Dr. Butrick and The Urogynecology Center’s staff have been caring for patients with pelvic floor disorders for over 20 years. Your evaluation will involve a few questionnaires to be filled out prior to the first appointment so we can fully understand your concerns and past history. Records concerning your previous evaluations and treatments by other providers are always helpful.
Your first appointment typically involves a careful history and a thorough examination. When your concerns involve prolapse of your pelvic organs, bladder control problems or pelvic pain disorders other tests and assessment of pelvic floor function are often required. After this, Dr. Butrick will carefully review your findings and together we will come up with an individualized game plan to help you. This plan might involve further testing, starting with nonsurgical therapies or at times discussing surgical options.
Urodynamics will tell us about the bladder, its nerves, its sphincters and the pelvic floor muscles. These are simple tests done in the office that involve filing your bladder with water while specialized equipment monitors the response of your nerves and muscles. These tests are the key to understanding the cause of your symptoms.
A small scope (the size of a small catheter) is placed through the urethra and into the bladder. This procedure takes just a few minutes, but allows the complete evaluation of the interior of your bladder. The doctor will look for stones, tumors, ulcers, or inflammation that could be causing your symptoms.
Periurethral Bulking Agents
Peri-urethral bulking agents can effectively relieve symptoms of stress incontinence by increasing tissue bulk and tightening the urethra to prevent urine from flowing out unexpectedly. The bulking agent is injected directly into the peri-urethral tissue as a liquid, which then solidifies to add the desired bulk to the insufficient urethral wall. Injections are administered in the office and take about 15 minutes, with no sedation required. This simple office procedure makes many patients dry for up to 12-24 months or longer.
Bladder BOTOX® Injections
Although primarily known for its cosmetic indications, BOTOX® has many effective uses within the medical field as well, including the treatment of overactive bladder. Overactive bladder affects millions of patients each year, causing frequent urination and an inability to hold urine, resulting in embarrassing leaks. Patients experience an overactive bladder when the muscle that controls the bladder contracts involuntarily. This office procedure can easily correct the worse cases of overactive bladder (even bladder pain), but must be repeated every 6-12 months. Rarely, it can cause urinary retention. Some insurance plans will not cover BOTOX® injections.
Pelvic Floor Rehabilitation
For most patients, pelvic floor rehabilitation is achieved through an individualized program of treatments that aim to improve the strength and function of the pelvic floor. These may include pelvic muscle exercises (Kegels), biofeedback, electrical stimulation and others, depending on each patient’s individual condition. After several treatments, effective symptom relief can often be achieved. Urinary incontinence (or fecal incontinence) is a common condition that involves an involuntary loss of urine as a result of weakened pelvic muscles that can no longer control the bladder (or the bowels). These muscles, known as the pelvic floor, support the bladder, urethra and other organs within the pelvis to allow for normal functioning. If the muscles are not able to properly support these structures, incontinence may occur, and can eventually lead to pelvic organ prolapse or urinary tract infections.
Trigger Point Injections
Trigger point injections are a treatment option for pain in areas that contain trigger points, or knots of muscle that form when muscles do not relax. These points can also irritate nerves around them and therefore cause pain in other areas of the body. A needle containing a local anesthetic (and sometimes a steroid as well) is inserted into the trigger point to make it inactive and therefore alleviate the pain. The procedure takes just a few minutes and is done in the doctor’s office. It is very safe and has minimal side effects. Trigger point injections not only relieve pain, but also loosen the muscles which are causing the pain to therefore help with the rehabilitation process.
Bioidentical Hormone Replacement
It is now recognized that urogenital atrophy (lack of estrogen in the vaginal/bladder tissues) can lead to urinary frequency, leakage, prolapse, pain with sex and bladder infections. The importance of correcting this deficiency has been known to Dr. Butrick and his staff for years. Local and/or systematic bioidentical hormone therapy is therefore an important component of your pelvic health.