Patrick Culligan, MD, FACOG, FACS Urogynecologist NYC

Opening Hours : Monday - Friday | 8 am - 4 pm
  Contact : 212-746-4600

Glossary of Terms

GENERAL TERMS

Pelvic floor muscles
A group of muscles in the pelvis that support and help to control the vagina, uterus, bladder urethra and rectum
Bladder
A muscular organ which stores urine
Ureters
A pair of tubes, each leading from one of the kidneys, to the bladder
Urethra
A short narrow tube that carries urine from the bladder out of the body.
Voiding
Passage of urine out of the body

COMMON PELVIC FLOOR DISORDERS

To see the various types of prolapse click here.
Urinary incontinence
leakage of urine
Stress incontinence
involuntary loss of urine during activities that put “stress” on the bladder such as laughing, coughing, sneezing, lifting, etc.
Urge incontinence
An involuntary loss of urine preceded by a strong urge (also known as “overactive bladder”)
Dysuria
Painful urination
Urgency
A powerful need to urinate immediately
Frequency
The need to urinate more often than normal (more than every 2 hours or more than 7 times a day)
Nocturia
Waking up frequently (more than once) during the night to urinate
Cystocele
Prolapse or bulging of the bladder into the vagina
Rectocele
Prolapse or bulging of the rectum into the vagina
Enterocele
Prolapse or bulging of the small intestine into a space between the rectum and vagina
Uterine prolapse
Prolapse or descent of the uterus into the vagina
Fecal Incontinence
Accidental loss of solid stool, liquid stool, or gas
Constipation
Variously defined as infrequent bowel movements (< 3 bowel movements per week), incomplete emptying of bowel contents, need to excessively strain to effect a bowel movement, passage of small, hard stools, or need to place your fingers in the vagina or the space between the vagina and anus to effect a bowel movement.

DIAGNOSTIC TESTS

Cystoscopy
Using a lighted scope to view the inside of the bladder.
Urodynamics
A test that uses a small catheter inserted in the bladder to study the function of the bladder and urethra during, filling, leakage and urinating
Dynamic cystoproctogram
A procedure that uses x-rays to measure the extent of prolapse
Electrodiagnostic testing (EMG)
A test that evaluates nerve and muscle function
Intravenous pyelogram (IVP)
An x-ray procedure that examines the kidneys, ureters and bladder
Urinalysis
A test that evaluates chemicals and cells in the urine
Urine culture
A test that determines whether a Urinary Tract Infection (UTI)  is present

SURGICAL TREATMENTS FOR STRESS INCONTINENCE

Burch retropubic urethropexy
Procedure done through an abdominal incision or through a laparoscope to resupport the bladder base by placing sutures in the vagina to attach it to a ligament on the pubic bone
Suburethral sling
Placing a “strap” of material under the urethra to support it and prevent stress incontinence. The sling material can be synthetic or natural. The natural material can be taken from your own body or from cadavers.
Periurethral injections
Injection of material next to the opening of the bladder in an effort to prevent stress incontinence. This procedure is performed in the office.  One material used for these injections is Botulinum Toxin (Botox).  Click on the following link to see an educational leaflet regarding  Botulinum Toxin A.
Tension-free vaginal tape – type- sling
A special type of suburethral sling that requires a less invasive procedure, which allows it to be performed under local anesthesia on an outpatient basis.
Suprapubic catheter
A catheter placed into the bladder through the abdomen – it is used to drain the bladder after surgery
Neuromodulation
This is a new approach in the treatment of the overactive bladder, urinary retention and urinary frequency. Electrodes are surgically inserted into the nerves that control the bladder.

SURGICAL PROCEDURES TO CORRECT PROLAPSE

Anterior Colporrhaphy
A vaginal procedure to reestablish the supports between the bladder and vagina to fix a cystocele. A synthetic mesh or organic graft material made be placed to reinforce this repair
Vaginal Repair with Mesh
  support the vaginal wall by attaching it to the pelvic sidewall to fix a cystocele. A synthetic mesh or organic graft material made be placed to reinforce this repair
Posterior Colporrhaphy
A vaginal procedure to reestablish the supports between the vagina and rectum to fix a rectocele. A synthetic mesh or organic graft material may be placed to reinforce this repair
Transvaginal enterocele repair
Close the space between the vagina and rectum through a vaginal incision to prevent the small bowel from pushing the vagina out. This procedure will also resuspend the top of the vagina.
Total abdominal hysterectomy (with or without bilateral salpingo/oophorectomy)
Remove the uterus (including the cervix), tubes and ovaries through an abdominal incision.
Total Laparoscopic Hysterectomy
removal of the uterus (including the cervix) and possibly the tubes and ovaries through a laparoscopic approach
Vaginal Hysterectomy (with or without bilateral salpingo/oophorectomy)
Remove the uterus (including the cervix), tubes and ovaries through a vaginal incision.
Bilateral salpingo/oophorectomy
Removal of tubes and ovaries (performed eiter abdominally, vaginally or laparoscopically).
Uterosacral Ligament Suspension
Suspend the top of the vagina to the uteroscral ligaments. this can be performed vaginally, abdominally or laparoscopically.
Sacrospinous vaginal vault suspension
A vaginal procedure that attaches the top of the prolapsed vagina to a ligament in the pelvis
Sacral colpopexy
A procedure (performed abdominally or laparoscopically) that attaches the top of the prolapsed vagina to the sacrum using either synthetic mesh or cadaveric material.
Illiococcygeal fascial attachment
A vaginal procedure that attaches the top of the prolapsed vagina to pararectal supportive tissue.
Supracervical hysterectomy
Removal of most of the uterus – leaving the cervix behind. This approach can be done abdominally or laparoscopically
Total colpectomy
Complete closure of the vagina to correct prolapse. This procedure is only performed when the patient is ABSOLUTELY sure that she will never want to have intercourse again.
Total colpocleisis
Closure of the vagina (similar to colpectomy) while leaving channels at the side for drainage from the uterus (which is not removed)
Overlapping anal sphincteroplasty
Reattach divided muscle edges around anus to correct fecal incontinence

NON-SURGICAL TREATMENT OPTIONS FOR PROLAPSE

Pelvic muscle exercises (PME)
Also known as Kegel’s exercises, they strengthen the support of the pelvic organs and are most commonly used to treat stress urinary incontinence. PME techniques are also useful in prolapse prevention. Once the symptoms of prolapse are severe, however, these exercises are of little benefit.  Animation 1,  Animation 2. Patient educational leaflet on Pelvic Floor Exercises.
Pessary
A device worn in the vagina like a diaphragm. Pessaries are used to support the vagina, bladder, rectum and uterus as necessary. They come in a variety of shapes and sizes, so a doctor or nurse must fit them. Click here for a picture and animation of the various pessaries that are available.

NON-SURGICAL TREATMENT OPTONS FOR URINARY INCONTINENCE

Pelvic Muscle Exercises (PME)
Also known as Kegel exercises, PME techniques are an effective treatment option for stress incontinence. Most women require guidance from a medical professional to learn how to contract the pelvic floor muscles correctly. For specific instructions on how to do these exercises CLICK HERE.
Biofeedback
This term refers to a variety of techniques that teach patients bladder and pelvic muscle control by giving positive feedback when the patient performs the desired action. This feedback can be from an electronic device or directly from health professional.
Bladder Training
This treatment for urge incontinence involves teaching a patient to urinate according to a timetable rather than an urge to do so. Gradually, the scheduled time between trips to the bathroom is increased as the patient’s bladder control improves. CLICK HERE for a copy of the instruction sheet we use to help with bladder training.
The Bladder Diet
This is a list of dietary irritants to the bladder. Avoiding the items on this list can greatly improve such bladder symptoms as frequency and urgency. For a copy of the bladder diet CLICK HERE.
Medications
There are a number of drugs that are used in the treatment of urge incontinence.
Commonly prescribed  drugs are Detrol, Ditropan XL, Sanctura, Vesicare, Enablex, and Toviaz.  There is even an over the counter version of Ditropan, called the Oxytrol Patch. A new medication is also available, called Myrbetrig.

Incontinence Dish Pessary

Several types of pessaries are available that are designed specifically for the treatment of stress incontinence. These are especially useful for women who leak urine during specific activities such as exercise.

Pelvic Floor Electrical Stimulation (PFES)

Vaginal or anal probes that deliver electrical current to the pelvic floor may be useful in the treatment of urge and mixed incontinence.