Pelvic Floor Dysfunction

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.

In April 2019, the FDA ordered manufacturers to stop producing mesh specifically to be implanted vaginally 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.

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.

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.