Urogynecology - Female Pelvic Health

Urogynecology is a specialized field of medicine that treats urinary and reproductive system ailments in women. Urogynecologists are specifically trained to treat conditions that affect the pelvic floor. 

The pelvic floor is made up of muscles and connective tissues that work together to provide structural support to the pelvic organs. A healthy pelvic floor keeps everything where it should be! Unfortunately, pelvic floor dysfunction is common and can lead to conditions such as incontinence, difficulty urinating or defecating, pelvic organ prolapse or pain. ⁽¹⁾

Your anatomy is just as complex and unique as you are. If you’re suffering from the consequences of a compromised pelvic floor, you deserve an experienced and compassionate expert to guide you through restoring these essential functions, as well as your comfort and confidence. At Swan Medical, Dr. Peter Castillo is committed to offering a kind, welcoming environment and effective solutions to treat these conditions and symptoms. To get started contact our Los Gatos and Danville offices by calling (925) 905-9922, or filling out a simple online form at your convenience.

About the Pelvic Floor

Simply put, the female pelvis works wonders. This relatively small area of the body regulates daily functions but also has the power to accommodate pregnancy. Cradled in the small area between your pubic bone and your tailbone, the bladder, uterus, vagina, and rectum are all supported and controlled by the pelvic floor muscles and connective tissue. When these tissues and muscles become weakened or injured, or the nervous system is no longer able to allow them to contract and relax normally, the consequences can be painful and debilitating.

Unfortunately, pelvic floor disorders, including urinary incontinence, fecal incontinence, and pelvic organ prolapse, are common. They affect up to one-third of pre-menopausal women and 45% of women after menopause. ⁽²⁾ And while many women are hesitant or embarrassed to seek treatment, there’s nothing shameful or unladylike about taking care of your health and well-being! Swan Medical offers surgical, minimally invasive, and noninvasive options for treating the many conditions and symptoms that accompany pelvic floor disorders.

Pelvic Organ Prolapse

Pelvic organ prolapse occurs when the uterus, vagina, urethra, small bowel, or rectum is no longer held in place and begins to collapse into the surrounding organs. This can lead to a variety of unpleasant symptoms and requires an experienced urogynecologist. Dr. Castillo performs minimally invasive surgery to address pelvic organ prolapse. And while a hysterectomy may be warranted in other severe cases, there are other options. 

Dr. Castillo performs a variety of surgeries that can secure the uterus and or vagina back into its correct position: 

Incontinence

Women suffering from incontinence and other urinary ailments may benefit from the reconstructive and therapeutic procedures that Swan Medical offers.

Not all incontinence is the same. There are different causes for urinary incontinence and thus different therapies. Urinary leakage that occurs with activity such as sneezing, jumping, running is called Stress urinary incontinence (SUI) and is caused by loss of mechanical support to the urethra. We offer various therapeutic options for this type of urinary leakage and is tailored to the patient’s specific needs.

These procedures include:

• Midurethral sling for stress urinary incontinence
• Periurethral bulking
• Vaginal Laser therapy
• PRP injection

Urge urinary incontinence or Overactive Bladder (UUI or OAB) is another common type of urinary incontinence where the urge to urinate is so strong that it causes frequent bathroom trips and some may not be able to make it to the bathroom. This type of incontinence is most distressing because there are several triggers that can cause this such as holding urine for long periods, hearing running water, pulling the car into the driveway or even putting the key in the door that triggers an involuntary urge and often large volume urine loss before making it to the bathroom. This type of incontinence has a neurologic component and requires pelvic floor re-education and lifestyle changes.  

Additional to therapies for UUI/OAB may include:

• Bladder Medications
• Sacral Neuromodulation
• Tibial Nerve Stimulation
• Bladder Botox™

Dierticulum and Fistulas

Other less common causes for urinary leakage include urethral diverticulum or vaginal fistula. Diverticulum are outpouches of the urethral wall that act like sacs that hold urine. These cause spontaneous urine leakage throughout the day simply with walking around or standing up. 

Fistulas on the other hand are communications between the vagina and other organs. Women experiencing fistulae need immediate medical treatment. Unfortunately, these injuries aren’t always apparent. These communications between organs can allow urine or fecal matter to enter the vagina. Childbirth, radiation, and trauma to the pelvic region can result in this condition. Dr. Castillo performs vesico-vaginal, urethro-vaginal, and recto-vaginal fistula repair.

Minimally invasive procedures for these conditions include:

• Urethral diverticulectomy
• Urethral reconstruction
• Vesico-vaginal fistula repair
• Urethro-vaginal fistula repair
• Recto-vaginal fistula repair

Staying Strong

Luckily, some pelvic health concerns can be addressed by training the pelvic floor muscles. Dr. Castillo can devise a treatment plan that assists patients in exercising and strengthening these critical muscles and may avoid the need for future surgery.

Treatments include:

• Pelvic floor re-education
• At-home pelvic floor therapy devices

Genito-Urinary Syndrome of Menopause (GSM)

This long name describes a collection of symptoms related to the effects of hormone loss on the vulva, vagina and lower urinary tract.

If you’re experiencing dryness, pain, and recurring vaginal infections, frequent UTIs or bladder infections,  hormonal and non-hormonal therapies such as laser vaginal resurfacing may be a rewarding solution for patients suffering from GSM. Gentle laser energy rejuvenates the walls of the vagina for improved vaginal health and sexual function. To learn more about the services offered at Swan Medical, follow Dr. Castillo’s blog.

Pelvic Pain

Pelvic pain is a complex and multifactorial symptom that requires an in depth consultation and detailed physical exam for guidance. Because the pelvic houses various organ systems and structures, pelvic pain can be very non-specific and can be caused by a variety of conditions.

Conditions that can cause non-descript or overlapping symptoms of pelvic pain include:

Therapies for Chronic Pelvic pain will differ depending on its origin. After a thorough evaluation, Dr Castillo will lay out a plan of action based on his findings. If additional studies are necessary to clarify the cause of pain, he and his team will clearly lay out next steps to treatment.

Benefits

The pelvic floor allows the vital organs in this area to function normally in very close quarters! 

However, when these muscles weaken or other conditions arise, the pelvic organs are no longer able to stay in place and begin to compromise each other’s normal functions. Similarly, the close proximity of the various organs within the pelvic often make the diagnosis challenging for providers that don’t specialize in these conditions. Many pelvic organ disorders are not apparent during a regular gynecological exam. Women that may have suffered injury during childbirth or develop pelvic floor disorders for other reasons may still be living with the symptoms decades later. 

Seeing a specialized urogynecologist for pelvic floor health can reduce the time to treatment by avoiding misdiagnosis or incorrect or subtherapeutic therapies. Starting the correct therapy in a timely manner can improve patient’s quality of life.

Candidates

Pelvic disorders are common, and many women will require urogynecological attention at some point in their lives.

Unfortunately, factors beyond our control are often responsible for pelvic disorders:

• Age
• Race
• Genetics
• Neurological, muscular, or connective tissue disorders

Other life events can result in changes in pelvic health:

• Childbirth
• Muscle or nerve injury
• Radiation therapy
• Previous surgery

Your chances of having to endure pelvic floor disorders increase with:

• Obesity
• Smoking
• Constipation
• Medications
• Infections
• Menopause ⁽³⁾

Because pelvic disorders are so common, and there are so many factors that contribute to their likelihood, be vigilant about your urogynecological health! If you’re experiencing symptoms, there’s no need to endure them any longer. Contact Swan Medical to schedule a case review. These consultations are complimentary and can be completed over the telephone or Skype from the convenience of your home. Call (925) 905-9922 to get started.  

Your First Appointment

When you schedule an appointment at Swan Medical, you can rest assured that you’ll be welcomed into a warm, supporting environment, and on your way to restoring your pelvic health and well-being. We want to have the best understanding possible of your symptoms, so we ask that you complete a questionnaire, and if pertinent, keep a bladder diary in the days before your first appointment. When you arrive at our beautiful Los Gatos and Danville offices, you’ll begin your visit by consulting with one of Dr. Castillo’s caring Medical Assistants. Dr. Castillo will then perform a thorough examination. Your comfort and concerns come first, so you’ll have plenty of time to address the issues that matter to you. Once Dr. Castillo has identified any urogynecological problems, he’ll be able to devise an effective treatment plan that is tailored to you. He’ll answer any questions you may have, and you’ll be given detailed information about your treatment and what to expect before, during, and after. To hear about how Dr. Castillo and his staff have helped other women, visit our testimonials page.

FAQ

References

1. Bø K, Nygaard IE. Is Physical Activity Good or Bad for the Female Pelvic Floor? A Narrative Review. Sports Medicine. 2019;50(3):471-484. doi:10.1007/s40279-019-01243-1
2. FASHOKUN TB (OMOTOSHO), HARVIE HS, SCHIMPF MO, et al. Sexual Activity and Function in Women with and without Pelvic Floor Disorders. International urogynecology journal. 2013;24(1):91-97. doi:10.1007/s00192-012-1848-2
3. Hallock JL, Handa VL. The Epidemiology of Pelvic Floor Disorders and Childbirth. Obstetrics and Gynecology Clinics of North America. 2016;43(1):1-13. doi:10.1016/j.ogc.2015.10.008