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The pelvic floor is a combination of muscles, ligaments and connective tissue that supports the pelvic organs –bladder, vagina, uterus and rectum.

Pelvic floor disorders can develop when the support structures become weakened.

-Causes:  child birth or aging.

-Can result in:  loss of urine, prolapse or problems with urination or defecation.

     -Conditions (including but not limited to):

Urinary incontinence

-- involuntary loss of urine


-1.  Stress incontinence

-Involuntary leakage of urine during increased abdominal pressure.

-You may feel leakage with standing, lifting or coughing.

-Usually due to weakened pelvic muscles that support the bladder and urethra.

-Dysfunction of urethral sphincter can also cause

-If the urethral sphincter is weak any increased pressure on the bladder will result in urine escaping

-2.  Urge incontinence

-Leakage associated with strong urge.

-Often referred to overactive bladder.

-Usually feeling of inability to make it to the bathroom in time.

-Exact cause in majority of women is unknown

-Can be associated with stroke or neurologic disorder

-3.  Mixed urinary incontinence

-Combination of stress and urge incontinence.

-4.  Overflow incontinence

-Caused by incomplete evacuation of the bladder.

-Bladder overflows when becomes too full.

-Evaluation will include a detailed questionnaire, history and thorough physical examination

-Further evaluation may also be necessary and include urodynamic studies to  further evaluate pressure and function  of the bladder and urethra

-Cystoscopy may also be necessary to further evaluate the bladder

-Treatment options depend on the factors causing the problem

-There are non-surgical and surgical options available

  Pelvic organ prolapse

-common condition, occurring in 35-65% of women

--  pelvic organs bulging into the vagina

--  usually noticed after standing, lifting or straining

--  usually occurs after childbirth

-- can occur after hysterectomy

--  evaluation includes detailed questionnaire, history and thorough physical examination

--  urodynamic studies and cystoscopy may also be performed

--  treatment options:

-Do nothing

-Wear a rubber dish


-1.  Cystocele 

-When roof of vagina starts to bulge.

-Mildgrade I – bladder only drops a short way into the vagina.

-More severegrade II – bladder drops enough to reach opening of vagina.

-Most advanced grade III – bladder bulges out through opening of vagina.

Symptoms include:  pelvic pressure, urinary frequency and urgency, 

-Waking up at night, inability to keep tampon in and discomfort during sexual intercourse.

-Treatment options range from no treatment for mild case to surgical for a serious case.

-2.  Rectocele

-Bulging of the rectum into the vagina.

-Most common cause is childbirth

-Other causes:  hysterectomy or other pelvic surgery.

-Symptoms include:  bowel movements are “stuck”, constipation.

-Treatment options can vary:  change in diet, Kegel exercises, use stool softeners, hormone replacement therapy, insertion of a pessary or surgery.

-3.  Enterocele

-Protrusion of the small intestine and peritoneum into the vaginal canal.

-Can be treated transvaginally or laparoscopically

-4.  Urethrocele

-When the urethra goes into the vagina.

-Often caused by child birth.

-Usually no symptoms.

If present symptoms can include:  stress incontinence, urinary frequency, difficulty in emptying bladder.

Can be treated surgically.

-5.  Uterine prolapse

-When the uterus goes into the vagina.

-Treatment is surgical and include hysteretomy

-6.  Vaginal Vault prolapse


-- opening between the bladder or vagina

--  can be due to complications from previous surgery, pelvic radiation or GI illness


-1.  Vesico-vaginal

-2.  Recto-vaginal

  Urinary retention

  Urethral masses

-E.g. urethral diverticulum

  Birth Injuries

Many vaginal prolapse operations have been done with mesh – Apogee, Avaulta, Perigee and Prolift.  In some cases the mesh has caused problems, such as: persistent bleeding, vaginal discharge and pain.  Sometimes, urinary problems and difficulty moving your bowels can result from the use of the mesh.

If you had a gynecological surgery with mesh and are having problems or continued pain since the surgery, please contact our office so we can get you scheduled with one of our OB/GYN providers for further evaluation of your problem.  



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Posture and Neck Pain

Chronic neck pain is a miserable experience. Although some cases of neck pain are caused by an injury, many are simply due to poor posture. Poor posture stresses the muscles of the neck and can cause muscle spasms, stiffness and pain. Over time, the stresses of poor posture on the neck can cause degenerative diseases to develop in the discs and bones of the neck. Forward head A very commonly seen posture that puts a lot of strain on the neck is the forward head. The individual habitually thrusts the head forward, carrying it out in front of the shoulders. In this position, the weight of the head is constantly pulling on the spine and the shoulders. Sitting for hours hunched over a desk or a computer is a common cause of forward head. Many people with this habitual forward head carriage suffer from sore shoulders as well as a sore neck. Over time, the vertebrae at the base of the neck (C5 and C6) can develop painful degenerative conditions due to the constant weight of the head pulling on them in the forward head posture. Correct posture A correct posture is one that keeps the spine in alignment. Some people call it a neutral or balanced posture. One exercise to encourage a neutral posture is to focus on opening the chest wide as you try to squeeze your shoulder blades together. Once your chest is open, bring your head into alignment. Think of a string pulling up the top of your head and lengthening the neck. When you do this, your chin will tuck in and your head will naturally shift into proper alignment with your spine. Do the open chest/ string exercise multiple times a day. Other exercises to build better posture are head nods and chin tucks. To do a head nod, slowly nod your head slightly up and down without moving your neck. To do chin tucks, tip your nose down toward the ground and move the top of your head backwards. Repeat head nods and chin tucks several times a day. These exercises strengthen the muscles on the front of the neck. Individuals with habitual forward head posture usually have very weak muscles in the front of the neck. If you've worked hard at correcting your posture and you are still suffering from neck pain, why not give us a call?

Note: The information on this Web site is provided as general health guidelines and may not be applicable to your particular health condition. Your individual health status and any required medical treatments can only be properly addressed by a professional healthcare provider of your choice. Remember: There is no adequate substitution for a personal consultation with your physician. Neither BPF Specialty Hospital, or any of their affiliates, nor any contributors shall have any liability for the content or any errors or omissions in the information provided by this Web site.