Female Urogynecology in Dallas, TX

Urogynecology is a subspecialty of Obstetrics and Gynecology that deals with pelvic floor disorders. Our practice offers the full scope of diagnostic techniques and treatment modalities to deal with these conditions. Dr. Quanita Crable provides comprehensive, state-of-the-art care for women with pelvic floor disorders and can help determine the best treatment option based on your condition. We serve patients at our urogynecology office in Dallas, TX.

These include:

• Urinary Incontinence
• Overactive Bladder
• Voiding Dysfunction
• Pelvic Organ Prolapse
• Pelvic Pain
• Sexual Dysfunction

Urinary Incontinence

Urinary incontinence, the involuntary loss of urine, is a major health and quality of life concern. It can adversely affect a woman’s daily activities, overall health and social interactions. Urinary incontinence can have a significant negative impact on the family from an economic, emotional and interpersonal standpoint. Approximately 20% of women in the community affected but the exact prevalence are uncertain due to patient’s difficulty in addressing such a sensitive topic.

Those at highest risk for this disorder are:

• Older women with medical problems such as diabetes, emphysema and weight issues.
• Women with a previous history of multiple vaginal births, prolonged labors and difficult deliveries with complications

Pelvic Prolapse

Pelvic organ prolapse refers to descent (or prolapse) of the vaginal walls and/ or uterus below their normal position. The degree to which the prolapse occurs is described as mild, moderate and severe. In severe cases, the vaginal walls or cervix protrude beyond the vaginal opening and are visible or palpable outside the body. Common terms for these conditions include cystocele, rectocele, pelvic relaxation and procedentia.

Many women with pelvic organ prolapse also report problems with bladder and bowel function. Symptoms that are often associated with pelvic organ prolapse include urinary incontinence, difficult urination, discomfort with sexual intercourse, stool incontinence, difficult defecation, low back pain and low abdominal pain.

What Causes Pelvic Organ Prolapse

Although the pelvic organs are supported by the pelvic diaphragm, the presence of the vagina creates a natural weakness in its integrity. Having multiple, large, prolonged births further weakens the tissue. As the tissue weakens, it stretches and allow descent of the organs to or beyond the vaginal opening.

Evaluation

History: Questions are designed to cover several important areas of pelvic floor function such as: voiding, bowel function, what activities lead to loss of urine, pelvic pain, and sexual function. Frequently a patient is asked to keep a voiding diary for 24 hours including times and amounts of voids. Other medical conditions will be reviewed in addition to prescription and over the counter medications, prior surgeries, previous deliveries and prior bladder infections.

Physical Exam: The examination is targeted at those systems which help support vagina, cervix, uterus and bladder. In particular, sensation of the surrounding external genitalia, the muscles of the pelvic floor, and the supports of the bladder, urethra and bladder neck will be evaluated regarding continence. A rectal exam is performed to evaluate tone and for the absence of blood. The amount of urine remaining inside the bladder can be measured with either a small catheter or bladder ultrasound. With the patient in a standing position or bearing down, the physician tries to determine which organs in the pelvis have lost support and how severe that loss of support is.

Urine culture: A clean catch midstream urine culture is obtained to exclude infection as a cause of urinary incontinence.

Cystoscopy: A small telescope is introduced into the urethra to evaluate the health and integrity of the urethra and bladder and look for the presence of a foreign body (stones, tumors or sutures from prior surgery), chronic infection or diverticulum. The physician can observe the response of the urethra and bladder neck to coughing or straining.

Treatment Options

Non-surgical treatments:

A. Medications: may be helpful in overactive bladder with 50-60% improvement, but also help about 40% on individuals with stress incontinence. Side effects are common.

B. Physical therapy: consists of pelvic muscle exercises such as Kegels, biofeedback, electrical stimulation, and bladder training drills. 50% of those with stress incontinence and 40% of those with overactive bladder show improvement.

C. Behavior modification: bladder training drills to lengthen time between voids

D. Continence Devices: may be small disposable devices designed to fit in the urethra temporarily to hold the urine by blocking the urethra and removed for urination.

E. Support Devices: Pessaries are flexible devices that are custom fit to the vagina helping support the cervix and bladder neck (improvement 30-40% of the time) Once inserted in the vagina, the pessary should be comfortable and stay in place with a variety of activities. It should be removed and cleansed on a weekly to monthly basis

Surgical treatments

A. Laparoscopic Vaginal Vault suspension: with the use of mesh the fallen vagina is anchored to the sacrum

B. Vaginal hysterectomy: is removal of the cervix and uterus through the vaginal opening. Tubes and ovaries may or may not be removed concurrently. This is usually combined with a bladder suspension if urinary incontinence exists.

C. Anterior Posterior Colporrhaphy: is removal of vaginal tissue superiorly beneath the bladder and/or inferiorly over the rectum both supporting and tightening the vaginal opening.