Urinary incontinence, also known as loss of bladder control, refers to the accidental loss of urine. This common condition affects nearly 25 million adults, most commonly, women over the age of 50.

If you are suffering with urinary incontinence, trust your care to the Johns Hopkins Women’s Center for Pelvic Health.

Urinary Incontinence Treatment: Why Choose Johns Hopkins

• Our expert team works closely with our patients to identify the unique causes of their incontinence and tailor treatments to their individual circumstances. We have received advanced training in treating pelvic floor disorders and are equipped to help women who have experienced unsuccessful prior treatments.
• We explore a broad spectrum of treatment options, first considering the least invasive, most effective treatment approaches for patients, including behavior and lifestyle changes.
• If surgery is needed, our urogynecologists specialize in the most advanced surgical treatment options for urinary incontinence, including minimally invasive surgical procedures.
• We work across many disciplines within Johns Hopkins to offer holistic care for the resolution of urinary conditions, including physical therapy, nonsurgical and surgical treatment options.

Pelvic organ prolapse, including uterine and vaginal prolapse, occurs when a woman’s pelvic floor muscles, ligaments and vaginal wall weaken and stretch, often due to aging, childbirth or a prior hysterectomy. Without adequate support of the pelvic floor, the pelvic organs slip out of place (prolapse) and bulge into the vagina, in some cases protruding out of the vaginal opening.

We treat all types of pelvic organ prolapse, including prolapse of the anterior vagina (cystocele), posterior vagina (rectocele), uterine prolapse and top of the vaginal (vaginal vault after hysterectomy).

If you are suffering from vaginal prolapse, trust your care to the Johns Hopkins Women’s Center for Pelvic Health and Reconstructive Surgery. If you are experiencing rectal prolapse (prolapse of the rectum through the anal opening), you may benefit from consultation with one of our colorectal surgeons.

Prolapse Treatment: Why Choose Johns Hopkins

• We listen closely to our patients and work with other specialties, including physical therapy, gastroenterology, colorectal surgery and urology, when appropriate, to develop individualized plans to address each patient’s concerns and specific condition.
• We use evidence-based treatments to address pelvic organ prolapse, including pelvic floor physical therapy, medical devices, such as pessary, and reconstructive surgical approaches with minimally invasive techniques, such as laparoscopic, robotic and vaginal surgery.
• Our researchers are at the forefront of exploring the link between pregnancy and delivery and pelvic floor disorders later in life. Understanding this link will allow us to develop new, advanced therapies for treating and preventing pelvic floor disorders.

Urinary tract infections (UTIs) are infections of any part of the urinary tract, including the urethra, bladder, ureters or kidneys.

The most common type of UTI is a bladder infection, also known as cystitis. Among women, 60% will experience a bladder infection at some point in their lifetime, and for most of these women, antibiotic treatment will clear their symptoms. Some, however, suffer from recurrent UTIs — defined as two or more infections, confirmed by a doctor, within six months— and may require further evaluation and treatment.

If you have frequent UTIs, trust the Johns Hopkins Women’s Center for Pelvic Health and Reconstructive Surgery to find a lasting solution.

Recurrent UTI Treatment: Why Choose Johns Hopkins

• Our team of experts specializes in the diagnosis and treatment of UTIs, and uses comprehensive diagnostic tools to help identify any cause of chronic UTIs to create an effective treatment plan.
• After treatment for active UTI, we counsel our patients on their risk factors for UTIs and how to protect their urinary health in the long term. We will work with you to develop personalized treatment plans that include a combination of therapies and lifestyles changes that reduce the risk of UTI recurrence.

A vaginal fistula is an abnormal opening between the vagina and other nearby organs, including the bladder or rectum. A fistula may be caused by childbirth, surgery, cancer or other pelvic injury. Fistulas can cause many complications, such as urinary and fecal leakage, tissue damage, kidney infections and other abdominal discomfort.

Vaginal Fistulas Treatment: Why Choose Johns Hopkins

• We listen closely to our patients and work with other specialties, including physical therapy, gastroenterology, colorectal surgery and urology, when appropriate, to develop individualized plans to address each patient’s concerns and specific condition.
• Experienced in a wide range of evidence-based treatments and surgical techniques, including minimally invasive surgery, our expert team has a high success rate with fistula repairs.

Fecal incontinence, also called bowel incontinence, is the inability to control bowel movements. Fecal incontinence affects as many as 12 million adults, and more often affects women and older adults. Symptoms may include bowel urgency and accidental loss of stool.

If you are suffering with fecal incontinence, trust your care to the Johns Hopkins Women’s Center for Pelvic Health and Reconstructive Surgery.

Fecal Incontinence Treatment: Why Choose Johns Hopkins

• Our expert team understands the sensitivity around uncontrolled bowel leakage, and we strive to provide compassionate care that alleviates your pain and discomfort and restores your quality of life.
• We work closely with our patients to identify the unique causes of their incontinence and create tailored treatment plans. Our experts have advanced training in the treatment of pelvic floor disorders and offer a broad spectrum of treatment options, including muscle training, nerve stimulation, minimally invasive surgeries and reconstruction.

A complete evaluation will allow your doctor to offer you the right solution for your care. You can expect the diagnostic process to include:

• A complete medical history and physical, which may include a brief neurological exam to assess any nerve damage. If you have had treatment or surgery in the past, your doctor may also review your medical records.
• Urine sample, to test for infection or other pathology that may cause incontinence.
• Urodynamic tests or a urinary stress test, where your doctor may assess urine loss with stress, such as exercise, sneezing, coughing or laughing, may be recommended.

Following your evaluation, we will review treatment options with you to develop a care plan that best meets your needs. Nonsurgical treatment, such as Botox injections of the bladder in women with overactive bladder, can be performed at any of our medical offices.

If you choose surgery, our team will recommend procedures that best treat your symptoms. A common option is the insertion of a bladder sling, a minimally invasive procedure in which a small strip of mesh is implanted to support the bladder opening to prevent leakage.

Read more about urinary incontinence in women.

A complete evaluation will allow your doctor to offer you the right solution for your specific condition.

At your initial appointment, your doctor will review your medical and surgical history and complete a physical exam. If you’ve had treatment or surgery in the past, your doctor may also review your medical records. Additional testing may include:

• Imaging studies, such as a ultrasound, CT scan or MRI
• Diagnostic procedures, such as urodynamics, to evaluate bladder function

After your initial consultation, we will review your results with you and work together to develop a treatment plan. Treatment will depend on the severity of the condition and can range from pelvic floor exercises for mild cases to vaginal pessaries (vaginal support devices) or minimally invasive surgery for moderate to severe cases.

Read more about pelvic/uterine prolapse.

During your initial consultation, the clinician will discuss your medical history. Please bring any relevant medical records, such as laboratory tests and notes about treatments you received, so your provider can review those with you.

Diagnostic testing at Johns Hopkins may include:

• A urine culture (to identify the bacteria causing your infection)
• An examination with a cystoscope (special camera) to view the inside of your bladder
• An ultrasound or CT scan to evaluate your kidney anatomy

After completing diagnostic tests, we will review the results with you and create a long-term management plan that protects you from future UTIs. This will include a combination of therapies and lifestyle changes. We will meet with you regularly to assess your progress and adjust the plan as needed.

Read more about urinary tract infections.

Your treatment path will vary based on the location and type of fistula.

At your initial appointment, your doctor will review your medical and surgical history and will perform a complete physical exam. It will be helpful if you can bring relevant medical records to your appointment, including past operative notes and test results. In some cases, additional consultations or tests may be recommended.

Additional testing may include:

• Imaging studies, such as ultrasound, CT scan or MRI
• Colonoscopy (using a camera to look into the colon) to screen for other potential causes, including inflammatory bowel disease
• Cystourethroscopy (using a camera to look into the bladder or urethra) to identify the location of your fistula

Your doctor will review these results with you to develop your care plan.

Read more about vaginal fistulas.

A complete evaluation will allow your doctor to offer you the right solution for your care. Diagnostic procedures may include:

• A complete medical history and physical, including a review of medications and prior surgeries. If you have had treatment for this condition in the past, review of your records will be helpful.
• Radiology tests or measurements to evaluate potential nerve injury, blockages and muscle functioning may be recommended.
• Diagnostic procedures, such as a colonoscopy or sigmoidoscopy to visualize the colon, may be recommended.

Following your evaluation, we will review treatment options with you to develop a care plan that best meets your needs. Noninvasive techniques, such as muscle rehabilitation, nerve stimulation, injections and other therapies, can successfully resolve many cases of bowel incontinence. Surgical repairs and reconstruction may be recommended in more severe cases.

Read more about understanding fecal incontinence.