Pelvic Medicine and Reconstructive Surgery

Our urologists have extensive experience treating pelvic floor conditions, which affect the muscles that support the bladder, bowel and genitals. Surgeons at Orlando Health Medical Group Urology also perform pelvic reconstructive surgery. We provide you with personalized, discreet care from diagnosis to treatment and follow-up.

We treat numerous pelvic conditions in men and women, including:

• Fecal incontinence or dysfunction
• Fistulas (abnormal connections between internal body structures)
• Overactive bladder or urinary incontinence 
• Painful intercourse 
• Chronic pelvic pain
• Pelvic organ prolapse in women (fallen pelvic organs, including the bladder, reproductive organs and bowels)
• Pelvic floor dysfunction (problems with the pelvic floor muscles) 
• Urethral diseases, including strictures and diverticulums
• Urinary retention (difficulty urinating)
• Complex vulvar disorders or vulvodynia (chronic pain in the vulva – area outside of the female genitals)
• Other bladder and bowel conditions

The pelvic floor is a group of muscles at the base of your pelvis that help control your ability to go to the bathroom. Normally, you’re able to go to the bathroom without a problem because your body tightens and relaxes your pelvic floor muscles. But if you have a problem with your pelvic floor, your body keeps tightening these muscles instead of relaxing them. This tension means you may have:

• Trouble releasing a bowel movement
• An incomplete bowel movement
• Urine or stool that leaks

Pelvic floor dysfunction also can interfere with both a man’s and a woman’s reproductive health. Men may experience erectile dysfunction or prostatitis, which is an infection or inflammation of the prostate. In women, the uterus and vagina are affected and may cause pain during sex.

There are several factors known to contribute to this condition. These include:

• Traumatic injuries to the pelvic area
• Pregnancy
• Overusing the pelvic muscles while going to the bathroom, which eventually affects muscle coordination
• Pelvic surgery
• Being overweight
• Getting older

Our specialists at Orlando Health Medical Group Urology have extensive training and experience in treating pelvic floor conditions and in pelvic reconstructive surgery. We offer personalized urological care for conditions involving bladder and bowel function.

Orlando Health Medical Group Urology provides a full spectrum of pelvic medicine treatments, including:

• Botox injections
  This medicine is introduced into the bladder to treat incontinence or lessen urinary urgency.
• Fistula (abnormal connection between body structures) repair
  Fistulas form as the result of sores (ulcers) that tunnel through the intestines and into surrounding tissue. The type of fistula surgery you receive depends on the location and severity of your fistula. All fistula repair procedures share the same goals of draining pus and infected tissue while preventing future collection of fluids.
• Medications
  Stool softeners and laxatives are taken daily to keep your bowel movements soft and regular.
• Neuromodulation or pudendal nerve blocks (Stimwave is a brand name)
  This therapy uses an implantable neurostimulator device that provides a minimally invasive, long-term treatment option for chronic pelvic pain by pinpointing stimulation directly to the affected nerves.
• Pelvic floor physical therapy
  Exercises are performed to stretch muscles in your lower back, pelvis and pelvic floor so their coordination can be improved. They often are done at the same time as biofeedback therapy, which uses sensors and video to monitor your pelvic floor muscles as you try to relax or clench them.
• Pelvic floor reconstructive surgery
  This restores prolapsed pelvic organs to their original position with mesh or tissue to support prolapsed organs.
• Percutaneous Tibial Nerve Stimulation (PTNS)
  A nonsurgical, in-office neuromodulation therapy provides electrical nerve stimulation to treat symptoms of urge incontinence (acupuncture needle treatment placed behind the ankle to help with bladder control).
• Sacral Nerve Stimulation or sacral neuromodulation
  This delivers gentle electrical impulses, similar to a pacemaker, through a thin wire that is placed near the sacral nerve. It stimulates the bowel, sphincter and bladder muscles to work normally to treat overactive bladder, urge incontinence, fecal incontinence and/or urinary retention without obstruction.
• Sling procedures to treat incontinence
  The inserting of mesh or tissue that supports the bladder to treat stress urinary incontinence.
• Trigger point injections to the pelvic floor for pelvic pain
  These shots deliver medication directly into the muscle knot to release the spasm immediately.
• Bulking agents and procedures for incontinence
  An in-office treatment for urinary incontinence, bulking agents are applied through a series of small injections around the urethra to provide long-lasting relief. (Bulkamid is a brand name.)
  *Orlando Health Medical Group Urology was the first in Central Florida to offer Bulkamid, the newest treatment for stress incontinence that, once injected, adds volume to the urethra and acts as a scaffold for cells to grow through, helping to provide long-lasting relief of stress urinary incontinence symptoms.
• Urethral reconstruction with or without buccal grafting for urethral strictures or diverticula
  This procedure begins by removing the narrowed section of your urethra or enlarging it. Tissues from other areas of the body, such as your skin or mouth, may be used as a graft during reconstruction.

When surgical treatment is determined to be the best treatment option, our physicians offer minimally invasive, robotic-assisted surgery for some pelvic procedures, offering enhanced access and precision for the surgeon and resulting in quicker recovery with less pain and scarring for you.