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School of Medicine
Our Treatments for Pelvic Floor Disorders
At Johns Hopkins, we are leaders in pelvic health care, pioneering treatment for women year after year. Our board-certified pelvic health specialists are involved in research and clinical trials for new and advanced treatments that will help prevent pelvic floor disorders in women.
In our nationally renowned program, our patients are the main focus. Our goals are to get you back to living life on your terms and provide an experience with us that is as stress-free as possible. This includes the possibility of meeting all your care needs in one convenient location. Everything you need — from experts who are trained to treat pelvic floor disorders, to innovative, nonsurgical therapies, to minimally invasive procedures — is here in our Women’s Center for Pelvic Health and Reconstructive Surgery.
We are also one of the few centers nationally that provides coordinated care among specialties. Our urogynecology team works with experts in urology, colorectal surgery, nursing and physical therapy to provide you with comprehensive, personalized care.
Our nonsurgical treatments include:
- Pelvic floor muscle training: Our skilled physical therapy team works with patients to rehabilitate pelvic muscles, strengthen the muscles and correct other musculoskeletal conditions contributing to pelvic floor disorders.
- Injections for bladder control problems: We offer injections of botulinum toxin into the bladder muscle to help the bladder relax, increasing its urine storage capacity and reducing episodes of urinary incontinence. Synthetic bulking material may also be injected into the urethra to help the urethra "seal" to improve urine control.
- Nerve stimulation: Electrical nerve stimulators send mild electrical pulses to nerves in the lower back to help manage urinary function.
- Vaginal pessary: A supportive device (plastic or rubber ring) is inserted into your vagina to help support your bladder.
- Oral medications: Used to improve bowel or bladder function, or reduce symptoms or discomfort.
Whenever possible, our surgeons use minimally invasive approaches to perform surgical procedures (pelvic reconstruction surgery). This includes vaginal surgery, laparoscopic surgery and robotic-assisted surgery.
Benefits of minimally invasive surgery include:
- Faster recovery
- Less pain (in most cases)
- Smaller abdominal incisions (or in the case of vaginal surgery, no abdominal incisions)
- Earlier return to normal activities
- Shorter hospital stay
- Decreased risk of infection
Our surgical treatments include:
Bladder Sling (Midurethral Sling)
If the bladder leaks during physical activity or exertion, such as sneezing or exercising, doctors may recommend a surgery called a bladder or midurethral sling. This procedure is usually performed through the vagina with two small incisions at the mons pubis (pubic hair area) or along the inner thigh area (near the vaginal opening). This procedure involves placing a small strap or material (surgical mesh) under the urethra (the opening of the bladder) to support the bladder opening to prevent leakage.
If the uterus or vagina have prolapsed out of the body, doctors may recommend a surgery called a sacral colpopexy. A sacral colpopexy can be performed through an abdominal incision or by minimally invasive techniques (laparoscopy or robot). During a sacral colpopexy, a strap is created using a surgical mesh material. This strap is used to reposition and suspend the vagina back into its original position.
Sacrospinous Ligament Suspension
If the uterus or vagina have prolapsed out of the body, doctors may recommend a surgery called a sacrospinous ligament suspension. A sacrospinous ligament suspension is performed through the vaginal opening, leaving no visible scars on the outside of the body. During a sacrospinous ligament suspension, the vagina is attached to the woman's own sacrospinous ligaments using stitches or sutures. This procedure suspends the vagina back into the sacrospinous ligament.
If the uterus or vagina have prolapsed out of the body, doctors may recommend a surgery called a uterosacral suspension. A uterosacral suspension is performed through the vaginal opening, leaving no visible scars on the outside of the body. This procedure can also be performed using laparoscopy or the robot. During a uterosacral suspension, the vagina is attached to the woman's own uterosacral ligaments using stitches or sutures. This procedure suspends the vagina back into its original position.
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