Pelvic conditions treated at the Buffalo NIagara Center for Pelvic Health

Conditions We Treat

Find out more about the conditions we treat below. View more patient resources here, or request an appointment online now.

Stress Urinary Incontinence (SUI) - women

What is Stress Urinary Incontinence? Stress Urinary Incontinence—the loss of urine control—is a common and often embarrassing problem. Some women may leak urine while coughing, sneezing or running. The effects of SUI can range from slightly bothersome to completely debilitating. For some women, SUI keeps them from enjoying activities with their family and friends for fear of public embarrassment.

What causes Stress Urinary Incontinence? SUI is twice as common in women as in men. Age, pregnancy, childbirth, and menopause are the primary causes. Other factors that may worsen SUI include obesity, smoking or illnesses that cause chronic coughing, excessive caffeine or alcohol use, or high impact activities or exercise for many years.

What are symptoms of Stress Urinary Incontinence? Patients with SUI may experience leakage of urine with coughing, sneezing, standing up, exercising, lifting heavy objects, laughing or sexual activity. Leakage may occur all the time or only occur when your bladder is full.

How is Stress Urinary Incontinence diagnosed? One of the fellowship-trained physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam. A urine sample and blood test may be requested, and you may be asked to keep a bladder diary for several days to provide the doctor with as much information as possible to determine the cause of your SUI. Other special tests might include measuring the amount of urine left in the bladder with an ultrasound, testing bladder pressure, or looking into the bladder with a camera (cystoscopy).

How is Stress Urinary Incontinence treated? Treatment for Stress Urinary Incontinence depends on the severity of your problem and the root cause. We will take your history and do a thorough exam to recommend the approaches best suited to you. This may include a combination of treatments. Rest assured that we always try to suggest the least invasive treatments first.

The first type of therapy for SUI involves behavioral therapy and lifestyle changes. This can be as simple as watching fluid intake throughout the day and scheduling time to use the bathroom (timed voiding). It also may include smoking cessation, weight loss, and treating chronic cough or asthma. Exercises to help strengthen the muscles in your pelvis (Kegels) may also be suggested.

Another option for treatment of SUI is placement of an incontinence pessary. This is a ring placed in the vagina with a bump that sits on the urethra. The physician will place the pessary initially to make sure it fits and is comfortable. The pessary needs to be removed and cleaned regularly by the physician or a nurse. This is a good option if you do not want to undergo surgery.

Multiple surgical options are available for treatment of SUI.

  • Sling—A piece of synthetic material, graft material, or a piece of the patient’s own tissue is used to create a hammock underneath the urethra to prevent leakage. This is the most common surgical procedure for SUI.
  • Injectables—A material is injected around the urethra to “bulk up” the muscle and allow the urethra to close more easily. This may be done with a local anesthesia or light sedation. It is generally reserved for patients with mild SUI and may require more than one injection.

Can Stress Urinary Incontinence be prevented? While you can’t completely prevent SUI, there are some steps you can take to reduce your chances of being affected or decrease the severity of symptoms. Doing pelvic floor (Kegel) exercises can help strengthen your pelvic muscles. Staying at a healthy weight and smoking cessation can also help.

Pelvic Organ Prolapse (Cystocele, Enterocele, Rectocele, Uterine) - women

What is Pelvic Organ Prolapse? Pelvic Organ Prolapse (POP) occurs when one or more of your pelvic organs—uterus, vagina, bladder or bowel—shifts downward and bulges into or out of the vagina. Nearly a quarter of all women in the U.S. suffer from some form of Pelvic Organ Prolapse. There are several types of POP: anterior prolapse (cystocele), posterior prolapse (rectocele), uterine prolapse, and small bowel prolapse (enterocele).

What causes Pelvic Organ Prolapse? Aging, pregnancy and childbirth are the primary factors that lead to weakening of the vagina and its supports. Prolapse affects about one in three women who have had one or more children. It may occur during or shortly after a pregnancy or may take many years to develop. It’s important to point out that only about 11% will ever need surgery for prolapse in their lifetime. Menopause and conditions that cause excessive pressure on the pelvic floor—such as obesity, chronic cough or constipation—can cause further weakening.

What are symptoms of Pelvic Organ Prolapse? Although many women who have pelvic organ prolapse do not have symptoms, the most common is a feeling of pelvic pressure from the uterus or other organs pressing against the vaginal wall. Some women also experience other symptoms, including a feeling as if something is falling out of the vagina, a pulling or stretching in the groin or lower backache, painful intercourse, spotting or bleeding from the vagina, urinary problems (incontinence) or frequent or urgent need to urinate, and problems with bowel movements. Symptoms of POP typically worsen when you’re standing.

How is Pelvic Organ Prolapse diagnosed? The physicians at Buffalo Niagara Center for Pelvic Health will begin by taking a thorough history and performing a physical exam of your pelvic organs. The exam helps us determine the type of prolapse and its severity. We will also ask you questions about your medical and family history, including details about your symptoms. Other special tests might include measuring the amount of urine left in the bladder with an ultrasound, testing bladder pressure, or looking into the bladder with a camera (cystoscopy).

How is Pelvic Organ Prolapse treated? Your doctor will make treatment recommendations based on the type of prolapse you have and its severity. This may involve one or a combination of treatment options, including physical therapy, non-surgical insertion of a pessary, or surgery to correct the area(s) of prolapse. Rest assured that we will always try to suggest the least invasive treatments first.

Non-surgical placement of a pessary into the vagina will help support the vaginal walls. The physician will place the pessary initially to make sure it fits and is comfortable. The pessary needs to be removed and cleaned regularly by the physician or a nurse. This is a good option for if you do not want to undergo surgery.

If you are looking for more permanent treatment, the prolapse can also be fixed surgically. Surgery can be performed through the vagina or the abdomen and may involve removal of the uterus, if still present.

Can Pelvic Organ Prolapse be prevented? Because vaginal and uterine prolapse have several different causes, there is no single way to prevent these problems. However, avoiding increased pressure inside your abdomen will diminish pressure on the pelvic floor. Steps you can take include: maintaining a healthy weight, avoiding constipation and chronic straining during bowel movements, alleviating chronic coughing, avoiding heavy lifting, smoking cessation, avoiding repetitive strenuous activities, and doing pelvic floor exercises (Kegels).

Interstitial Cystitis/Bladder Pain Syndrome - women and men

What is Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)? IC or BPS is a chronic condition that causes bladder pressure, pelvic pain or bladder pain. The discomfort may range from mild to severe, or even debilitating. It can be made worse by filling the bladder and is often associated with urinary frequency.

IC most often affects women in their 30s and 40s, however, men may also be affected, often at an older age. When men have symptoms of IC/BPS, they often have inflammation of the prostate gland (prostatitis).

What causes Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)? There is no known exact cause of IC/BPS, but there are likely multiple factors involved. Some possible causes include a break in the protective lining of the bladder, autoimmune reactions, infection, allergy or hereditary causes.

What are the symptoms of Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS)? Symptoms of IC/BPS can vary and fluctuate with time. Symptoms may be made worse by stress, menstruation, sexual activity or even exercise. The most common symptoms include:

  • Pain in the pelvis or vagina
  • Pain in the area between the vagina and anus (women) or scrotum and anus (men)
  • Urinary frequency—urinating small amounts during the day and night. Some patients may urinate up to 60 times a day.
  • Increased pain as the bladder fills that is relieved by emptying the bladder.
  • Pain during sexual intercourse or pain with ejaculation (men).

Symptoms are similar to those of a urinary tract infection (UTI), but most often, the urine is clear of bacteria. Patients who do get a UTI might have worsening symptoms.

How is Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS) diagnosed? IC/BPS is a clinical diagnosis of exclusion, meaning no other cause of the symptoms can be identified. One of the physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam, including a pelvic exam or prostate exam. A urine sample will be requested, and you may be asked to keep a bladder diary for several days to provide the doctor with as much information as possible to determine the cause of your pain.

A cystoscopy (looking into the urethra and bladder with a camera) may be performed to look for any abnormal areas of the bladder (ulcers) and to determine how much urine your bladder can hold. If a suspicious area is found, a biopsy might be performed.

How is Interstitial Cystitis (IC)/Bladder Pain Syndrome (BPS) treated? Treatment of IC/BPS is often challenging, because there is no single treatment that eliminates the symptoms, and no one treatment works for everyone. You may need to try multiple options before you find a plan that works for you.

  • Physical therapy—Working with a pelvic floor physical therapist may help to relieve the pain and pressure associated with pelvic floor muscle tightening. Often they can give you exercises to do at home that help relax the pelvic floor muscles.
  • Medications—Various medications may been used to treat IC/BPS, including non-steroidal anti-inflammatory meds (ibuprofen, Naprosyn), tricyclic antidepressants, antihistamines, and Elmiron, which is one of the only medications that is FDA approved to treat IC/BPS. For men with prostatitis symptoms, a course of antibiotics can be helpful if we suspect chronic infection of the prostate.
  • Bladder distention—This involves cystoscopy (looking into the bladder with a camera) and stretching the bladder with water. Some patients see temporary improvement in their symptoms, and this treatment may be repeated if the result is long lasting.
  • Bladder instillations—This involves placing a catheter in your bladder and instilling medication for approximately 15 to 30 minutes. The initial treatment is usually once a week for six to eight weeks, followed by treatments once or twice a month if your symptoms improve.
  • Nerve stimulation—This treatment can help with urgency and frequency by stimulating the nerves that supply the bladder. This can be achieved with weekly stimulation through the ankle, or with a permanent implant in the lower back, similar to a pacemaker.
  • Surgery—Surgery is used only rarely to treat IC/BPS, because removing the bladder or parts of the bladder often does not relieve the pain. In cases where other treatments have failed, surgery can be considered.

If you suffer from IC/BPS, you may require pain management beyond the scope of our practice. In this case, we will refer you to a pain management specialist who can work with you to develop a specific pain management treatment plan.

Neurogenic Bladder (NGB) - women and men

What is Neurogenic Bladder? Neurogenic Bladder (NGB) is the loss of normal bladder function, caused by damage to part of the nervous system. This can lead to bladder overactivity, when the bladder contracts frequently, or bladder underactivity, when the bladder does not contract enough to empty or does not contract at all. Some patients may also have injuries to the nerves supplying the sphincter muscle controlling urine flow, possibly leading to incontinence or inability to empty the bladder.

What causes Neurogenic Bladder? Any disease that affects the nervous system may lead to dysfunction of the bladder. This includes conditions patients are born with, trauma, or long-term diseases that lead to nerve damage, including:

  • Spina bifida (spine abnormality of newborns)
  • Tumors of spinal cord or brain
  • Spinal cord injuries
  • Stroke or brain injuries
  • Multiple sclerosis
  • Parkinson’s disease
  • Pelvic surgery or radiation
  • Long-term diabetes

What are the symptoms of Neurogenic Bladder? Neurogenic Bladder may have a variety of symptoms. The inability to control urination is quite common. This may occur along with urinary urgency, with or without leakage and urinary frequency (daytime or nighttime). Often your bladder cannot hold as much urine as a normal bladder.

Some patients may not be able to urinate at all. Commonly after a traumatic injury or stroke, patients undergo a “shock” phase, which causes Urinary Retention. This is usually temporary, lasting six weeks to three months. Some patients have long term Urinary Retention because the sphincter muscle that normally keeps patients dry between urination is unable to relax when the bladder tries to empty. 

The bladder normally stretches easily and stores urine at a low pressure. Some patients with NGB develop bladders that do not stretch well and cause pressure to the kidneys. This could lead to kidney damage long term if not treated. The increase in bladder pressure does not necessarily cause symptoms.

What are the risks of Neurogenic Bladder? Patients who have Neurogenic Bladder are at risk of developing various problems over time, including:

  • Stones—These may develop in the kidney or the bladder.
  • Urinary tract infections—Patients who do not empty the bladder well or manage their bladder with catheterization are at increased risk of infection in the urine.
  • Reflux—Urine can back up into the kidneys if bladder pressures are too high. If a patient also has an infection, the infection may be transferred up to the kidneys causing a more serious infection called pyelonephritis.
  • Kidney damage—If the bladder is not managed appropriately, recurrent infections or high pressures might cause kidney damage over time.

How is Neurogenic Bladder Diagnosed? Neurogenic Bladder is a clinical diagnosis, meaning patients with bladder symptoms or problems who also have a neurologic disease are considered to have NGB. When you have symptoms, one of the physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam, including a pelvic exam or prostate exam. A urine sample is often requested to look for any signs of infection.

Baseline tests to look at the urinary tract and how the bladder functions are often performed, including:

  • Renal and bladder ultrasound and abdominal x-rays that examine the anatomy of your urinary tract and look for stones.
  • Imaging of the spine and/or brain may be performed as part of the work up of a your neurologic disease.
  • Urodynamics (bladder pressure testing) are performed to establish a pattern of how your bladder behaves while it is filling and emptying.
  • A cystoscopy (looking into the urethra and bladder with a camera) may be performed to look into your bladder and ensure there are no anatomical abnormalities.

Often many of these tests are repeated on a regular basis depending on how your bladder is behaving or if treatments have changed.

How is Neurogenic Bladder Treated? The main goals of treatment of NGB are to prevent kidney damage and minimize bothersome bladder symptoms, such as urinary incontinence.

Patients who are unable to empty their bladder are often started on Clean Intermittent Catheterization (CIC). This is a method of emptying the bladder by placing a catheter into your bladder multiple times a day to empty the bladder and then remove the catheter after you are empty. Patients who are unable to do CIC on their own sometimes have the help of a caregiver. If a patient does not have access to a regular caregiver and is unable to do CIC, an indwelling catheter can be considered.

Patients who urinate on their own or perform CIC who experience inability to control their urine (Urinary Incontinence) are often initially managed with oral medications. If medications do not work, surgical options can be considered, including injection of medication into the bladder to help it relax, or surgery to make the bladder larger (bladder augmentation).

Fecal Incontinence - women and men

What is Fecal Incontinence? Fecal Incontinence is the inability to control bowel movements or unexpected leakage of stool from the rectum. This can occur while passing gas, or it can be complete loss of bowel control. Loss of bowel control is often quite embarrassing and may keep patients from doing many of their daily activities.

What causes Fecal Incontinence? Fecal Incontinence may be caused by a number of sources, including:

  • Damage to the anal sphincter muscle, which usually occurs in women during childbirth—especially with an episiotomy or forceps delivery.
  • Constipation or diarrhea.
  • Nerve damage caused by childbirth, spinal cord injury, stroke, multiple sclerosis, or even long-term diabetes. Nerve damage may also occur during pelvic surgery.
  • Radiation that has caused nerve damage or scarring in the rectum and does not allow the rectum to stretch.
  • Inflammatory bowel disorders, such as Crohn’s or Ulcerative Colitis, which may cause scarring in the rectum that does not allow the rectum to stretch.
  • Prolapse of the rectum through the anus or vaginal prolapse of the rectum in women may cause issues with bowel control.

What are the symptoms of Fecal Incontinence? Patients may only have episodes of incontinence with passing of gas or when they have diarrhea. The amount of leakage may be very small or might be significant. Patients may experience fecal urgency—the need to rush to the bathroom or inability to make it to the bathroom in time.

Fecal Incontinence may be associated with other common bowel symptoms, including constipation, diarrhea and/or gas or bloating.

How is Fecal Incontinence diagnosed? One of the physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam, including a pelvic exam or prostate exam. Testing of the nerves around the anus during the exam is also performed.

Other tests may be ordered to evaluate the cause of incontinence. This could include an ultrasound, pressure tests, x-rays, MRI and/or using a camera to look into the rectum (similar to a colonoscopy). You may be asked to see a colorectal surgeon if further evaluation is needed.

How is Fecal Incontinence treated? There are various treatments for Fecal Incontinence depending on the cause. Often the first line treatment involves changes in diet and exercise. If diarrhea or constipation are not already being managed, medications may be given to help with these symptoms. Physical therapy to help control the muscles in the pelvis may also be recommended.

Nerve stimulation may be performed to help control the sensation and strengthen the sphincter muscles, similar to the treatment of Overactive Bladder.

If there is an anatomical problem, such as a damaged sphincter muscle or prolapse, surgery might be considered. For patients with severe incontinence who have failed other treatments, diversion of the stool through an opening in the abdomen (colostomy) may be considered.

Urinary Tract Infection (UTI) - women and men

What is a Urinary Tract Infection? Urinary Tract Infections (UTIs) can involve any part of your urinary system—kidneys, ureters, bladder and urethra. However, the most common infections involve the bladder and the urethra. Women have a higher risk of developing UTIs than men. An infection that is limited to your bladder can be painful or uncomfortable, but if a UTI spreads to your kidneys, serious consequences can occur. Because Urinary Tract Infections in men are quite rare, most men who are diagnosed with a UTI will be advised to have other tests to determine if something else is responsible.

What causes a Urinary Tract Infection? Urinary Tract Infections typically occur when bacteria enter the urinary tract through the urethra and begin to multiply in the bladder. The most common UTIs are cystitis (bladder) and urethritis (urethra).

  • Cystitis is typically caused by Escherichia coli (E. coli), a type of bacteria that is commonly found in the gastrointestinal (GI) tract. Sexual intercourse can lead to cystitis. However, women who are not sexually active are also at risk because of the short distance from a woman’s urethra to the anus and from the urethral opening to the bladder. Women who have gone through menopause and women and men who do not empty the bladder completely are also at higher risk.
  • Urethritis can occur when gastrointestinal bacteria spread from the anus to the urethra. It can also be caused by sexually transmitted infections, such as herpes, gonorrhea and chlamydia.

What are symptoms of a Urinary Tract Infection? You may or may not experience symptoms with a Urinary Tract Infection. If you do, they can include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • Passing frequent, small amounts of urine
  • Urine that appears cloudy
  • Urine that appears red, bright pink or cola-colored—a sign of blood in the urine
  • Strong-smelling urine
  • Pelvic pain, in women
  • Rectal pain or perineal pain in men (pertaining to the area between your scrotum and rectum)

UTIs may be overlooked or mistaken for other conditions in older adults. The physicians at Buffalo Niagara Center for Pelvic Health can help.

How is a Urinary Tract Infection diagnosed? There are a number of tests and procedures that the physicians at Buffalo Niagara Center for Pelvic Health may use to diagnose Urinary Tract Infections, including:

  • Urine sample—Your specimen will be analyzed to look for white blood cells, red blood cells or bacteria.
  • Urine culture—This test uses your urine sample to grow bacteria in a lab. This tells the doctor what types of bacteria are causing your infection and which medications will be most effective.
  • Ultrasound or a computerized tomography (CT) scan—If the doctor suspects that an abnormality in your urinary tract is causing frequent infections, these tests may also be used.
  • Cystoscopy—If you have recurrent UTIs, your doctor may use a long, thin tube with a lens (cystoscope) inserted through the urethra to see inside your urethra and bladder.

How is a Urinary Tract Infection treated? UTIs are typically treated with antibiotics. The specific drugs that are prescribed for you and the length of time you need to take them will depend on your health condition and the type of bacteria found in your urine. Although the symptoms may clear up within a few days of treatment, it’s important that you continue the antibiotics for the full course prescribed by the physician to ensure that the infection is completely gone. The doctor may also prescribe a pain medication that numbs your bladder and urethra to relieve burning while urinating.

Can Urinary Tract Infections be prevented? Although there is no way to entirely prevent Urinary Tract Infections, there are steps you can take to reduce your risk. Drinking plenty of liquids—especially water—helps dilute your urine and ensures that you’ll urinate more frequently, allowing bacteria to be flushed out before infection can begin. Wiping from front to back helps prevent bacteria in the anal region from spreading to the vagina and urethra. Emptying your bladder soon after intercourse and drinking a full glass of water can also help flush out bacteria. Also, avoiding potentially irritating feminine products, such as deodorant sprays, douches and powders that can irritate the urethra will help.

Overactive Bladder: Urgency, Frequency, Nocturia - women and men

What is Overactive Bladder? Overactive Bladder (OAB) impacts millions of men and women. In fact, 30% of all men and 40% of all women in the U.S. live with OAB symptoms, and those figures may be much higher because many others suffer in silence. OAB isn’t a disease; rather, it is a group of troubling urinary symptoms. The most prevalent symptom is a sudden, strong urge to urinate that you can’t control. Some people with OAB also have “urgency incontinence,” meaning urine leaks after they feel the sudden urge to go. This is different from incontinence that leads to leaking urine when you sneeze, cough or do other physical activity. With OAB, you may also experience frequent urination or waking at night to urinate.

What causes Overactive Bladder? As you grow older, the risk for OAB symptoms increases. For women who have gone through menopause and men who have had prostate problems, the risk for Overactive Bladder is higher. Often, the specific cause of an OAB is unknown. However, there are several factors that can contribute to signs and symptoms of OAB, including:

  • Neurological disorders, such as Parkinson’s disease, strokes, spinal cord injury and multiple sclerosis
  • High urine production that can occur with high fluid intake, poor kidney function or diabetes
  • Medications that cause a rapid increase in urine production or require that you take them with lots of fluids
  • Factors that block bladder outflow, such as enlarged prostate, constipation or previous surgeries to treat other forms of incontinence
  • Excess caffeine or alcohol consumption or other dietary triggers

What are symptoms of Overactive Bladder? OAB is itself a group of symptoms, not a disease. Signs of Overactive Bladder include feeling a sudden urge to urinate that’s difficult to control, urge incontinence or leaking urine immediately following an urgent need to urinate, or urinating frequently—usually eight or more times in 24 hours, and awakening two or more times during the night to urinate (Nocturia).

How is Overactive Bladder diagnosed? One of the fellowship-trained physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam. A urine sample and blood test may be requested, and you may be asked to keep a bladder diary for several days to provide the doctor with as much information as possible to determine the cause of your OAB. Other special tests might include measuring the amount of urine left in the bladder with an ultrasound, testing bladder pressure, or looking into the bladder with a camera (cystoscopy).

How is Overactive Bladder treated? OAB may require a combination of treatments, including specific behavioral interventions. We will take your history and do a thorough exam to recommend the treatments best suited to you. Rest assured that we always try to suggest the least invasive treatments first.

The first type of therapy for OAB involves behavioral therapy and lifestyle changes. This can be as simple as watching fluid intake throughout the day and scheduling time to use the bathroom (timed voiding), as well as making sure that the bladder is emptying by urinating again a few minutes after first emptying the bladder (double voiding). It also may include dietary changes to avoid foods and drinks that irritate the bladder, as well as weight loss. Exercises to help relax the muscles in the pelvis when the bladder is overactive may help. Working with a pelvic floor physical therapist may help with these exercises.

Multiple medications are available to help with OAB symptoms. The most common medications, anticholinergics, have been used for many years. Common side effects include dry mouth and constipation, which can cause worsening of bladder symptoms, so management of constipation before you start these medications is crucial.

A newer medication, Mirabegron, is now available for treatment of OAB. This medication doesn’t have the same side effects of dry mouth or constipation, but may cause a slight rise in blood pressure.

Injecting the bladder with onabotulinumtoxinA (Botox®) is a third line therapy, if medications and behavioral therapy fail. The medication helps by paralyzing the muscle of the bladder so that it doesn’t contract as often. The biggest side effects are Urinary Retention, Urinary Tract Infections, and blood in the urine. The effects of the medication last 6 to 9 months, on average.

Nerve stimulation is another third line option. The nerves of the bladder can be stimulated through the ankle (peripheral tibial nerve stimulation or PTNS), which requires weekly treatments for 12 weeks. If this option works well, continued monthly treatments are needed. A more permanent nerve stimulation called Sacral Nerve Stimulation is like a pacemaker for the bladder. A test is performed in the office to see if you are a good candidate before the stimulator is placed.

If all of these options are unsuccessful, surgery can be performed to make the bladder larger using a piece of intestine. In the most severe cases, the bladder can be removed and a new bladder can be surgically created using the intestines.

Can Overactive Bladder be prevented? While nothing can completely prevent OAB, there are some steps you can take to reduce your chances of being affected or the severity of symptoms. Managing chronic conditions like diabetes, staying at a healthy weight, watching fluid intake, and smoking cessation can also help.

Fistulae - women and men

What is a Fistula? A fistula is an abnormal connection between two organs that are not usually connected, such as the vagina and bladder, or between an organ and another structure, such as the skin. The types of fistula of the pelvis involve abnormal connections between the bladder, bowel and/or vagina.

  • Vesicovaginal fistula—a connection between the vagina and the bladder.
  • Enterovaginal fistula—a connection between the vagina and the small intestines.
  • Rectovaginal fistula—a connection between the vagina and the rectum.
  • Enterovesical fistula—a connection between the small intestine and the bladder.
  • Colovesical fistula—a connection between the large intestine (colon) and the bladder.

What causes a Fistula? Fistulas are usually caused by tissue damage. This damage leads to inflammation and eventually can form an abnormal tract between two organs or an organ and the skin.

There are a number of risk factors for developing Fistulae in the pelvis:

  • Prior surgery in the pelvis, vagina or rectum. The most common cause of a vesicovaginal fistula in the United States is prior hysterectomy.
  • Radiation for cancer in the pelvis (cervical, vaginal (vulvar), bladder, rectal or prostate cancer).
  • Inflammatory bowel conditions, including Crohn’s disease, ulcerative colitis, and diverticulitis.
  • Tear in the vaginal wall during childbirth or an infected episiotomy.

What are the symptoms of a Fistula? Fistulae are usually painless. Depending on the two areas that are connected, you may experience a variety of symptoms.

If the bladder is involved, you may experience:

  • Symptoms of a Urinary Tract Infection, such as burning with urination, urinary frequency, urgency, blood in urine.
  • Passage of air while urinating.
  • Passage of stool contents in the urine.

If the vagina is involved, you may experience:

  • Continuous leakage of urine from the vagina (continuous incontinence).
  • Leakage of stool contents from the vagina.
  • Foul odor, discharge or gas from the vagina.

If the rectum is involved, you may experience:

  • Watery stools and/or urgency to pass bowel movements.
  • Continuous or frequent urine leakage from the rectum.

How is a Fistula diagnosed? One of the physicians at the Buffalo Niagara Center for Pelvic Health will talk with you about your symptoms and perform a physical exam, including a pelvic exam or prostate exam. A urine sample is often requested to look for any signs of infection.

Imaging of the urinary tract, bladder or bowels might be necessary to identify the exact site of the abnormal connection. This may be performed with an x-ray of the bladder while filling your bladder with dye through a catheter (cystogram) and/or dye given orally or in the rectum.

If your symptoms involve a possible connection to the bladder, a cystoscopy (looking into the urethra and bladder with a camera) might be performed to find the fistula site.

How is a Fistula treated? Most fistulae are treated with surgery. The timing of surgery depends on a number of factors, including the cause and site of the fistula, as well as any other procedures that might need to be performed related to the cause. 

Many fistulae to the vagina can be managed with surgery through the vagina, but some cases do require surgery through the abdomen. Fistulae involving the intestines may require the help of a general surgeon or colorectal surgeon to manage the bowel portion of the fistula.

Urinary Retention - women and men

What is Urinary Retention? Urinary Retention is the inability to empty the bladder. With chronic urinary retention, the patient may be able to urinate, but has trouble starting a stream or emptying their bladder completely.

What are the symptoms? The patient may urinate frequently; feel an urgent need to urinate but have little success; or feel they still have to go after they're finished urinating. With Acute Urinary Retention, it may be impossible to urinate at all, even with a full bladder. Acute Urinary Retention causes great discomfort, and even pain. Anyone can experience Urinary Retention, but it is most common in men in their 50s and 60s because of prostate enlargement.

What causes Urinary Retention? Urinary Retention can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the brain and the bladder. If the nerves aren't working properly, the brain may not get the message that the bladder is full. Even if the bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax. A weak bladder muscle can also cause retention.

Chronic Urinary Retention, by comparison, might cause mild but constant discomfort. Patients have difficulty starting a stream of urine. Once started, the flow is weak. They may need to go frequently, and once they're finished, still feels the need to urinate. They may dribble between trips to the toilet because the bladder is constantly full, a condition called overflow incontinence.

How is Urinary Retention treated? Treatments to relieve prostate enlargement range from medication to surgery. With Acute Urinary Retention, treatment begins with the insertion of a catheter through the urethra to drain the bladder. This initial treatment relieves the immediate distress of a full bladder and prevents permanent bladder damage.

If you have retention after surgery, you will probably regain your ability to urinate after the effects of the anesthesia wear off. In such cases, you may need to have a catheter inserted once or twice with no other treatment required after you have shown you can urinate on your own. If you have Chronic Urinary Retention, or if acute retention appears to become chronic, further treatment will be necessary.

Treatments for men with urethral stricture may involve a procedure called dilation, in which increasingly wider tubes are inserted into the urethra to widen the stricture. Strictures can be treated using a cystoscope and a knife or laser, or more extensive surgery to remove the narrowing and repair the scarred area.

Post-Prostatectomy Incontinence - men

What is Post-Prostatectomy Incontinence? Post-prostatectomy urinary incontinence (PPI) is the involuntary leakage of urine following radical prostatectomy to treat prostate cancer or after surgical treatment for BPH. PPI represents a specific form of stress urinary incontinence where increased abdominal pressure from a cough, sneeze, or simple physical straining results in the leakage of urine. Under normal conditions, this increase in abdominal pressure is managed uneventfully by contraction of the external urinary sphincter, the muscle surrounding the early part of the male urethra, preventing loss of urinary control. During PPI, this sphincter mechanism is insufficient in maintaining closure of the urethra, permitting urinary leakage.

There are three types of incontinence seen following prostate surgery, stress incontinence, total (dripping faucet) incontinence, and detrusor instability (caused by bladder muscle and nerve instability seen following many types of pelvic surgery). As many as 30% of patients undergoing prostate cancer surgery will notice some degree of urinary incontinence postoperatively. The majority of these patients will, however, regain urinary control within the first post-operative year and require no additional therapy.

What causes Post-Prostatectomy Incontinence? The prostate gland surrounds the male urethra, the tube that urine passes through from the bladder to the outside. If cancer grows in the prostate, it squeezes the urethra causing an obstruction that allows less and less urine to pass, and the bladder has to work harder to force the urine out. Both stress incontinence and total incontinence are caused by injury to the urethral sphincter muscle during surgery. The prostate itself also contributes a great deal to continence in males, as it contains a large amount of smooth muscle that helps control urinary flow.

What are the symptoms of Post-Prostatectomy Incontinence? Most men experience some urine leakage or urinary incontinence (UI) after surgery (post-prostatectomy) but the UI usually resolves. Men can experience urine leakage with a cough, change in position, or for no reason at all and it can be as minor as a few drops of urine lost or cause experiences of sopping wet clothes and furniture. The urinary incontinence can be devastating as men wait for the problem to resolve over time.

How is Post-Prostatectomy Incontinence treated? Many times patients will have transient forms of any of these types of incontinence that will resolve with time or conservative measures.

Nonsurgical Treatment Options

  • Biofeedback and pelvic floor physical therapy. Patients who have very mild incontinence may benefit from this therapy.

Surgical Treatment Options

Surgical procedures may be used as treatments for urinary incontinence that is caused by damage to the sphincter.

  • If nonsurgical treatment options did not improve symptoms or the patient would like to achieve further improvement, urethral bulking agents and male slings are available. Urethral bulking agents are injected through the urethra through a scope placed into the urethra.
  • One is the insertion of an artificial urinary sphincter. Approximately 89% of men receiving this treatment achieve total dryness.
Benign Prostatic Hyperplasia (BPH) - men

What is Benign Prostatic Hyperplasia? Benign Prostatic Hyperplasia (also called BPH or Benign Prostatic Hypertrophy) is a condition that affects the prostate gland in men. As men age, the prostate gland slowly enlarges. As the prostate gets bigger, it may press on the urethra and cause the flow of urine to be slower and less forceful. "Benign" means the enlargement isn't caused by cancer or infection. "Hyperplasia" means enlargement. According to John Hopkins, one-third of men experience BPH symptoms by age 50, and 70% have them by age 70. The National Association for Continence reports that about 19 million men have symptomatic BPH.

What causes Benign Prostatic Hyperplasia? Benign Prostatic Hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.

What are the symptoms of Benign Prostatic Hyperplasia?

  • Hesitation. Having to wait for the urinary stream to begin. Hesitation occurs because the enlarged prostate prevents the urethra from opening wide right away.
  • Starting and stopping. When it’s a struggle to keep the urine flowing, the bladder muscles eventually become overgrown, damaged, and weakened. Muscles may react with a series of weak pushes that cause the urinary flow to stop and start.
  • Weak stream. The bladder muscles have been weakened by repeatedly trying to push the fluid through the narrowed prostate.
  • Dribbling. When the urinary system has been weakened by BPH, more than a few drops remain in the bladder or urethra waiting for your final push. You think you’re done, but you’re not.
  • Frequent urination. The trigone, a part of the bladder that tells the brain when it’s time to urinate, becomes more and more sensitive as the bladder muscles become overgrown. Simply put, the trigone sends off too many “gotta go” messages.
  • Incomplete urination. Eventually, a weakened bladder can become unable to empty itself completely, leaving some urine behind. It refills faster, which then triggers the urge to urinate sooner than expected.
  • Frequent nighttime urination (nocturia). Men with BPH may need to get up and go to the bathroom two, three, or more times a night.
  • Urgency. An overworked and damaged bladder becomes overly sensitive and sends emergency signals to the brain that you need to go immediately.
  • Urinary tract infections. Urine that is left behind in the bladder can become a breeding ground for bacteria, resulting in urinary tract infections.
  • Incontinence. Men with BPH may experience this problem if damage to the bladder is extensive, making it impossible to control the flow of urine.
  • Inability to urinate. If the prostate overgrowth becomes too severe, the flow of urine may be blocked completely, causing acute urinary retention, which is an emergency.

How is Benign Prostatic Hyperplasia treated? Once we are sure that your symptoms are caused by benign growth of the prostate gland, we may suggest that you wait to see if your symptoms get better. Sometimes, mild symptoms get better on their own. If your symptoms get worse, we may suggest another treatment option. Risks are generally small, and include bleeding, infection or impotence. 

Erectile Dysfunction (ED) - men

What is Erectile Dysfunction? Erectile Dysfunction, also known as impotence or ED, refers to a man's inability to sustain an erection which is sufficient for sexual intercourse. If the inability to reach or maintain an erection persists for more than a few weeks or months, medical help should be sought. We will assess your general state of health, because ED may be a sign of a more serious health condition, such as heart disease, diabetes, hypertension or something else. If an underlying health problem is detected and treated effectively, the Erectile Dysfunction may well resolve too.

What are the symptoms of Erectile Dysfunction?

  • Difficulty in achieving an erection
  • Inability in sustaining an erection
  • Reduced libido
  • Only being able to achieve an erection during masturbation, but not during sexual intercourse. Most men occasionally experience problems in gaining an erection. It becomes a problem only if it occurs regularly.

What causes Erectile Dysfunction? There can be a large number of conditions that contribute to Erectile Dysfunction, including:

  • Diabetes. This chronic disease can damage the nerves and blood vessels that aid in getting an erection. When the disease has not been well controlled over time, it can double a man's risk of erection problems.
  • Kidney disease. Kidney disease can affect many of the things you need for a healthy erection, including your hormones, blood flow to your penis, and parts of your nervous system. It can also sap your energy level and rob you of your sex drive. Drugs for kidney disease can also cause ED.
  • Neurological (nerve and brain) disorders. You can't get an erection without help from your nervous system, and diseases that disrupt signals between your brain and your penis can lead to ED. Such diseases include stroke, multiple sclerosis (MS), Alzheimer's disease, and Parkinson's disease.
  • Blood vessel diseases. Vascular diseases can block the blood vessels. That slows the flow of blood to the penis, making an erection difficult to get. Atherosclerosis (hardening of the arteries), high blood pressure, and high cholesterol are among the most common causes of ED.
  • Prostate cancer. Prostate cancer doesn't cause ED, but treatments can lead to temporary or permanent erectile dysfunction.
  • Surgery. Surgery for both prostate cancer and bladder cancer can damage nerves and tissues necessary for an erection. Sometimes the problem clears up, usually within 6 to 18 months. But the damage can also be permanent. If that happens, treatments exist to help restore your ability to have an erection.
  • Injury. Injuries to the pelvis, bladder, spinal cord, and penis that require surgery also can cause ED.
  • Hormone problems. Testosterone and other hormones fuel a man's sex drive, and an imbalance can throw off his interest in sex. Causes include pituitary gland tumors, kidney and liver disease, depression, and hormone treatment of prostate cancer.
  • Venous leak. To keep an erection, the blood that flows into your penis must stay in your penis. If it flows back out too quickly—a condition called venous leak, in which the veins in your penis don't constrict properly—you will lose your erection. Both injuries and disease can cause venous leak.
  • Tobacco, alcohol, or drug use. All three can damage your blood vessels. That makes it difficult for blood to reach the penis, which is essential for an erection. If you have hardened arteries (arteriosclerosis), smoking will dramatically raise your risk of ED.
  • Prescription drugs. There are more than 200 prescription drugs that can cause ED.
  • Prostate enlargement. Prostate enlargement, a normal part of aging for many men, may also play a role in ED.

How is Erectile Dysfunction treated? Erectile Dysfunction can be treated at any age. Treatment depends on your overall health and the underlying cause of the problem.

How can we help?

How can we help?

If you’re suffering from discomfort, inconvenience or embarrassment due to urological or gynecological problems, we can help you. Contacting us is the first step to relief.

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