Pelvic Health Center

Chronic pelvic pain is one of many common pelvic floor disorders affecting people of all ages. Usually pain is considered “chronic” when it lasts longer than 6 months, and “pelvic” pain refers to the area below the belly button. Pain symptoms can be felt internally or externally and can be described as burning, sharp, achy, stabbing or cramping. The pain can happen anytime, including during intercourse, bowel movements, or when you urinate.

Pelvic Pain in Both Women and Men

Pelvic pain can be caused by a number of conditions affecting the organs, tissues, or structures below the belly button. That would include structures like the uterus, the bladder, the small bowel, the rectum, the vagina, or the penis and testicles. Some of the common causes for chronic pelvic pain include endometriosis, uterine fibroids, pelvic floor trauma (including childbirth), aging, and sports injuries (even in childhood).

Diagnosing Chronic Pelvic Pain

Your doctor will start with a complete history and pelvic exam. Imaging studies, muscle tests, nerve tests, or blood and urine tests could follow, depending on what they see on examination.

Treatment for Chronic Pelvic Pain

There are a wide range of treatments available for chronic pelvic pain. Some of the more conservative approaches include behavioral modification and physical therapy. Other options could include topical, injectable, and oral medications. The most advanced treatments include surgery. You and your doctor should discuss the options that are appropriate for you, based on your unique medical history and what their examination and testing has revealed. The good news is that you don't have to suffer from pelvic pain - treatment is available!

You are not alone; many people are affected by a Pelvic Floor Disorder (PFD). While PFDs such urinary/bowel incontinence, pelvic pain and pelvic organ prolapse are common, they are not a normal or acceptable part of aging. They can often be reversed and effectively treated with painless, low-cost treatments options. CHI Health physicians are specially trained and understand that the symptoms associated with these conditions are often uncomfortable and embarrassing. They are committed to providing proactive and compassionate care this is individualized to your unique condition.

Symptoms of Pelvic Floor Disorder

• Uncontrollable bladder
• Stopping and starting of urine stream
• Painful urination
• Incomplete emptying
• Constipation, straining or pain during bowel movements
• Pain or pressure in the low back, pelvic region, genital area, or rectum
• Pain during or after intercourse
• A heavy feeling in the pelvis or a bulge from the vagina or rectum
• Muscle spasms in the pelvis region

Diagnosing Pelvic Floor Disorders

A urogynecologist is a physician who has completed medical school and a four-year residency in obstetrics and gynecology, and then gone on to receive additional, highly specialized training in surgical and non-surgical treatment of pelvic floor disorders. At CHI Health, these PFD experts diagnose the condition during a physical examination. Using external and internal manual techniques to evaluate the function of the pelvic floor muscles, they can assess your ability to contract and relax these muscles. A urodynamics study may also be performed in the clinic to measure the bladder's functions and efficiency.

Treatment for Pelvic Floor Disorders

Treatment can have a dramatic and positive effect on quality of life. For most people, treatments include:

• Behavior changes, such as avoiding pushing or straining when urinating and having a bowel movement. This also might include learning how to relax the muscles in the pelvic floor area. For example, warm baths and yoga can help relax these muscles.
• Medicines, such as low doses of muscle relaxants like diazepam
• Physical therapy which can help you learn how to relax and coordinate the movement of your pelvic floor muscles
• Surgery

Causes of Pelvic Organ Prolapse

There are many causes for pelvic organ prolapse.  Here is a partial list.

• Aging
• Menopause
• Obesity
• Pregnancy  
• Chronic cough
• Heavy lifting
• Pelvic surgeries

Symptoms of Pelvic Organ Prolapse

Some of the obvious ones include the feeling something is falling out of the vagina or there is a protrusion or bulge. Some of the less obvious include pelvic pain, backache, problems going to the bathroom, or painful intercourse. Sometimes there are no symptoms with pelvic organ prolapse.

Diagnosis Pelvic Organ Prolapse

Pelvic organ prolapsed is diagnosed through a simple pelvic exam done in the office. It does not require any specific testing or tools.

Treatment for Pelvic Organ Prolapse

There are many ways to treat pelvic organ prolapse. One approach includes strengthening the pelvic muscles through exercises and physical therapy. Your doctor can support the pelvic muscle by inserting a device that holds the prolapsed in place. There are also surgical options using minimally invasive procedures. Pelvic organ prolapse is an uncomfortable, often embarrassing condition but you don’t have to live with it. It is a medical condition not a normal part of aging and treatment is available.

Urinary and fecal incontinence are pelvic disorders that result in involuntary loss of control of a bodily function, including normal voiding reflex for urine or the control of a normal bowel movement. These are disabling conditions that are very common especially in older people. People often don't talk to their doctor about it because they are embarrassed, but it’s important to remember that the sooner you talk about it, the sooner you can fix the problem, and keep it from getting worse. 

Urinary Incontinence

There are two types of urinary incontinence, and frequently people have a combination of both.  Consulting a urologist or urogynecologist will be appropriate to determine your unique condition.   

• Stress incontinence is caused by activities (coughing, sneezing, laughing, running, or lifting) that affect the bladder due to increased abdominal pressure.   When this happens and the pelvic floor muscles aren’t capable of resisting the pressure, leakage can occur.  
• Urge incontinence is marked by a need to urinate frequently, even when the bladder isn’t very full.  People with this type of urinary incontinence will often describe difficulty making it to the bathroom in time, or often having to interrupt daily activities. There are many causes of urge incontinence, including medical conditions (benign prostatic hyperplasia, Parkinson's disease, multiple sclerosis, stroke, and spinal cord injuries), surgeries (including hysterectomy or prostatectomy), and infections.  However, sometimes it’s just a matter of eliminating bladder irritants and using a few simple re-training strategies under the guidance of a specialized physical therapist.

Fecal Incontinence

Fecal incontinence is the involuntary loss of stool and/or air through the rectum, including “smearing” which is just a small amount of feces on the underclothing due to incomplete evacuation of bowels.  This can occur for a number of reasons including changes to medication, decreased activity, or dietary factors. Pelvic floor musculature can be dysfunctional, contributing to inability to hold stool, but it’s important for the stool consistency to be optimal (ideally soft and formed, like a ripe banana).  It’s also important that bowel movements are regular and consistent, reflecting the body’s ability to properly absorb nutrients and fluid.  Consulting a gastrointestinal specialist, colorectal specialist and/or a nutritionist may be necessary.

Causes of Urinary and Fecal Incontinence

Causes for urinary and fecal incontinence can be diagnosed in an office setting. An evaluation by your medical provider will include a physical exam to rule out potential serious medical conditions. Testing could involve tests such as urodynamic assessment, cystoscopy, or anal manometry to pinpoint the cause of incontinence. Once we have completed the tests, we can offer you a variety of treatment options.

Treatment for Urinary and Fecal Incontinence

There are very effective treatments available for urinary and fecal incontinence that include medical, therapeutic, and surgical options. The most important thing to remember is incontinence is not a normal part of aging. Talk to your doctor – help is available for this very common condition.

If you have pain with periods, you are not alone.

Endometriosis affects 1 in 10 women worldwide, and symptoms can begin before age 20.

Endometriosis is an estrogen-dependent disease that occurs when endometrial cells and tissue from inside the uterus get out and attach to other areas of the body. These rogue cells are stimulated by estrogen, which triggers an immune response – leading to inflammation, hypersensitivity, and ultimately, pain.

Read more on this condition.

CHI Health is one of the first institutions in the country creating 3D ultrasound prints for prospective parents. With the three-dimensional print, the new parents can feel the contours of the baby's face and get an understanding of what their baby looks like – whose nose he or she has, for example. 

Having access to a 3D print of an ultrasound is more than a parent-pleasing use of technology. CHI Health researchers are studying how it can raise oxytocin levels and increase attachment to the baby for new parents. While potentially beneficial for all new parents, specific reasons 3D prints can be provided include: 

• Parents who are visually impaired and would otherwise be unable to view a regular ultrasound print.
• Mothers who are smoking while pregnant (11-15% of pregnant women) to help increase the likelihood of smoking cessation.
• Parents of babies who have a cleft lip, to improve familiarity and bonding even before their baby is born. 
• Parents experiencing anxiety or depression or other psychological issues. 
• Fathers to enhance paternal attachment before their baby is born. 

Overall, the technology holds potential to enhance the prenatal and postnatal experience for all parents and families by providing this unique piece of the puzzle of their future newborn. 

CHI Health researchers are continuing to study whether using this technology can reduce smoking by pregnant women and decrease prenatal ER visits, for example, and whether its ability to enhance the bonding experience could potentially make 3D prints a new standard of care. 

Anorectal manometry is a noninvasive medical procedure that assesses the function of the anal and rectal muscles and measures pressures in the anus and rectum. During the test, a doctor inserts a catheter containing a probe with pressure sensors through the anus and into the rectum. The catheter is connected to a computer with a graph that records how well the muscles around the anus are working. The test also measures the sensation in the rectum and the neural reflexes needed for normal bowel movements.

A cystoscopy is a surgical procedure that allows a doctor to view the inside of the bladder and urethra using a thin, lighted tube called a cystoscope. The cystoscope has lenses like a telescope or microscope. Fluid is used to fill the bladder, and the doctor looks at an image of the inner wall of the bladder on a computer monitor to check for abnormal areas.

Urodynamics is a test we do in our office to help us understand how the bladder functions - how the bladder stores urine, how the bladder empties urine and how the sphincter and the muscles of the bladder act. It helps us determine the problem with the bladder. Patients should allow up to 90 minutes for this process, as each stage is carefully prepared and completed. We ask patients to arrive with a full bladder. We then have them urinate into a container. The volume of urine is measured at the rate at which the bladder empties. We then insert a thin catheter or a tube into the bladder. We continue to pump water into the bladder. More measurements are taken from the first urge to urinate until you can't hold it anymore.

Who's a candidate for Urodynamics?

A good candidate for this test is a patient who has urinary difficulty - incontinence, frequent urination, sudden -- strong urges to urinate, problems starting to urinate, painful urination, problems completely emptying the bladder and frequent urinary tract infections.

What are the benefits of Urodynamics?

A urodynamics test allows your physician to determine the specific cause of your symptoms, so that they can provide the appropriate treatment. For example, they will be able to determine whether the problem is related to bladder or sphincter function, because these are treated very differently. You and your physician will discuss the results of the test and decide how best to proceed from there.

What are the risks of Urodynamics?

There is some minor discomfort with this test when the catheter is inserted.

The pelvic floor is made up of several different muscle groups. If the muscles are too weak or too tight, physical therapists treat them. It’s just like any other muscle in the body that needs a little help. A number of pelvic floor disorders can be treated with physical therapy including: urinary incontinence, fecal incontinence, some prolapse conditions, constipation, and painful intercourse.

Read more about our Pelvic Floor Rehabilitation program.

Make accidental urine leakage a thing of the past with Adjustable Continence Therapy.

What can patients expect?

The innovative outpatient procedure takes approximately 30 minutes; no overnight stay is required:

• Silicon balloons are placed on either side of the bladder neck to provide support to the bladder by restricting the flow of urine through two valves.
• Balloons are connected to a titanium filling port.
• During adjustment visits, the implanted balloons are tailored to each person's individual needs.
• Small needle is inserted through the skin into the port to add or remove fluids.
• Optimal results are generally achieved in 3- 4 adjustment visits.
• Device does not need to be manipulated by the patient at any time.

Robot Assisted Radical Prostatectomy (RARP) is a minimally invasive procedure for removal of the prostate due to cancer. It is the most common surgical treatment for this condition.

What can patients expect?

Recovery tends to involve one night in the hospital and placement of a foley catheter for 7-14 days. Patients are advised to avoid heavy lifting for 3-6 weeks following surgery.

Many patients also wonder about recovery of urinary and sexual function following prostate surgery. A number of different options are available, depending on which structures have been impacted by the enlarged prostate. You can speak with your surgeon, and they may also recommend a referral to physical therapy services in order to maximize your potential for a good surgical outcome.

Many people who have had kidney stones, tend to continue making them. There are a number of options to help people avoid making new kidney stones. This process starts with a chemical analysis of the stone to determine what it is made of. An increase in fluid intake sufficient to generate 2 liters of urine a day is typically recommended. Further evaluation into stone prevention requires a 24 hour urine collection done at home and mailed to a special laboratory for analysis. Our providers analyze and interpret the 24 hour urine chemistry, and create a customized kidney stone prevention plan for the patient. Such a plan usually involves a dietary modification and sometimes medication. If the treatment plan is followed consistently, kidney stone production is typically reduced by over 90%.