Pelvic Floor Dysfunction – What is the Right Treatment Approach?

Pelvic floor dysfunctions are common and include a wide range of conditions that affect women on a daily basis, significantly impairing one’s quality of life. In the United States, up to 35% of women suffer from stress urinary incontinence (SUI), and up to 50% of women have physical findings consistent with some degree of pelvic organ prolapse.


At Emory Women’s Center, our Female Pelvic Medicine and Reconstructive Surgery specialists offer help to patients with a wide variety of conditions including pelvic organ prolapse (when the pelvic organs “drop” due to pelvic floor weakness) and stress urinary incontinence (the involuntary leakage of urine with physical activity).

Symptoms associated with pelvic organ prolapse include:

  • Vaginal bulge/pressure
  • Vaginal pain
  • Incomplete bladder emptying
  • Difficulty with defecation

Symptoms associated with stress urinary incontinence (SUI)

  • Loss of urine with coughing, sneezing or laughing
  • Loss of urine during intercourse
  • Loss of urine without sensation
  • Loss of urine during the night time

Nonsurgical Options

There is a broad range of treatment options for these two conditions. Nonsurgical options may include:

  • Adopting lifestyle changes
  • Strengthening your pelvic floor muscles with specific pelvic exercises with or without the help of a pelvic floor physical therapist
  • Using a pessary –┬áremovable device that is placed into the vagina to support areas of prolapse

While these nonsurgical options are explored with all patients, you may find that surgery is often an option to solve issues related to bowel or bladder pain or even painful sexual intercourse. One in six women will opt for surgery. The use of permanent mesh material to reinforce the prolapsed area is one of the many successful surgical approaches. This has many patients wondering, “is the use of mesh right for me?”

Surgical Option: Mesh

Mesh, also known as Polypropylene mesh, has been used for decades across most surgical subspecialties. In recent years, the use of mesh has garnered a lot of media attention. Centered around the July 2011 U.S. Food and Drug Administration (FDA) advisory on the safety and effectiveness of mesh, the treatment of pelvic organ prolapse media coverage may raise questions about whether the mesh is right for your specific Pelvic Disorder needs. Transvaginal mesh as it is mentioned in the 2011 FDA is different from our use of mesh augmentation materials for pelvic floor disorders. When treating pelvic organ prolapse, the mesh is placed abdominally, a technique that has been used for many years offering lower complication rates.

We also use vaginal mesh to treat stress urinary incontinence in the form of mid-urethral slings. This leading surgical treatment option for women who suffer from SUI is supported as the “standard of care” in the surgical treatment of stress urinary incontinence by the American College of Obstetrics and Gynecology (ACOG), the American Urogynecologic Society (AUGS) and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU).

If you suffer from vaginal prolapse or stress urinary incontinence, don’t hesitate to consult an Emory Clinic Female Pelvic Medicine and Reconstructive Surgery subspecialist and ask them if surgery is right for you. The Female Pelvic Medicine and Reconstructive Surgery team at Emory Clinic’s Department of Gynecology and Obstetrics includes specialized pelvic surgeons, colorectal surgeons and a dedicated group of physical therapists. Our goal is to collaborate with you to find a treatment approach tailored to your symptoms and treatment goals. Whether or not you decide on a treatment option that includes the use of permanent mesh material, our team is here to address all your urogynecological questions and concerns.

Emory Clinic Female Pelvic Medicine and Reconstructive Surgery have specialized surgeons available to discuss your options, schedule an appointment today by calling 404-778-3401.

About Jessica Harroche, MD FACOG

Jessica Harroche, MD FACOG is an Assistant Professor at Emory University Department of Gynecology and Obstetrics, Female Pelvic Medicine, and Reconstructive Surgery Division. Dr. Harroche attended the Sackler School of Medicine at Tel Aviv University. She completed her Residency and Fellowship at the Albert Einstein School of Medicine/Montefiore Medical Center in the Bronx, NY. Dr. Harroche specializes in pelvic floor disorders and offers women a breadth of surgical approaches including minimally invasive procedures (vaginal, robotic).

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