Urogynecology

Sometimes, you can’t completely empty your bladder. You may feel an uncomfortable fullness, have urine leakage from an overly full bladder or have repeated urinary tract infections (UTIs).

To determine why your bladder won’t empty, we take a combination approach. We pair noninvasive tests that assess your lower urinary tract function with real-time X-ray imaging to determine what’s causing your problem.

Causes can include:

• Certain medications
• Nerve damage from certain diseases or spinal cord injury
• Obstruction to urine flow (from prolapse or surgical repair)
• Weak bladder muscles

Bladder pain (or painful bladder syndrome) refers to lingering pain or discomfort in your bladder, urethra or surrounding pelvic region. It can cause:

• Pelvic pain
• Pelvic pressure
• Urgent or frequent need to urinate

Hematuria — blood in your urine — isn’t always a serious condition but you should always have it evaluated. You may see blood in your urine when you go to the bathroom. Other times, it’s only visible under a microscope.

We use these tests to determine why you have blood in your urine:

• CT/MRI imaging
• Cystoscopy (a procedure that lets us examine the inside of your bladder)
• Lab tests

OAB occurs when your bladder muscles squeeze to empty urine without warning. This condition is not an age-related problem. It affects women of all ages.

There are three types of OAB:

• Frequency – You go to the bathroom more than seven times a day.
• Nocturia – You wake up more than once at night to go to the bathroom.
• Urgency –A sudden, intense need to urinate that you can’t delay. Your bladder may or may not be full, and you may leak urine (urge incontinence).

We treat vaginal fistula (abnormal opening between the vagina and another pelvic organ) and pelvic organ prolapse (bulging against the vagina by the bladder, uterus or other pelvic organ).

Prolapse happens when your bladder, rectum or uterus falls into your vagina. You feel a heaviness or pelvic pressure when you stand or move around for a long time.

Incontinence refers to involuntary bladder control issues or leaks. Prolapse and other factors can cause several types of incontinence, including:

• Fecal – An unintentional loss of feces, gas or liquid stool
• Stress urinary – A loss of urine when you cough, exercise, laugh or sneeze
• Urge urinary – A loss of urine with a strong urge to urinate. Cold temperatures, passing a bathroom or the sound of running water can trigger this urge.
• Mixed – A combination of stress and urge urinary incontinence

Urinary tract infections (UTIs) develop when bacteria like E. coli enter the urethra, the tube that lets urine flow from your bladder. Women are more likely than men to experience a UTI. Approximately 40 percent of women will have at least one of these infections.

UTIs occur most often in women who are:

• Going through menopause
• Pregnant
• Recovering from surgery
• Sexually active

In many cases, we can relieve your symptoms and improve your well-being without surgery. These treatments include:

• Behavior modifications – Dietary changes and pelvic exercises can strengthen your pelvic muscles and reduce your symptoms.
• Bladder Botox – Injections to reduce urine leakage caused by overactive bladder.
• Medication – Various types of prescription medications can stop your bladder contractions. Others can tighten or relax your bladder muscles.
• Nerve retraining – During an in-office procedure, we insert a small, battery-powered acupuncture-like device into your ankle. It sends out electricity to activate the nerves that control bladder function.
• Pessaries – You can place a plastic, rubber or silicone removable device in the vagina to support the vaginal walls.
• Sacral neuromodulation – We place a tiny pacemaker under your skin in your pelvis. It sends electrical impulses that help regulate and control your bladder.

For mild, moderate and even severe pelvic floor symptoms, your doctor may recommend pelvic floor therapy before turning to medication or surgery. Pelvic floor therapy is a type of therapy involving exercises and nonsurgical techniques that help strengthen your pelvic muscles and improve control and function.

TriHealth is home to one of the largest groups of physical therapists certified in pelvic floor rehabilitation in the region. With care available at seven locations, you can find expert support close to home. Our physical therapists work closely with TriHealth’s urogynecology team to create personalized treatment plans, often helping patients manage symptoms without the need for more invasive options.

Pelvic floor therapy can be especially helpful after childbirth. If you’re recovering postpartum, we tailor your care to meet your unique needs. You’ll be supported by a collaborative, multidisciplinary team that includes your physical therapist, OB-GYN and other specialists focused on your long-term well-being.

If you’ve recently given birth, especially if you experienced a tear during delivery, we offer specialized care to support your healing and long-term pelvic health.

Our Post Delivery Care Center is a collaborative service that brings together your OB, urogynecologist and a pelvic floor physical therapist to care for you during and after your hospital stay. This includes:

• In-hospital physical therapy consults, where a certified pelvic floor therapist visits you before discharge to talk about recovery, normal voiding and bowel movements, and answer your questions, no exam needed
• Early outpatient appointments with urogynecology for those with more severe tears, helping ensure you heal properly and regain comfort and confidence
• Education and support around postpartum urine or stool changes, pain or intercourse concerns when the perineum has been injured

This collaborative care model is one of only a few like it in the country, and the only one of its kind in the region. It’s designed to help you recover faster, feel supported and prevent long-term pelvic floor issues.

In some cases, surgery is your best option. Trust your care to TriHealth, which performs the most urogynecologic surgeries in the region and earns top scores for patient satisfaction.

Your care team will perform your procedure using the least invasive approach possible. Many procedures are available on an outpatient, in-office basis, which means you receive treatment and go home the same day. Benefit from a faster, smoother recovery thanks to our experience using the most advanced tools and technologies available, including robot-assisted and laparoscopic options.

We offer:

• Ultrasound-sounded guided ablation – Uses heat or energy to treat pelvic pain, fibroids and other conditions precisely detected by imaging scans
• Mid-urethral sling – Places a thin strip of mesh material under the urethra to prevent stress incontinence, providing more support when you cough, exercise or laugh
• Sacrocolpopexy – Repairs a bulging or dropped uterus (uterine prolapse) and restores pelvic support using robotic tools during surgery
• Surgical repair of bladder and bowel fistulas – Fixes abnormal connections between your organs that can develop after an injury
• Surgical repair of the vagina – Robotically or laparoscopically treats pelvic organ prolapse, bulging or incontinence caused by weakened pelvic muscles and ligaments
• Burch procedure – Places two stitches in the bladder to reduce stress incontinence
• Pubovaginal fascial sling – Helps stop urinary incontinence by placing a small piece of donor tissue or your own tissue under the urethra for support