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Interstitial Cystitis

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Hormone Replacement

The symptoms of urinary urgency, frequency and incontinence are sometimes caused by declining estrogen levels in the pelvic-floor tissues. Low-dose vaginal estrogens are an often times an effective treatment option. Low-dose vaginal estrogens are available in creams (Estrace®, Premarin®), Ring (Estring®) and suppository (Vagifem). Click Here to learn more about Hormone Replacement.

Urinary Tract Infections (UTIs)

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Pelvic Organ Prolapse
If you have a bulge, you may be experiencing pelvic prolapse. Pelvic organ prolapse is a condition that results from weakening, breaking and/or stretching of the connective tissue, muscles, and nerves that make up the pelvic floor. This weakening and stretching allows pelvic organs to drop, bulge, or “prolapse” into the vagina. Commonly, prolapse is related to the pressure and stretching involved in childbirth, but it can also be related to repetitive strenuous work, chronic coughing, smoking and less commonly, accidental injury, or to an inherited weakened tissue. Loss of pelvic support can involve a variety of problems:

  • The bladder can bulge through the front wall of the vagina. This is known as a Cystocele.
  • The rectum can bulge through the back wall of the vagina. This is known as a Rectocele.
  • The uterus can fall down into or out of the entrance to the vagina. This is known as Uterine Prolapse.
  • The bowels or intestines can prolapse into the vagina. This is known as an Enterocele.

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Urinary Urgency & Frequency – Overactive Bladder (OAB)
Generally, it is considered normal to urinate up to eight times during a twenty-four hour period including waking up once at night. If a person is urinating more often than that, they are said to have urinary frequency. Sometimes, frequency is worse during certain times of day. When a woman has an uncomfortably strong need to void that arises quickly this is called urinary urgency . If a needs to urinate more than once a night and her sleep is being disrupted, this is called nocturia. Any combination of urgency, frequency, and nocturia with or without urine leakage are now often referred to as overactive bladder.

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Urinary Incontinence – Leakage
Uncontrollable urine leakage is an embarrassing and debilitating disease that can lead to depression and social isolation if not treated. There are two main types of urinary incontinence in women known as urge incontinence and stress incontinence. Urge incontinence is urine leakage that occurs before a woman has a chance to get to the bathroom in response to an urge to urinate. This may happen during the day, at night or both. Stress incontinence is urine leakage that occurs with activities such as coughing, laughing, exercise or sneezing.
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Painful Urination (Dysuria)

Dysuria is a painful feeling that accompanies urination is most often but not always due to a urinary tract infection (UTI). Other causes include infection of the urethra (called urethritis), and painful bladder syndromes such as interstitial cystitis (IC) not due to infection. A Herpes outbreak is occasionally a cause of severe pain with urination.

Fecal Incontinence
Normally bowel movements (stools) are stored in the rectum until the bowel sends a message to the brain that it is full, and the person finds a convenient bathroom. This voluntary control is provided by a ring of muscular tissue called the anal sphincter, which surrounds the anal opening and lower rectum. Sometimes, damages to the anal sphincter, or the other muscles, nerves or connective tissue of the pelvis can cause uncontrolled loss of stool.

Examples include:

  • Irritable Bowel Syndrome (IBS)
  • Damage to the pelvic floor at the time of childbirth
  • Pelvic surgeries and scarring
  • Nervous system diseases like Multiple Sclerosis (MS) or Parkinson’s Disease

Fecal incontinence in women is a more wide spread problem than previously thought. As many as 10% of women over age 65 who are not living in nursing homes report troublesome loss of bowel control. Many younger women are also troubled by fecal incontinence. It is important to know that while not everyone can be cured, most women with fecal incontinence can be helped substantially—often without surgery.


A condition where the support to the top of the vagina is weakened, allowing bulging of the small intestine. This type of prolapse is most often seen in women who have undergone a hysterectomy.

Painful Sexual Intercorse (Dyspareunia)

Dyspareunia is the medical term that refers to painful intercourse. It is a general term used to describe all types of sexual pain. Sexual pain may occur upon penetration, during intercourse, and/or following intercourse. Perineal injuries can increase the risk of sexual pain after childbirth. In other cases, tenderness or “spasm” of the levator muscles may lead to pain during penetration. Other causes also include endometriosis or a retroverted uterus. There are a variety of treatment options for dyspareunia.

A condition where the back wall of the vagina sags outward, allowing the rectum to bulge into the vagina.

A posterior prolapse occurs when the thin wall of fibrous tissue (fascia) that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge. Posterior prolapse is also called a rectocele because in many cases, it’s the front wall of the rectum that bulges into the vagina.

Childbirth, aging, weight gain and other bodily processes that put pressure on the fascia can contribute to posterior prolapse. A small prolapse may cause no signs or symptoms. If a posterior prolapse is large, it may create a noticeable bulge of tissue through the vaginal opening.

This type of prolapse occurs when the supportive tissue or fascia supporting the bladder stretches or detaches from his attachments on the pelvic bones. This loss of support allows the bladder to prolapse or fall down into the vagina.


Symptoms of anterior wall prolapsed are variable. Often as the anterior vaginal wall prolapsed worsens it progresses outside the opening of the vagina. Sometimes the bladder may not empty well which can lead to urinary frequency, nighttime voiding, loss of bladder control and recurrent bladder infections. Anterior vaginal prolapse also affects support to the urethra, which can lead to urinary incontinence with activity such as laughing, coughing, sneezing, or exercise. Anterior prolapse often occurs with prolapse of the uterus or top of the vagina where the uterus used to be in women who have had a hysterectomy.

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