Many women, particularly after giving birth, think an overactive bladder or urinary incontinence is just part of life.

Maybe they cross their legs when they sneeze so they don’t leak urine. They might forego activities such as running. Or they avoid situations with limited bathroom access.

Likewise, they may think that vaginal prolapse, when the uterus falls down or comes out, is not worth treating, or is unable to be treated, even though it is uncomfortable, limits physical activity and can cause urine leakage. 

What Do Urogynecologists Do?

Johns Hopkins urogynecologists Daniel David Gruber and Shannon VanderPas Lamb, based in the greater Washington area, say women don’t have to accept these conditions.

Urogynecologists diagnose and treat conditions related to the pelvic floor, including leaky or overactive bladders, fecal incontinence, vaginal or pelvic organ prolapse, frequent or recurring urinary tract infections, and vaginal fistulas.

“I saw a woman recently with a prolapsed vagina and stress incontinence,” says Gruber, director of urogynecology and reconstructive pelvic surgery at Sibley Memorial Hospital and assistant professor of gynecology and obstetrics in the Johns Hopkins University School of Medicine.

“She said it only bothers her when she’s running a lot or goes to the gym, so she curtails those activities,” he says. “A lot of people come in and say, ‘It’s not a problem because I’ve stopped doing this or that.’ And my response is, ‘Wouldn’t you like to be able to do those things?’ A lot of patients don’t realize there are treatments for what they are experiencing.”

Nonsurgical Treatments

Close to 70% of urogynecology patients do not need surgery, says Lamb, and can be helped with physical therapy and/or medications. For the remainder, surgeries are almost always minimally invasive.

Even with major surgeries, patients rarely require overnight stays, says Gruber.

A new therapy for overactive bladder is a neuromodulation device that sits at the ankle instead of being implanted in the buttock, as is the traditional approach.

The newer device, which looks like an ankle bracelet, consists of a small capsule inserted behind the ankle bone, and sends an electrical stimulus through the tibial nerve to interrupt signals in the sacral nerve that affect bladder function, says Lamb. Patients can adjust the settings and replace batteries without going to a doctor, says Lamb. 

Gruber and Lamb joined Johns Hopkins Medicine from Walter Reed Medical Center, where each completed a fellowship in female pelvic medicine and reconstructive surgery.

Gruber earned his medical degree at Creighton University in Omaha, Nebraska, and serves in several roles for the American Urogynecologic Society and Society of Gynecologic Surgeons.

Lamb completed her medical degree at the University of Virginia Medical Center. She most recently served as the chief medical officer for the Defense Health Network National Capital Region.

Lamb operates at Sibley Memorial Hospital and sees patients at the Johns Hopkins Community Physicians location in Arlington, Virginia. Gruber sees patients at Sibley and at the Johns Hopkins Health Care & Surgery Center — Bethesda.

Sibley and Arlington have on-site pelvic floor physical therapists. Both doctors work closely with these therapists, who can help patients strengthen or relax their pelvic floors, sometimes before and after surgery, and sometimes help them avoid surgery altogether.

More Collaborations Means Fewer Procedures

Both Gruber and Lamb note that being part of a large academic medical center means they can collaborate with other Johns Hopkins surgeons.

“We have such good relationships with other surgeons,” says Gruber. “That’s why we can do things simultaneously. For example, if it’s an early cancer, a surgical oncologist can perform a hysterectomy and then I can do a sling procedure to help with leaking. Occasionally, we’ll even have three surgeons involved, which takes a lot of logistical coordination. But if it’s the right thing to do, we do it.”

To schedule a urogynecology appointment, call 202-243-5295.