Urogynecology Conditions

Urogynecology is a subspecialty of obstetrics and gynecology that focuses on disorders of the pelvic floor. The pelvic floor includes the muscles, ligaments, and connective tissue that work together to support a woman’s internal organs (bladder, bowel, uterus, and vagina.) The pelvic floor helps to keep a woman’s organs in place and also help them to function properly. When the muscles of the pelvic floor become weak or the connective tissues tear, women can develop pelvic floor disorders. Common bladder problems include urinary incontinence (leakage of urine), difficulty emptying the bladder and overactive bladder. Common bowel issues include leakage of stool or gas (anal or fecal incontinence) or difficulty emptying the bowel (constipation.) Some women also feel a bulge or heaviness in the pelvic area if the cervix, uterus, or vaginal walls begin to prolapse.

GBMC’s Division of Urogynecology and Reconstructive Pelvic Surgery includes providers who are specially trained to diagnose and treat disorders of the pelvic floor. Both Dr. Blomquist and Dr. Jacobs have completed a four year residency training in obstetrics and gynecology, as well as fellowship training in urogynecology and pelvic reconstructive surgery. Dr. Blomquist is also certified in Female Pelvic Medicine and Reconstructive Surgery. Our nurses and nurse practitioner add to our practice so we can offer a full range of diagnostic and treatment options for our patients.

Our philosophy encompasses GBMC’s vision, “To every patient, every time, we will provide the care that we would want for our own loved ones." As a result, we spend time explaining your individual disorder. We believe in offering a full range of treatment options including conservative treatments such as pelvic floor physical therapy, medications, and vaginal support devices (pessary) as well as surgical options when appropriate. We will take the time to review all treatment options and determine what is best for you.

Urinary incontinence

Female urinary incontinence affects up to 50 percent of woman at some point during their life. It is more common as we get older, but is never considered “normal.” There are several different types of urinary incontinence, so it is important to determine the type of incontinence as the treatment options differ.

Stress incontinence: Leakage which occurs with increases in abdominal pressure such as cough, sneeze or exercise.

Urge incontinence: Leakage which is associated with a sudden urge to empty the bladder. This is frequently referred to as overactive bladder and can be associated with urinary frequency during the day or night.

Overflow incontinence: Leakage or “spill-over” of urine when the bladder does not empty well due to a blockage or obstruction of urine flow.

Functional incontinence: Leakage due to the inability to get to the bathroom in time because of a physical condition, such as arthritis.

Fistula: Leakage due to an abnormal connection or hole between the bladder and vagina.

Treatment depends on the particular type of incontinence, however, may include:

Lifestyle changes
  • Pelvic floor physical therapy
  • Pelvic floor electrical stimulation
  • Pessaries (vaginal support devices)
  • Medications
  • Transurethral injections
  • Surgical repair

Pelvic Organ Prolapse

Loss of support of the pelvic organs results in pelvic organ prolapse. The loss of support may be from tears in the connective tissues, weak muscles, or loss of nerve supply to the area. If the loss of support involves the anterior vaginal wall (which supports the bladder) a cystocele develops. Loss of support of the posterior vaginal wall (which supports the rectum) is called a rectocele. Loss of support of the top or apex of the vagina results in uterine prolapse or vaginal vault prolapse (if the uterus has previously been removed.) Pelvic organ prolapse may cause symptoms including pelvic heaviness, a bulge, and discomfort with intercourse or difficulty emptying the bladder or bowels.

Treatment options include:
  • Observation
  • Pelvic floor exercises
  • Pessary
  • Surgery

Fecal incontinence

Fecal incontinence may result from weak or torn pelvic floor muscles. Treatment options include:

  • Pelvic floor exercises
  • Dietary Changes
  • Electrical Stimulation
  • Surgery

Bladder Pain

Painful bladder syndrome or interstitial cystitis, encompasses a group of conditions that can cause debilitating urinary frequency, urgency and pain. A thorough history and physical exam as well as a cystoscopy (looking inside the bladder with a special scope) are frequently needed to diagnose the condition. Although we do not understand what causes painful bladder syndrome, we know that there is an abnormality in the lining of the bladder wall.

Treatment options we offer include:
  • Dietary Changes
  • Medications
  • Bladder distention (stretching of the bladder)
  • Bladder instillations(placing a combination of medications directly into the bladder which help to heal the bladder)
  • Pelvic floor physical therapy
  • Acupuncture
For more information about painful bladder syndrome, we recommend that you visit the Interstitial Cystitis Association website.
Greater Baltimore Medical Center | 6701 North Charles Street | Baltimore, MD 21204 | (443) 849-2000 | TTY (800) 735-2258
© 2017  GBMC. This website is for informational purposes only and not intended as medical advice or a substitute for a consultation with a professional healthcare provider.