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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.
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
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East Greenwich Medical Office
1050 Main Street
East Greenwich, RI 02818
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Lincoln Location
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.
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.
As an Alpert Medical School teaching hospital, 
Women & 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.
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.
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.
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.
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.
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.
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.
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.
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.
Urodynamics helps to determine the cause of the bladder problem you are experiencing. The results of this test will help your doctor determine the best treatment plan for you.
The testing should not be painful. As your bladder is filling with water, you may feel as though you need to urinate. Some people have some mild burning when they urinate after the test. The burning should go away within 24 hours. You should be able to resume normal activities after your urodynamics. You may have slight discomfort but, for the most part, the testing is not considered painful.
This test needs the undivided attention of the patient and the nurse performing the test. In order to obtain the most accurate results, we ask that no one under the age of 18 accompany you to your appointment. If you need an interpreter or special assistance, please notify the office.
No, you may eat and drink normally prior to your testing. Please do not apply any lotions or creams to your legs or thighs on the day of the testing. A full bladder is NOT required for this testing. Testing is allowed even if you have your menstrual period.
If you don’t already have a follow-up appointment with your doctor, please stop at the checkout desk and schedule this appointment as you leave after your testing. Call our office, or the doctor on call after hours, for any of the following:
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.
Cystoscopy looks at the inside of your bladder. It is used to look for bladder stones, tumors, or any other problems.
The testing is not painful. There is slight discomfort but not pain. As your bladder is filling with water, you will feel the need to urinate. Some people have some mild burning when they urinate after the test. The burning should go away within 24 hours. You should be able to resume normal activities after your cystoscopy.
No. You may eat and drink normally prior to your testing. Testing is allowed even if you have your menstrual period.
If you don’t already have a follow-up appointment with your doctor, please stop at the checkout desk and schedule this appointment as you leave after testing. Call our office, or the doctor on call after hours for any of the following:
Basic facts about pessaries
Please bring:
Please inform your surgeon if you have a history of:
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.
If you have health problems that require you to take medications or see a doctor regularly, please schedule an appointment with your PCP or specialist as soon as possible. During this visit you should plan to:
If you take blood thinners (examples listed below) your PCP, cardiologist (heart doctor), pulmonologist (lung doctor), or hematologist (blood doctor) should tell you when to stop taking them before surgery.
Health records and recommendations from your PCP or specialist can also be faxed to (401) 453-7573 Attn: Surgical Coordinator.
Please note: We should receive this information at least one week before surgery.
Your surgeon should review your medications with you and provide instructions on how to take them before surgery. Please stop taking the following medications seven days before surgery (unless instructed otherwise):
ADDITIONAL INSTRUCTIONS
Before coming to the hospital, shower again with regular soap or with surgical soap (if provided).
Bleeding and Vaginal Discharge
This schedule is usually only needed for the first two to three days after surgery. When your pain starts to get better, you can take the medications less often and only as you need them. If you do not have pain, you do not need to take pain medications.
Until six weeks after your surgery, or after your doctor says your incisions are healed:
Please call our office at (401) 453-7560, option #2 for the Nursing Line if you have any of the following:
If you go home with a catheter:
Post-operative appointments:
For the next 24 hours, you may have some:
You should drink at least 6 glasses of water over the next 24 hours.
Please call the doctor if:
Please call the nurse line at (401) 453-7560, select your preferred language then option 2.
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:
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.
Quick Kegels:
Slow Kegels:
Please remember:
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.
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.
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.
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.
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.
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.
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.
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:
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.
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:
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, 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, 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.
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, 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, 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 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 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 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.
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