Common Questions

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Pelvic organ prolapse refers to any of the pelvic organs (bladder, uterus, vagina or rectum) dropping from their normal position and causing pressure or creating a vaginal bulge.

Many women experience no symptoms, while others may experience some of the following, which tend to progress very gradually:

While women of all ages may be affected by pelvic organ prolapse, it is more common in older women. Certain factors may increase your risk, including:

Diagnosis begins with your medical history and a physical exam of your pelvic organs. Some additional tests may be necessary (including bladder function tests, pelvic floor strength tests, MRI or ultrasound) to help determine the exact type of prolapse.

The treatment for pelvic organ prolapse depends on your type of prolapse, severity of symptoms, lifestyle, and treatment goals. There are non-surgical and surgical options.

Urinary incontinence (UI) is the uncontrollable leakage of urine. This can be caused by nerve or muscle dysfunction of the bladder, loss of support of the urethra and/or bladder, or weakened urinary sphincter.

Approximately 30 percent of women in the U.S. suffer from urinary incontinence, which can affect women of all ages. Some women may be at increased risk for urinary incontinence due to: Pregnancy and childbirth (your risk increases with the number of children you have), Menopause or aging, Being overweight or obese, Diabetes, Stroke, Prior hysterectomy (removal of uterus), Smoking.

Stress urinary incontinence: occurs most commonly when there is a weakness in urethral support or in the urinary sphincter. As a result, certain activities, such as sneezing, coughing, laughing, bending or exercising, place pressure on the bladder and causes urine to leak involuntarily, Urge urinary incontinence (also known as overactive bladder): the sudden urge to urinate, often with little or no warning. Your bladder muscles may be too active and squeeze to pass urine before you can get to the bathroom, Mixed incontinence: a combination of having stress urinary incontinence and urge urinary incontinence, Overflow incontinence: when you are unable to empty your bladder and the urine overflows or leaks out. Symptoms include frequent urination of small amounts or a constant drip.

In order to determine the type of urinary incontinence that you have, your doctor will first ask for your medical history. You should be prepared to share details of any pregnancies and deliveries you've had, as well as if you're experiencing menopause, since these can all be major causes of urinary incontinence. Your doctor will also perform a physical examination. They may also request a urinalysis to test for signs of infection or blood in your urine, or ask you to urinate in a container to measure the amount of urine you produce.

Treatment for urinary incontinence depends on what type of urinary incontinence you have. Generally, patients may be offered non-surgical options (such as lifestyle modifications or physical therapy) or surgical options. Based on your history, examination, lifestyle, and goals, you and your doctor will come up with a personalized plan.

Stress urinary incontinence means leakage of urine with activities like coughing, laughing, or sneezing. This type of urinary leakage occurs because of general wear and tear over time to the pelvic muscles. The urethra (the tube through which you urinate) loses its support from the pelvic floor muscles, causing urine to leak with activities.

The treatment for stress urinary incontinence depends on the severity of your symptoms, your lifestyle, and your treatment goals. There are non-surgical and surgical options. Your doctor will help you select the best option for you. Non-surgical options include: Observation, Lifestyle modifications (weight loss, anti-cough medications, etc.), Pelvic floor physical therapy, Pessary, Intra-vaginal inserts. Surgical options include: Urethral Bulking Agent, Mid-urethral Sling.

Overactive bladder is a group of symptoms including bothersome urinary urgency, frequency, and waking up to urinate in the middle of the night. Some patients may also have leakage of urine or loss of urine control associated with the urge to urinate.

Approximately 20-40 percent of women in the U.S. suffer from overactive bladder, which can affect women of all ages. Some women may be at increased risk for urinary incontinence due to: Pregnancy and childbirth, Menopause or aging, Being overweight or obese, Diabetes, Stroke or other neurologic diseases, Prior hysterectomy (removal of uterus), Smoking.

First, your doctor will perform a history and physical examination. While a patient history often is sufficient for a diagnosis, your doctor may request other tests including a urine test, urodynamics, or cystoscopy.

Treating overactive bladder requires a personalized approach. Your doctor will work with you to create a treatment plan tailored to your needs. Conservative treatment for overactive bladder include behavioral modifications, such as dietary and fluid changes, and pelvic floor physical therapy. Pharmacologic treatment includes the addition of medications such as beta-3 agonists or anti-cholinergic drugs. Minimally-invasive treatment involves ambulatory procedures including bladder botox, sacral neuromodulation, implantable tibial nerve stimulation and posterior tibial nerve stimulation.

Recurrent urinary tract infections (UTIs) are defined as having two or more infections in six months or three or more in one year. These frequent infections can significantly impact quality of life and may indicate an underlying condition that needs to be addressed.

Frequent, urgent need to urinate Burning sensation during urination Cloudy or strong-smelling urine Pelvic pain or pressure Blood in urine Low-grade fever

Women are more prone to recurrent UTIs due to anatomical factors. Other risk factors include pelvic organ prolapse, incomplete bladder emptying, menopause, sexual activity, and certain types of birth control. Dr. Tabakin specializes in identifying and treating the underlying causes of recurrent UTIs.

Treatment may include lifestyle modifications, vaginal estrogen therapy for postmenopausal women, preventive antibiotics, treatment of underlying conditions like prolapse, and other specialized interventions based on the cause of recurrent infections.

Urinary retention occurs when you are unable to completely empty your bladder. This can be acute (sudden inability to urinate) or chronic (difficulty emptying the bladder over time). Voiding dysfunction encompasses various problems with bladder emptying.

Difficulty starting urination Weak or intermittent urine stream Feeling of incomplete bladder emptying Frequent urination in small amounts Urinary urgency Lower abdominal discomfort

Urinary retention can be caused by various factors including pelvic organ prolapse, neurological conditions, medications, prior pelvic surgery, or bladder dysfunction. Dr. Tabakin will perform a thorough evaluation to identify the underlying cause and develop an appropriate treatment plan.

A vaginal fistula is an abnormal opening between the vagina and another organ. A vesicovaginal fistula is an abnormal connection between the bladder and the vagina; a rectovaginal fistula is an abnormal opening between the rectum and the vagina; an enterovaginal fistula is an abnormal opening between the small bowels and the vagina. These openings may result in incontinence.

The symptoms of a vaginal fistula are urine or feces being released through the vagina. Women who have a vaginal fistula may feel embarrassed by the condition, as it can cause vaginal leakage and unpleasant smells.

The most common cause of vaginal fistulas is prolonged labor. Fistulas can also be caused by urologic or pelvic surgery, an infection or cancer. Sometimes, conditions like Crohn's disease or diverticulitis can lead to a vaginal fistula. Accidents and traumatic injuries can also lead to a vaginal fistula.

Nonsurgical treatment may be an option for some patients with this condition. For vaginal fistulas that are detected early and are less than half a centimeter in size, a catheter can often be inserted to see if the fistula will repair itself. Small, uncomplicated rectovaginal fistulas can sometimes be treated with a plug that is placed in the rectum. This is often used to treat patients who are not good surgical candidates. Vaginal fistulas are typically repaired surgically through the vagina. This procedure has the lowest risk of complication. However, depending on the location and complexity of the fistula, it may be necessary to perform the surgery through the abdomen. Repairing fistula through the abdomen can be done via robotic surgery, which typically minimizes the size of the incision and the amount of pain for the patient. If a patient presents with a clean fistula and is in good health, the success rate of fistula surgery is high. The procedure, like any surgery, does carry the risk of bleeding, infection and damage to surrounding organs.

A urethral diverticulum (UD) is a condition that causes a "pocket," or an outpouching, along the urethra (the tube that connects the bladder to the outside of the body and allows for urination). Urethral diverticulum is rare, but is more common in women between the ages of 40 and 70.

Not everyone who has a urethral diverticulum will experience symptoms. However, some symptoms of a urethral diverticulum may include: Urinary urgency or frequency, Recurring urinary tract infections, Pain with urination (dysuria), Pain with sexual intercourse (dyspareunia), Blood in the urine, Leaking urine, Non-urine discharge, Feeling or incomplete bladder emptying after urination, Bladder pain.

While urethral diverticulum isn't common, various factors increase the chances of having this condition. This includes frequent urinary tract infections and trauma to the area, such as obstetric trauma during delivery, including vaginal tears caused by the use of forceps or a vacuum. A urethral diverticulum can be caused by an infection of the glands that are connected to the urethra. The glands can fill with fluid or materials, which will cause the outpouching. Over time, urine may collect in that area, causing the pouch to increase in size.

In women, a urethral diverticulum looks like a fist-like protrusion on the top of the vaginal wall and can be detected by your doctor during a physical exam. Because not all UDs have symptoms, a urethral diverticulum may be found during a routine exam or test for another condition. It may take some time before a urethral diverticulum is properly diagnosed. Other tools used to diagnose a UD include: MRI (magnetic resonance imaging), Ultrasound, Tests that measure urinary tract function.

Urethral diverticulum is treated by a urethral diverticulectomy, in which the protrusion on the urethra is surgically removed. In some instances, the surgeon may be able to drain the contents of the sac rather than removing the UD completely. After your surgery, you will most likely need a course of antibiotics and to use a catheter for several weeks while you heal from the procedure.

The pelvic floor muscles support the pelvic organs, which include the bladder, bowel and uterus in women. Maternal pelvic floor trauma, sometimes referred to as childbirth injury, can occur during pregnancy or delivery and encompasses a variety of complications. Stress from pregnancy and vaginal delivery puts pressure on the pelvic floor muscles, weakening them and causing conditions such as prolapse, incontinence, pelvic pain, pain with intercourse or vaginal fistula.

Issues stemming from maternal pelvic floor trauma can develop throughout a woman's lifetime. Symptoms for this condition can vary, and may include one or more of the following: Urinary problems: these include urine leakage when coughing, sneezing or laughing (stress incontinence), Bowel problems: fecal incontinence from maternal pelvic floor trauma results in losing stool involuntarily, Prolapse: women who have a prolapse will have symptoms that include pelvic pressure and a pelvic organ that bulges out of the vagina, Pain: some women experience pain with intercourse as a result of tears or cuts to the vagina and perineum during childbirth.

Common factors that can increase the risk of maternal pelvic floor trauma include: Pregnancy, Vaginal birth, Advanced maternal age, Delivery with forceps or vacuum, Prolonged pushing (second stage) during labor, Obesity, Delivering a large baby, Deep, excessive vaginal tears.

Pelvic floor trauma can often be diagnosed via a physical examination by your gynecologist, urogynecologist, or urologist. Depending on your symptoms and medical history, your doctor may order additional tests, such as urodynamic testing or cystoscopy (bladder testing), to properly diagnose your condition.

Treatment for maternal pelvic floor trauma depends on the nature of the injury. Behavioral modification is often the first step, and physical therapy is frequently recommended to help retrain and strengthen the muscles as part of a treatment plan.

According to the North American Menopause Society, genitourinary syndrome of menopause (GSM) is a condition describing the symptoms and signs of decreased estrogen on the female genitourinary tract, including the vagina, labia, urethra, and bladder.

There are many symptoms of GSM, many of which mimic those of urinary tract infections. The most common symptoms include: Vaginal dryness, Vaginal burning and irritation, Burning with urination, Urinary frequency and urgency, Recurrent urinary tract infections (UTIs), Pain and dryness with sexual activity.

Your doctor can generally diagnose genitourinary syndrome of menopause with a history and pelvic examination. The patient history can help your doctor identify symptoms while the pelvic examination may identify findings consistent with GSM and eliminate other pathologic conditions that may cause similar symptoms.

There are number of treatment options for genitourinary syndrome of menopause. Non-hormonal treatments include vaginal lubricants or moisturizers. Many of these are over-the-counter. Your doctor can make specific recommendations to you. Hormonal treatments include vaginal estrogen, administered as either a cream or tablet with an applicator or a vaginal ring. Once prescribed, vaginal estrogen should be used as lifelong therapy. Vaginal estrogen, which is different than oral estrogen, acts locally in the vagina with only a small amount absorbed into the bloodstream. If used regularly, estrogen bloodstream levels are similar to those of postmenopausal patients not using vaginal estrogen. There are a multitude of high-quality studies demonstrating that vaginal estrogen does not increase your risk of blood clots, breast cancer, or uterine cancer. However, many studies have shown that vaginal estrogen is very effective at reducing symptoms of GSM and recurrent UTIs.

Surgical mesh is sometimes used in pelvic floor surgery to provide support for prolapse or incontinence treatment. While mesh can be effective, some patients may experience complications including pain, mesh erosion, infection, or mesh contraction.

Chronic pelvic pain Pain during intercourse Vaginal discharge or bleeding Urinary problems Mesh erosion or exposure Recurrent infections

Dr. Tabakin specializes in the evaluation and treatment of mesh complications. Treatment options may include conservative management, mesh removal (partial or complete), or reconstructive surgery. Each case is evaluated individually to determine the best approach.

Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of the prostate gland that commonly affects men as they age. The enlarged prostate can compress the urethra and cause urinary symptoms.

Frequent or urgent need to urinate Difficulty starting urination Weak urine stream Incomplete bladder emptying Frequent nighttime urination (nocturia) Dribbling at the end of urination Urinary retention

Dr. Tabakin offers comprehensive evaluation and treatment for BPH. Treatment options range from watchful waiting and medications to minimally invasive procedures and surgery, depending on the severity of symptoms and patient preferences.

Robotic-assisted surgery is a form of minimally invasive surgery, performed through a few small incisions. During robotic-assisted surgery, your surgeon controls the da Vinci surgical system through a special console in the room.

The da Vinci's vision capabilities give your surgeon a highly magnified, crystal-clear, 3D view while operating, so he or she can see the fine details of your surgery. Your surgeon uses tiny instruments that fit through small incisions to make precise movements and access hard-to-reach places beyond the limits of the human hand.

Robotic surgery has been associated with shorter length of hospital stay, fewer complications, and lower blood loss.

This method involves the surgeon removing the uterus entirely through your vagina. It does not require any incisions, but cannot be done if your uterus is too large to be safely removed through the vagina.

During a uterosacral suspension, a vaginal hysterectomy is first performed to remove the uterus. Then, the top of the vagina is lifted with sutures and attached to ligaments in the pelvis, returning the vagina to its normal position.

A sacrospinous suspension, also known as a sacrospinous ligament fixation, is a surgery that is performed to restore support to vaginal walls that have been affected by prolapse, or a bulging that occurs in the vagina. During this procedure, an incision is made in the vagina, and the vagina is lifted up and reattached to the sacrospinous ligament (a connective tissue in the body that is attached to the lower pelvis, bottom of the spine and tailbone) with stitches.

This type of surgery lifts the bladder back into place by placing stitches in the top part of the vagina. A cystocele repair is commonly performed at the same time as a mid-urethral sling insertion for stress urinary incontinence.

This type of surgery lifts the rectum back into place by placing stitches in the back part of the vagina.

Prolapse surgery can either be performed vaginally or through a robotic (laparoscopic) approach. Your doctor will help you make an informed decision regarding the best type of surgery for you.

Mesh may or may not be used during prolapse surgery depending on the type of prolapse you have and the surgical approach your doctor performs. Your doctor will discuss surgical options with and without mesh to ensure you are well-informed.

Length of stay depends on what type of surgery you undergo. Some surgeries are done as an outpatient (go home the same day), while others require a one night overnight stay in the hospital.

The tube connected to the bladder that allows you to urinate is called the urethra. When the support tissue below the urethra weakens, pressure from activities like coughing, sneezing and exercising cause the urethra to move up and down, opening it and allowing urine to leak out. This is known as stress incontinence. A mid-urethral sling is a mesh device surgically placed underneath the urethra to act as a supportive "hammock" so when you cough, sneeze or laugh, the urethra stays straight, in place and closed to prevent leakage. It's a minimally invasive procedure with a high success rate, and is therefore widely considered to be one of the best options when treating stress incontinence surgically.

A mid-urethral sling is the most common surgical option for treating stress incontinence in women. The mesh does not break down in the body, which means the device holds steady over time. The procedure is minimally invasive, can be performed in about 15 to 30 minutes, and is done through a small incision in the vagina. Women who have a history of pelvic radiation or who may potentially need pelvic radiation in the future are not good candidates for a mid-urethral sling. If you've had issues with a mesh procedure before, your physicians would take this into account when considering whether to use this type of sling.

During the surgery, a small incision is made on the vaginal skin directly under the urethra. The sling is placed between the urethra and vagina, then the sling is brought up behind the pubic bone and secured. You won't be able to feel or see the mesh sling once it's in place. The incision inside the vagina is closed with stitches that dissolve over time. After the procedure, most patients are able to go home the same day. You might experience soreness, but you should be able to return to work and do normal activities within two to three weeks. Within a month of surgery, your stress incontinence symptoms should be resolved.

A urethral bulking agents is a gel-like or permanent filler-like substance that is injected into the urethra (channel through which you urinate) in order to prevent urine from leaking out.

Urethral bulking agents are used to treat stress urinary incontinence, which is leakage with activities such as laughing, coughing, or sneezing. This procedure will not treat urinary leakage from overactive bladder or urge incontinence. Typically, urethral bulking agents are used for women who: Have mild stress urinary incontinence, May want to consider future pregnancies, Women who do not want surgery with general anesthesia, Women who are not good candidates for surgery requiring anesthesia.

Generally, we perform urethral bulking agent injections in the office under local anesthesia. Patients go home the same day and can immediately return back to their activities.

SNM is a clinically proven solution for treating symptoms of overactive bladder (including urinary urgency incontinence), bowel (fecal) incontinence and non-obstructive urinary retention.

Small Size: Safely delivers therapy with a miniaturized implant, Long-Term Therapy: Designed to provide long-term symptom relief, Full-Body MRI: Eligible for full-body MRI under approved conditions.

Sacral neuromodulation provides gentle stimulation to the nerves that control the bladder and bowel, which can restore normal control and result in symptom improvement. The Evaluation Step: To see if SNM is right for you, you will undergo a short period of therapy using a temporary system. The evaluation period allows you to experience the level of symptom relief the therapy may provide before you commit to long-term therapy. Long-term Therapy: If you and your doctor determine that SNM is right for you, you will have an outpatient procedure where the miniaturized SNM implant is placed just beneath the skin in the upper part of your buttock.

Your doctor will help you decide if SNM is a good therapy for you. SNM is an approved treatment for patients suffering with: Overactive bladder: the urgent need to urinate which may result in frequent urination and/or incontinence (leakage) episodes, Urinary frequency: the need to urinate 8 or more times a day, which may or may not be associated with urgency, Urinary urgency incontinence (UUI): the urgent need to urinate or trouble holding urine before making it to the restroom, Fecal (bowel) incontinence: involuntary loss of stool which may or may not be associated with urgency, Non-obstructive urinary retention (UR): the inability to completely empty the bladder which may result in trouble urinating or frequent small voids, SNM may be indicated for patients who have failed conservative treatments, such as lifestyle changes, physical therapy, or medications.

Onabotulinum Toxin A, more commonly referred to as botox, can be used to treat both overactive bladder or neurogenic bladder. For overactive bladder patients, it is traditionally used after patients have not experienced symptoms relief with behavioral modifications and medications, For patients with neurogenic bladder, botox injections can help relax the bladder and increase bladder capacity in order to protect the kidneys.

Botox is a neurotoxin that can be used to disrupt the activity of certain nerves. Injecting botox into the bladder helps to relax the bladder so that it doesn't contract as frequently. As a result, patients with overactive bladder experience less urinary frequency, urgency, and leakage episodes.

We perform the injections in our office as an outpatient procedure. When you arrive for your appointment, we will check your urine to ensure you don't have an infection prior to beginning. A numbing medication will be instilled into your bladder for several minutes. Then, a small camera called a cystoscope is inserted into the bladder. Then, your doctor will inject the botox into several locations throughout the bladder; this takes about 5 minutes. You may have some minor burning with urination or blood in the urine for a few days following the procedure.

The benefits from botox last anywhere from approximately 3 months to 1 year, with most patients needing re-injections every 6-8 months.

Percutaneous tibial nerve stimulation (PTNS) is an FDA-approved method of treating an overactive bladder. It is similar to electrical stimulation of the pelvic floor, but does not require a device to be inserted into the vagina. Because the tibial nerve shares some of the same nerve supply as the bladder, when this nerve is stimulated in the ankle, it can help regulate bladder function. During PTNS, a very small, fine needle (similar to an acupuncture needle) is inserted into the ankle. A low-dose nerve stimulator (similar to a TENS unit used in physical therapy) is attached; it provides a mild electrical current to stimulate the nerve ending in the ankle. This electrical pulse then blocks nerve signals that are causing the bladder to be overactive. The procedure has been proven to be safe and effective in many high-level studies.

PTNS is used to treat overactive bladder. Symptoms of overactive bladder may include: The urge to urinate frequently, Nighttime trips to the bathroom, A strong urge to go to the bathroom that cannot be suppressed, Urine leakage associated with urgency symptoms. An overactive bladder can occur in people of all ages, from young children to adults, but is more likely to increase with age.

PTNS is performed in your doctor's office on an outpatient basis. You can expect to spend around 30 minutes receiving the treatment, which is not painful. In order to have the best results, you will need to repeat the treatment every 7-10 days for a total of 8-12 treatments. Some patients return for a single maintenance session every few months. While this involves several visits, obtaining good results without medications and without a more invasive option is appealing to many women.

PTNS is well tolerated by most people. You can expect to see a marked improvement in your bladder control and a reduction in the urgent need to urinate after completing the series of percutaneous tibial nerve stimulation treatments. You may need to have an additional PTNS session after a certain period of time. This timing varies by individual but may be anywhere from several months to a year after the initial series of treatments.