Frequently Asked & Answered Questions

The Pelvic Floor Doctor

 

What is a Pelvic Floor Doctor?

The pelvic floor is the base of the women’s pelvis. Most women are familiar with their bony pelvis.  In the front is the pubic bone, in back the sacrum and coccyx, and on the sides, the hip bones. As shown in the figure, at the base of the pelvis are muscles and ligaments that support the pelvic organs which include the uterus, bladder, rectum, and vagina. There are many conditions where the support of the pelvic organs is deficient and as a result, one or more of the organs sag, or ‘prolapse.’

A pelvic floor doctor specializes in prolapse and other problems related tothe organs that occupy the pelvis. These problems include protrusion (prolapse), pain, bladder frequency and urgency, bladder infection, and bladder control problems. Pelvic floor specialists also care for sexual problems, spasm of the pelvis, problems urinating or defecating, and pain issues related to the pelvic region.

What is Female Pelvic Medicine and Reconstructive Surgery?

The American Board of Medical Specialties approved Female Pelvic Medicine and Reconstructive Surgery, also known as Urogynecology, as a certified subspecialty in 2011, and the first doctors were board-certified in 2013. Urogynecologists are physicians who complete medical school and a residency in Obstetrics and Gynecology or Urology. These physicians are specialists with additional years of fellowship training and certification in Female Pelvic Medicine and Reconstructive Surgery. The training provides expertise in the evaluation, diagnosis, and treatment of conditions that affect the muscles and connective tissue of the female pelvic organs. Pelvic floor conditions that urogynecologists commonly treat include urinary incontinence, overactive bladder, and pelvic organ prolapse. These physicians are also knowledgeable on the latest research in the field pertaining to these conditions. Dr. Lind was among the first formally certified Urogynecologists in Long Island.

What is a Urogynecologist?

Urogynecologists, or Female Pelvic Medicine Soecialists dedicate themselves to the study and treatment of pelvic floor disorders in women.  Urogynecologists complete medical school and complete a residency in Obstetrics and Gynecology or Urology. These doctors then receive an additional 2-3 years of additional specialty training in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs. Many, though not all, complete formal fellowships (additional training after residency) that focus on the surgical and non-surgical treatment of non-cancerous gynecologic problems. Some of the common problems treated by a urogynecologist include urinary incontinence or leakage, pelvic organ prolapse (dropping of the vagina, uterus, cystocele, rectocele), overactive bladder, spasm or pain of the pelvis, and sexual dysfunction.  Dr. Lind completed his residency at Cornell University medical College – North Shore University Hospital and then completed a dedicated fellowship at U.C.L.A. in California. Dr. Lind is double board certified in Obstetrics and Gynecology and in Female Pelvic Medicine & Reconstructive Surgery

What is vaginismus?

Vaginismus is a condition that can make sexual intercourse, gynecological exams and even tampon insertion painful, if not impossible. The condition occurs when inserting an object such as a tampon, penis or speculum into the vagina.

What is a Board Certified Urogynecologist or Female Pelvic Medicine and Reconstructive Surgeon?

A physician who has passed an exam from the American Board of Obstetrics & Gynecology and American Board of Urology attesting that they possess exceptional expertise in Female Pelvic Medicine and Reconstructive Surgery. The first board certification exam was in 2013. Dr. Lind, and all the physicians in his practice are formally Board certified in Female Pelvic medicine & Reconstructive Surgery.

Is surgery required for urinary incontinence?

Regarding urinary incontinence, medications are available for urgency, frequency, and incontinence related to an overactive bladder. For many, dietary modifications, and pelvic floor training and strengthening can greatly relieve symptoms. Bladder nerve stimulation and bladder retraining are physical therapy methods that can greatly help many patients without needing surgery.

For both stress incontinence and for urge incontinence, there are non-invasive surgical options available if symptoms persist after trying non- surgical options. For the overactive bladder procedures include Botox injection of the bladder and placement of a small implanted bladder ‘pace-maker.’ These are both minimally invasive.

The most studied, most reliable, first choice surgical procedure for stress incontinence is the sub-urethral sling. This is a 15-20 minute vaginal procedure through a 1-1.5 centimeter vaginal incision.  Almost all patient go home shortly after the procedure. The sling has a high success rate and a low complication rate. Patients generally are pain-free within just a few days. Some patients have read concerning descriptions related to slings. Dr. Lind will carefully review the safety record regarding slings so that you can be reassured that you are having a procedure that has been tested and determined to be safe at the highest standards.

Is surgery required for pelvic organ prolapse?

We treat approximately half of our patients with with surgery and half without surgery. If you have pelvic prolapse you have the option to have no intervention, to use a vaginal pessary, to perform pelvic strengthening, and the option to have surgery. For some women, the non-surgical options relieve their symptoms and for some women, they do not. If you are retaining a large volume of urine then from a medical view, you may need to have surgery but in most cases, surgery is only necessary if the bother for you is high enough that you need relief. Pain, retention of urine, and recurrent bladder infections related to pelvic prolapse are the moist common indications for surgery.

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