Bhumy Davé Heliker, MD

Pelvic Organ Prolapse refers to a hernia of the pelvic floor that occurs when pelvic muscles and tissues are weakened or damaged. This can allow the pelvic organs to fall out of position leading to the bladder, rectum or uterus descending down and outside of the vagina. For many women, this feels very uncomfortable and cause sensations of pressure or discomfort. Options for treatment include physical therapy, pessaries, or minimally invasive surgery.

Pessaries are soft devices fitted specifically for each patient that are placed in the vagina to reduce prolapse. There are many different shapes and sizes to accommodate the individual woman. Some women are taught to remove and replace the device themselves. Other women choose to have routine visits for pessary management.

Surgical options for pelvic organ prolapse include vaginal and Da Vinci® robot-assisted laparoscopic procedures. All of these options are minimally invasive and spare one from a large and often painful abdominal incision. Most patients go home the same day or the next morning. These surgeries are ideal for reconstruction of the pelvic floor and allow patients to have a speedier recovery.

Stress incontinence refers to the loss of urine with activities such as coughing, sneezing, laughing, and exercise. It often occurs because the pelvic floor muscles are weakened and the muscles around the urethra fail to close properly. Options for treatment include physical therapy, an incontinence pessary, urethral bulking, and surgical procedures such as the mid-urethral sling.

The Mid-urethral sling is often considered the gold standard for treating this condition. This is an outpatient surgery with high success rates.

Overactive bladder (Urgency urinary incontinence) typically occurs when a patient has the urge to go the bathroom but is not able to make it there in time or is forced to go to the bathroom so often that it disrupts her life. Treatment options include physical therapy, medications, bladder acupuncture (PTNS), Botox™ (bladder) injections, or a bladder pacemaker (Sacral Neuromodulation).

Percutaneous tibial nerve stimulation (PTNS) is a weekly office based procedure in which an acupuncture needle is placed near the tibial nerve (ankle) for 30 minutes. This weekly stimulation has been shown to help control bladder overactivity and reduce urgency.

Intravesicular Botox™ is an office based procedure in which a camera is placed inside the bladder and Botox™ is injected into several sites. This lasts for 6-12 months and provides profound relief from overactive bladder symptoms.

Sacral neuromodulation is a bowel and bladder control system similar to a pacemaker. It has been used to treat countless women with urgency incontinence, urinary urgency and frequency, urinary retention, and accidental bowel leakage.

Many women suffer from bowel/bladder incontinence and discomfort postpartum. Some of these women have third- or fourth-degree lacerations and require extra attention to ensure their perineum is healing appropriately. The goal of early evaluation and intervention is to help optimize a new mom’s pelvic floor recovery now and for her future.

The inability to control stool or gas is also known as accidental bowel leakage. Hundreds of thousands of women suffer in silence from this remarkably common condition. A revolutionary and highly successful treatment for this condition is Sacral Neuromodulation. Other treatments include medications, physical therapy with biofeedback, vaginal bowel control devices, and occasionally surgery to rebuild the muscles around the anus (sphincteroplasty).

Sacral neuromodulation is a bowel and bladder control system similar to a "pacemaker." It has been used to treat countless women with urgency incontinence, urinary urgency and frequency, urinary retention, and accidental bowel leakage.

Interstitial cystitis/Bladder Pain syndrome can result in episodic burning, pressure, and pain in the bladder along with urinary urgency and frequency. Initial therapy includes dietary modification and stress management. If symptoms persist, patients are referred to physical therapy which can have profound and last effects for prevention of ‘flares’ or episodes. Advanced therapeutic options include procedures to help alleviate symptoms.

Recurrent urinary tract infections (UTIs) are very common among women partly because the female urethra is significantly shorter than the male urethra, thereby predisposing women to more UTIs. There are a number of risk factors such as incomplete bladder emptying or vaginal atrophy (low estrogen in the vagina) that can exacerbate this problem. For women found to have culture proven recurrent UTIs, interventions such as vaginal estrogen, natural remedies, and short courses of antibiotics can make a significant difference.

Telehealth via video (zoom) or telephone is available upon request — a great first step for patients who want some preliminary information.