Female Pelvic Medicine & Reconstructive Surgery
Why Yale Urology
At Yale Urology, our multidisciplinary team works together to evaluate and treat your pelvic floor disorder (PFD). Because more than one PFD can occur simultaneously—including urinary incontinence, pelvic organ prolapse, and fecal incontinence—our team includes urologists, uro-gynecologists, gastroenterologists, gastrointestinal surgeons, radiologists, and nurse practitioners. At Yale, we gather the most knowledgeable and compassionate specialists together in one place and we take the time to listen to what matters most to you. We understand that your PFD is having a big impact on your daily life. We are committed to working with you, understanding your unique experience with PFD, and arriving at the best possible treatment options for you—to help you get your life back.
At Yale, we believe that the simplest, least invasive treatment options for PFDs should be tried first. We will not rush you into surgery without first exploring all other options. Treatment approaches will be tailored to your specific needs and may include pelvic floor physical therapy, self-management strategies, medications, and/or surgery. If surgery is necessary, we are committed to helping you to thoroughly understand every aspect of the process and to answer all of your questions. Our surgeons are highly skilled in both traditional and minimally invasive surgeries, including robotic and trans-vaginal surgeries. Our physicians are knowledgeable regarding the latest treatments and seek to improve our treatments through research. Members of our team have been investigators in seminal clinical trials which determined best treatment options for urinary incontinence.
About Our Female Urology Program
FPMRS is a sub-specialty that evaluates and treats women with a variety of PFDs such as urinary incontinence, pelvic organ prolapse and fecal incontinence.
Urinary incontinence (UI) is the involuntary loss of urine. The two main causes in UI are bladder-related and urethral-related, although both causes may occur in the same patient.Bladder-related UI is termed “overactive bladder” (OAB) or urgency UI. Urethral-related UI is termed stress urinary incontinence. Other symptoms that frequently occur with UI include: feeling of having to urinate frequently (frequency), getting up frequently to urinate (nocturia), having sudden strong urges to urinate, and having frequent urinary tract infections. The causes of bladder-related incontinence is not well understood but probably involve alterations of how the nerves and bladder muscle interact which result in a propensity of abnormal sensations of fullness and/or uncontrolled contractions of the bladder muscle which can overcome normal urethral continence mechanisms, thus resulting in UI.The causes of urethral-based incontinence are secondary to loss of mechanical support of the urethra resulting in the urethra not able to maintain urinary continence during increased abdominal pressure situations such as coughing, laughing, sneezing, or straining.Rare causes of urinary incontinence include fistulae (holes) in the urinary tract which are usually iatrogenic (caused by other surgical treatments for other conditions). Neurologic diseases can cause UI (see section on Neurogenic Bladder).Urodynamics is a test that is done on patients to assess both the bladder and urethral sphincter function. It involves placing a catheter into the bladder. The bladder is filled with saline or water while measuring the pressure in the bladder. The goal of urodynamics is recreate the UI during the test. Since there are different causes of UI, urodynamics may help determine which one is causing the UI and potentially help guide treatment.
Pelvic organ prolapse (POP) occurs when the vaginal is not well supported and different pelvic organs fall through that portion of the weakened vaginal support. The two main symptoms of POP are feeling of a bulge in the vaginal area and seeing part of the vagina come out. POP is anatomically divided into 3 locations within the vagina, depending on where in the vagina POP occurs. Apical prolapse is when the inner most part of the vaginal support is weakened. Anterior wall vaginal prolapse is weakened support of the “top” part of the vagina. Posterior vaginal wall prolapse is weakened support o the “bottom” part of the vagina. With apical prolapse, the pelvic organs that fall through the vagina are the uterus and small bowel. With anterior wall vaginal prolapse, it is the bladder that falls through. With posterior wall vaginal prolapse, it is the rectum that falls through.
Fecal incontinence (FI) can occur for different reasons. Having an inconsistent quality of stool may create a condition for FI. Certain medical conditions can increase the risk of FI. The anal sphincter may not work properly to prevent stool from leaking and a test called anal manometry assesses the function of the anal sphincter. Sometimes, a radiologic test (MRI defecogram) to determine if there is an anatomical cause for the FI.