include:

  • Diabetes
  • Kidney or bladder stones
  • Sexual intercourse
  • Spermicide use
  • Genetics

The key to prevention is good hygiene. Your doctor may advise that you take an antibiotic for a longer period of time or after intercourse to prevent recurrent infections.

What is genital prolapse?
Genital prolapse is the relaxation of the pelvic floor muscles that support the bladder, uterus, and rectum. Prolapse is described by its location and severity. Descent of the bladder into the vagina is called anterior prolapse. Apical prolapse is usually due to relaxation of the uterus (or upper vagina after a hysterectomy). Posterior prolapse is the term given to the relaxation of the rectum into the back wall of the vagina. The severity of prolapse may range from the feeling of a bulge into the vagina to the complete protrusion outside of the vaginal opening.
What is pelvic floor dysfunction and what causes it?

Pelvic floor dysfunction refers to the inability of the pelvic muscles and their connective tissue to support the pelvic organs resulting in a change of control of the bladder and rectum. This may include the inability to hold urine or stool or the inability to empty it. Pelvic floor dysfunction is likely the result of repeated stress on the pelvic floor muscles, most commonly from pregnancy and childbirth. The connective tissue and muscles that stretch during the pregnancy may not fully return to their pre-pregnancy strength, possibly due to trauma sustained during childbirth. Other conditions that increase abdominal pressure may also lead to pelvic floor dysfunction. These include:

  • Age
  • Obesity
  • Chronic lung conditions
  • Repetitive heavy lifting
  • Some neurologic or spinal cord conditions
  • Genetics
  • Age
Do these problems limit a woman's life, including her intimate relations?
These problems often limit a woman's desire to engage in physical activity, travel on long trips, or even socialize with friends in public places because of the fear of involuntary passage of urine or feces. They may also prevent a woman's desire to be intimate or to enjoy intimate relations with her partner. There are multiple options available to address the many types and severity of pelvic floor dysfunction. These options range from medications to surgery. Women no longer have to be limited by pelvic floor dysfunction and, with treatment, many are able to resume an active and normal lifestyle.
What are some signs of urogynecologic problems? When should a woman call her doctor?
Some of the common signs of urogynecologic problems are in the inability to urinate or the leakage of urine involuntarily, the feeling of a bulge in the vagina, the appearance of a bulge outside of the vagina, difficulty with intercourse due to a bulge, the inability to hold urine or feces during intercourse, difficulty having a bowel movement or the need to facilitate urinating or having a bowel movement by changing position, or using a hand in the vagina to assist in evacuation. A woman should call her doctor if symptoms present suddenly or when chronic symptoms become troublesome or interfere with her quality of life.

Meet the Team

Deborah L. Myers, MD, FACOG

Deborah L. Myers, MD, FACOG, is a professor of obstetrics and gynecology at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Myers is a graduate of the SUNY at Stony Brook Medical School and completed a residency in obstetrics and gynecology at Women & Infants Hospital.

Kyle J. Wohlrab, MD, FACOG

Kyle J. Wohlrab, MD, FACOG, is an associate professor, clinician educator at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Wohlrab is a graduate of Rosalind Franklin University of Health Sciences, Chicago Medical School and completed a residency in obstetrics and gynecology at Women & Infants Hospital.

Charles Rardin, MD, FACOG

Charles Rardin, MD, FACOG, is a professor at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Rardin is a graduate of the University of Rochester School of Medicine and completed a residency in obstetrics and gynecology at Beth Israel Deaconess Medical Center. 

B. Star Hampton, MD, FACOG

Star Hampton, MD, FACOG, is a professor at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Hampton is a graduate of Mt Sinai School of Medicine and completed her residency in obstetrics and gynecology at New York University School of Medicine.

Vivian Sung, MD, MPH, FACOG

Vivian Sung, MD, MPH, FACOG, is professor at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Sung is a graduate of Tufts University School of Medicine and completed a residency in obstetrics and gynecology at Magee-Women's Hospital. 

Cassandra L. Carberry, MD, MS, FACOG

Cassandra L. Carberry, MD, MS, FACOG, is an associate professor, clinician-educator at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Carberry is a graduate of The University of Texas Health Science Center at San Antonio School of Medicine completed a residency in obstetrics and gynecology at New York University School of Medicine.

Nicole B. Korbly, MD, FACOG

Nicole Korbly, MD, FACOG, is an assistant professor, clinician educator at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital. Dr. Korbly is a graduate of the University of Massachusetts Medical School and completed a residency in obstetrics and gynecology at Women & Infants Hospital. 

Stacy J. Ramsey, NP, MSN

Stacy Ramsey earned a bachelors degree in biology at Washington University in St. Louis, MO and a masters of science degree in nursing with a dual certification in Women’s and Adult Health at the MGH Institute of Health Profession in Boston, MA. 

Elizabeth Howland, DNP

Elizabeth Howland received her Bachelor's degree in Anthropology from Dartmouth College. She earned her Master of Science in Nursing and her Doctorate of Nursing Practice from Vanderbilt University in Nashville, TN.