Urogynecology at Mount Sinai West
If you are a woman experiencing urinary incontinence, pain or pressure in your bladder, or other pelvic organ issues, you need the expert care of an urogynecologist. Our urogynecologists provide skilled and compassionate care for these and other noncancerous gynecologic conditions, using both surgical and nonsurgical approaches. Getting help for these conditions will improve your health and your quality of life.
At Mount Sinai West, our team of urogynecology experts offer highly skilled care for organs located in the pelvic area, including the bladder, uterus, vagina, and rectum. Urogynecology, an emerging area of subspecialty care within gynecology, is not offered at every hospital or health care practice. Here, you and your doctor will work together to develop the treatment plan that is right for you. If you do need surgery, it is important to be treated by a surgeon who performs these types of operations frequently. Our urogynecologists are highly trained and have extensive experience in meeting the specific needs of our female patients.
Conditions We Treat - FAQs
At Mount Sinai West, we can help with a range of noncancerous conditions. We know you may have questions about your incontinence, bleeding, fistula, or other urogynecologic condition. Below, we answer some of the most commonly asked questions, organized by topic.
Abnormal Bleeding
How do I know if my bleeding is considered abnormal?
Any bleeding that occurs outside your normal menstrual cycle, lasts more than seven days, or is unusually heavy is considered abnormal. Once your periods have stopped for a year (menopause), any bleeding is abnormal.
What causes abnormal bleeding?
Many things can cause abnormal bleeding. They range from very serious conditions to slight changes in the menstrual cycle that do not need treatment. If you bleed between your periods or after menopause, you should see a gynecologist promptly. If you have any concerns, you should consult a doctor to see if you need treatment.
How do you treat abnormal bleeding?
Treatment depends on what is causing the bleeding. There are a large number of both medical and surgical treatments for abnormal bleeding, and they can usually be tailored to your preferences.
Fibroids
What are fibroids?
Fibroids are “tumors” of uterine muscle growing within the walls of the uterus. They are almost always benign (not cancerous), but they can grow quite large and can cause heavy bleeding and other symptoms.
What are the symptoms?
Because fibroids can grow quite large, they can cause both heavy bleeding and pressure in the pelvis. They can get so big that it looks like you are four to six months pregnant.
Are fibroids cancerous?
Very rarely. About one in every 2,000 cases is cancerous.
What can I do to prevent getting fibroids?
Unfortunately there is nothing you can do. Fibroids are very common and occur in about 40 percent of women. The good news is that they are usually small and don’t cause any problems. Fibroids also run in families. If you need treatment, a variety of minimally invasive procedures are available.
How do you treat fibroids?
There are many treatment options. Most of them are not surgical or are minimally invasive procedures. The most important thing to remember is that if you’re not having any symptoms, you don’t need treatment.
Fistula
What is a fistula?
A fistula is a passageway between two areas of the body that shouldn’t have one. Women are most likely to have fistulas between the vagina and rectum (called a rectovaginal fistula) or between the bladder and vagina (vesicovaginal fistula). A vesicovaginal fistula affects your bladder control and a retrovaginal fistula makes it difficult to control your fecal matter.
What causes a fistula?
Rectovaginal fistulas can occur after a difficult childbirth or after surgery on the rectum. You might develop a vesicovaginal fistula after surgery, usually removal of the uterus (hysterectomy). Fortunately both are very rare.
How do I know if I have a fistula?
The symptoms of fistula are severe urinary or fecal incontinence.
Will I need surgery?
Probably. Fistulas are generally treated surgically.
Incontinence
What are the common forms of incontinence?
- Stress incontinence is when you lose a little urine as you laugh, cough, sneeze, and with physical activity. This usually affects younger women who are premenopausal and is more frequently linked to pregnancy and childbirth.
- Urge incontinence is a sudden need to urinate that is so strong you might have difficulty making it to a toilet in time. This type is more common in older women who are no longer menstruating (postmenopausal).
How common is incontinence?
Many women experience incontinence and it increases with age. At age 50, about one in three women (30 percent) has incontinence; by age 80, it affects twice as many women (60 percent).
Do I need to see a doctor if I have trouble controlling my bladder?
You should see a doctor if you are bothered by it and want treatment.
How do you treat incontinence?
The treatment depends on the type and severity of incontinence. There are a variety of treatments including physical therapy, medications, bladder retraining, lifestyle modifications, and surgery.
Overactive bladder
How do I know if I have an overactive bladder?
Overactive bladder causes you to have to urinate frequently and urgently.
How is it different from incontinence?
Overactive bladder can include incontinence, but not everyone with overactive bladder has incontinence.
What causes an overactive bladder?
Medications, surgery, infections, menopause, radiation, and neurological conditions can cause an overactive bladder, but most of the time there is no specific cause.
How do you treat this condition?
Doctors treat overactive bladder with lifestyle changes, physical therapy, medications, office procedures, Botox injections, and/or an internal bladder stimulation.
Pelvic Organ Prolapse
What is pelvic organ prolapse?
Pelvic organ prolapse is when your pelvic floor isn’t strong enough to hold all your pelvic organs. It results in the dropping or falling of the uterus, bladder, rectum, or vagina. The types of pelvic organ prolapse are:
- Uterine prolapse: When the uterus drops into the vagina. Other organs may also be out of place.
- Anterior wall prolapse (cytocele): The bladder drops and rotates into the vaginal opening. It may bulge out and may also cause urinary leakage or difficulty voiding. This is the most common type of pelvic organ prolapse.
- Posterior wall prolapse (rectocele): The rectum bulges into the vaginal opening. A large rectocele can make it difficult to move the bowels.
How do I know if I have pelvic organ prolapse?
Most women will feel a heaviness in the vagina or have a sense that something is coming through the vagina.
Can I prevent pelvic organ prolapse?
The condition is usually caused by a combination of childbirth and aging. Kegel exercises can help to treat the condition and prevent it from getting worse.
Will I need surgery?
Not necessarily. There are both nonsurgical and surgical treatments. It depends on your symptoms and the type of prolapse.
Urinary Tract Infections
How do I know if I have a urinary tract infection (UTI)?
The symptoms of a UTI include sudden urinary frequency or urgency, or pain when you urinate.
What causes UTIs?
Urinary tract infections are quite common in women. This is mostly due to their anatomy. The female urethra is short and the vulva is covered in bacteria so it is not difficult for the bacteria to get into the bladder. On average, it is only a few inches from the urethra to the anus. For these reasons, 50 to 60 percent of women will get at least one UTI during their lifetime and about 10 percent of women experience them chronically.
What are recurrent UTIs and why do some women get them?
For many women, chronic UTIs start when they become sexually active. During sex, the bacteria from the vulva can get into the bladder. Most of the time, the bacteria will not be able to grow and multiply but if they do, women will experience the pain and discomfort of a UTI.
When do I need to see a doctor?
You should see a doctor if you think you have a urinary tract infection or if you have them repeatedly.
Treatments We Offer
At Mount Sinai West, we tailor treatments to your specific condition and symptoms. We use a wide variety of state-of-the-art treatments. These include:
- Pessary: A device made of silicone that is placed into the vagina to improve the symptoms of prolapse and stress incontinence. It can also keep the prolapse from getting worse. Once it has been fitted, you won’t notice it is there
- Medications: Helpful for certain types of incontinence
- Behavioral treatment and education: We offer several approaches including:
- Pelvic floor exercises, also known as pelvic muscle rehabilitation, can help with stress incontinence and improve quality of life for people with prolapse
- Bladder retraining is a behavior modification technique that helps with incontinence
- Physical therapy: We use a variety of approaches including:
- Kegel exercises: involve tightening and loosening the muscles you use to hold your urine in
- Gynecologic surgery: We perform a variety of procedures including:
- Scarless gynecologic hysterectomy: A time-tested vaginal approach to gynecologic surgery that is safer, less expensive, and produces less scarring than the latest robotic and laparoscopic methods
- Colporrhaphy: Repairing a defect in the vaginal wall
- Dilation and curettage: Sampling uterine tissue
- Endometrial ablation: Removing the lining of the uterus
- Hysterectomy: Removal of the uterus. May also involve removing the cervix, ovaries, Fallopian tubes, and other surrounding structures
- Laparoscopic hysterectomy: A camera and instruments are threaded through small incisions to remove the uterus--a minimally invasive procedure
- Tension-free transvaginal tape procedure: This 20-minute outpatient procedure is a minimally invasive approach to bladder control
- Minimally invasive prolapse surgery: A dropped (prolapsed) vagina or uterus is repaired using your own tissue
- Myomectomy: Taking out fibroids from the uterus
- Oophorectomy: Removal of one or both ovaries
- Pelvic floor reconstruction: A procedure to treat pelvic organ prolapse
- Tubal ligation: Commonly known as “tube tying,” this is a contraceptive procedure
Meet Our Team
Lisa Dabney, MD, and Anne Hardart, MD, are in practice together and have more than 40 years of combined experience treating patients. They are board certified in both general obstetrics and gynecology and in urogynecology and reconstructive pelvic floor medicine. They are among the few physicians who are board certified in urogynecology. Drs. Dabney and Hardart have extensive surgical experience treating all types of noncancerous gynecologic conditions. They place a high value on taking a holistic approach to your care, using both surgical and nonsurgical methods.
Chandhana Paka, MD, is board certified in both general obstetrics and gynecology and in urogynecology and reconstructive pelvic floor medicine. She is fellowship trained in both urogynecology and minimally invasive gynecologic surgery. Dr. Paka provides both surgical and non-surgical treatment options for a wide range of routine and complex gynecologic issues.