Pelvic Floor Dysfunction

Incontinence and Vaginal Prolapse

Duke urogynecologists offer a range of effective options to treat pelvic floor dysfunction. If your pelvic floor has weakened to the point that surgery is necessary, our use of minimally invasive gynecologic surgery hastens your recovery, and helps you return to your normal activities.

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About Pelvic Floor Dysfunction

Nearly half of all women experience pelvic floor dysfunction, which includes:

urinary incontinence, bladder leakage, and fecal incontinence.
pelvic organ prolapse (dropped bladder, vagina, uterus, or rectum).
recurrent urinary tract infections, voiding difficulties, and vaginal fistulas.

Childbirth, constipation, obesity, respiratory problems, and other conditions can weaken the pelvic muscles. In advanced cases, the upper section of the vagina or portions of the pelvic area drop into the vaginal canal. Too often, women don’t seek medical care because they are embarrassed or don’t realize a variety of treatments can help.

Learn about preparing your pelvic floor for childbirth.

Schedule a New Appointment Online

You can schedule a new appointment with some of our providers online. Use this link to find available times and clinic locations.

Schedule a New Appointment

or call 919-684-2471

Nonsurgical Treatments

Behavior Modification

Dietary changes and Kegel exercises that strengthen the pelvic floor muscle can be very beneficial for a variety of pelvic floor muscle conditions. Even if you’ve tried pelvic exercises in the past, many of our patients see significant improvement after sitting down with one of our specialized physical therapists, who work closely with you to help you strengthen your pelvic floor.

Pessaries

Removable devices made of rubber, plastic or silicone are placed in the vagina to support the vaginal wall. They may be recommended as either a temporary treatment for prolapse or as a long-term option.

Medication

Depending on the type of pelvic floor dysfunction you are experiencing, medication may be prescribed to prevent bladder contractions, tighten or sometimes relax the urethra and bladder muscles.

Nerve Retraining for Overactive Bladder Symptoms

A small, acupuncture-like needle, connected to a battery-powered stimulator, is inserted near your ankle during this office-based procedure. The needle emits electrodes that stimulate the nerves in your leg that lead to your pelvic area and control bladder function. The process is called neuromodulation, and has proven effective in overactive bladders and urge incontinence.

Bladder Botox

Our urogynecologists were involved in the clinical trials that resulted in the FDA approval of Botox to treat overactive bladder. Botox injections may be used to reduce urine leaked by paralyzing the spasms that occur when the bladder muscle squeezes too often or without warning.

Sacral Neuromodulation for Bladder Control

A tiny pacemaker, called InterStim, is placed under the skin through small incisions to regulate bladder function. Your doctor can test how well InterStim works before you commit to it.

Our Locations

Duke Health offers locations throughout the Triangle. Find one near you.

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Pelvic Floor Surgeries

In April 2019, the FDA ordered manufacturers to stop producing mesh specifically to be implanted through a vaginal incision for prolapse repair. Women who have undergone these procedures in the past should continue to receive routine check-ups and alert their doctor if they experience any symptoms.

The FDA ruling does not apply to mesh that is placed for stress urinary incontinence or placed for abdominal/robotic prolapse repair (sacrocolpopexy). Duke urogynecologists continue to safely and effectively perform these procedures.

Sacrocolpopexy for Vaginal Prolapse

Robotic tools are used by surgeons to correct vaginal prolapse laparoscopically and support the pelvic floor with a synthetic mesh that is anchored to the cervix through small incisions in the abdomen. Robotic surgery affords your surgeon more precision in performing the procedure. It also avoids the need for a large abdominal incision, which reduces infection risk associated with open surgery. You resume your normal activities faster.

Vaginal Repair of Prolapse Without Mesh

Vaginal prolapse can be repaired through the vagina without the use of vaginal mesh. This option may be appropriate for some people, and allows for a quick recovery without any abdominal incisions.

Mid-Urethral Sling for Stress Incontinence

Newer mesh technologies are used to create a soft “hammock” which is placed under the urethra through small incisions. It provides support during laughing, coughing and lifting, and prevents stress incontinence. Patients go home the same day and can return to work within a few days.

Fascia Pubovaginal Sling for Leakage

Tissue from your body or from a donor is placed under the urethra. This option has proven effective for women with severe leakage as well as women who have undergone radiation, or who may not tolerate the mesh sling.

Burch Procedure for Stress Incontinence

Two stitches are placed on the bladder through a small incision. Primarily recommended to women who suffer from stress incontinence and do not wish to have a mesh procedure, or who may be having additional surgery such as a hysterectomy.

Surgical Repair of Bladder and Bowel Fistulas

Fistulas are abnormal connections between organs. These can occur in the pelvis after an injury or other event. Our urogynecologists are experts at identifying these problems and managing surgical repair. We often work in partnership with Duke colorectal and urologic surgeons or may refer you to a specialty service depending on the nature of the fistula.

Tests

During a consultation, your doctor will perform a pelvic exam and will determine whether additional tests are needed. They may include:

Urodynamics

This in-office test records how efficiently you empty your bladder, your bladder sensation, and provides information about the causes of bladder symptoms.

Cystoscopy

A camera is used to look at the inside of the bladder and urethra. A numbing jelly is administered to provide comfort during this procedure.

MRI and Ultrasound

Both MRI and ultrasound scans create detailed pictures used to diagnose pelvic floor dysfunction.

Defecography

While sitting in a toilet-like seat called a defecography chair, X-rays record how fast your rectum empties and how well your muscles work.

Manometry

A small tube, attached to pressure monitors, is placed in the rectum to measure the strength of the muscles involved in bowel movements.

Why Choose Duke

Nationally Recognized Leaders

Our surgeons work closely with leaders in pelvic medicine to help set standards and treatment guidelines. We are known for our work helping to develop evidence-based practices for non-surgical and surgical treatments. Our providers are experts in the use of implantable stimulators that can provide lasting relief for bowel and bladder symptoms.

Surgical Expertise

Our surgeons have completed advanced fellowship training in female pelvic medicine and reconstructive surgery, and have a wealth of experience using transvaginal and robotic minimally invasive surgical techniques. We developed one of the most effective minimally invasive options used today to treat recurrent pelvic organ prolapse, which results in smaller scars and fewer complications when compared to surgery using a large abdominal incision. As a result, you experience less pain, a shorter hospital stay, and faster recovery.

Expert Management of Transvaginal Mesh

Our specialists are trained and experienced in managing complications for people who've previously had transvaginal mesh. We are a national referral center for patients with severe complications related to transvaginal mesh, including scarring, fistulas, and vaginal mesh erosions.

A Team of Specialists

We frequently collaborate with pelvic floor physical therapists, neurologists, and colorectal surgeons so you receive the most comprehensive care. Our urogynecologists and urologists are board-certified, meaning they have undergone advanced training and certification in urogynecology and reconstructive pelvic surgery.

Access to Clinical Trials

We are one of eight centers in the nation funded by the National Institutes of Health as a pelvic disorder network site. This means you may have access to new therapies to treat incontinence, prolapse, and other pelvic conditions before they become widely available.

Best Hospital for Obstetrics and Gynecology in North Carolina

Where you receive your care matters. Duke University Hospital is proud of our team and the exceptional care they provide. That is why our obstetrics and gynecology program is nationally ranked and is the highest-ranked program in North Carolina, according to U.S. News & World Report for 2025-2026.

This page was medically reviewed on 08/31/2023 by

Alison C. Weidner, MD, MMCi | Urogynecologist