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Urogynecology and Pelvic Floor Disorders

Division of Urogynecology and Reconstructive Pelvic Surgery

If you are incontinent, you are not alone. Many women face personal health problems that impair their quality of life. Most of these conditions are unique to women such as urinary incontinence and genital prolapse.

Approximately 10 million women in the US suffer from incontinence – about one in four between the ages of 30 and 59. Many women are too embarrassed to talk about it so they are unaware that help is available for these uncomfortable and frequently debilitating conditions.

Contact Information

Division of Urogynecology and Reconstructive Pelvic Surgery
101 Plain Street
5th Floor
Providence, RI 02903
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.

Urinary Incontinence

Urinary incontinence is any time urine comes out (leaks) 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. 

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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 multiple 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 physician may also recommend keeping a bladder diary that can help regulate fluid intake and time intervals between bathroom visits.

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 at different capacities by using a specialized catheter (tube into the bladder).

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

Chronic bladder infections are due to bacteria within the bladder that cause symptoms of pain with urination or frequent 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. We can usually resolve this by switching antibiotics. Incompletely treated infections may also lead to recurrent infections. Other causes of chronic 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 vagina after a hysterectomy). Posterior prolapse is the term given to 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 of the bladder or uterus outside of the vagina.
What is pelvic floor dysfunction and what causes it?

Pelvic floor dysfunction refers to the inability of the connective tissue and muscles of the pelvis to perform the anatomic functions that they had once successfully managed. This may include the involuntary leakage of urine, gas or feces. 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-partum 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 vice chair of the Department of Obstetrics and Gynecology, director of the Division of Urogynecology and Reconstructive Pelvic Surgery, 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. 

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 professor at The Warren Alpert Medical School of Brown University and a member of the active staff at Women & Infants Hospital, where she holds the position of vice chair of education for the Department of Obstetrics and Gynecology.

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 assistant professor, clinician-educator at The Warren Alpert Medical School of Brown University, and a member of the active staff at Women & Infants Hospital. 

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. 

Leah K. Moynihan, NP, MSN, Nurse Practitioner

Leah Moynihan RNC, MSN, is a women's health nurse practitioner in the Division of Urogynecology and Reconstructive Pelvic Surgery. Ms. Moynihan earned a bachelor's degree in biology from Rhodes College and a master's of science in nursing degree from Vanderbilt University School of Nursing.

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 speciality in women’s health at the MGH Institute of Health Profession in Boston, MA. 

Additional Locations

East Greenwich Medical Office Building

Women & Infants Hospital
1050 Main Street
East Greenwich, RI 02818
P: (401) 453-7560

South County Commons

Care New England Center for Health
49 South County Commons Way
South Kingstown, RI
P: (401) 453-7560

Women & Infants Hospital

640 George Washington Highway,
Building A, 1st Floor
Lincoln, RI 02865
P: (401) 453-7560