Frequently Asked Questions

What is prolapse?
What is stress urine incontinence?
What is overactive bladder?
What is urgency urine incontinence?
What is a fistula?
What is a “bladder lift”?
What is a pessary?
What is Interstitial Cystitis (or Painful Bladder Syndrome)?
What is pelvic floor muscle therapy?
What is Posterior Tibial Nerve Stimulation (PTNS)?
What is Sacral Nerve Stimulation?  
What is urodynamics (urodynamic testing)?
What is a cystoscopy?
What is a Urogynecologist?
What kind of training does a Urogynecologist have?
When is it a good idea to see a Urogynecologist?
What is “Female Pelvic Medicine and Reconstructive Sugery”?

What is Pelvic Organ Prolapse (or vaginal prolapse)?
Pelvic organ prolapse is the descent and possible protrusion of the pelvic organs onto the vaginal walls that sometimes results in their protrusion through the vaginal opening.
It results from the weakening, stretching and detachment of the muscles and ligaments of the pelvic floor that hold those pelvic organs (the vagina, the uterus, the bladder, the urethra, the rectum) in place.
Pelvic organ prolapse can receive different names depending on the part of the vagina that is most affected. Examples are: “prolapse”, “vaginal prolapse”, “vaginal vault prolapse”, “dropped vagina”, “uterine prolapse”, “dropped uterus”, “bladder prolapse”, “dropped bladder”, “cystocele”, “rectal prolapse”, “rectocele”, “dropped rectum”, “enterocele”. They are not necessarily synonyms.
Symptoms vary. The most common one is a sensation of a bulge at or through the entry of the vagina. Some patients have described it as a “ball”, a “baby’s head”, “an egg” or a “roma tomato” coming out of the vagina. Other possible symptoms can include: vaginal pressure, lower back pain, vaginal pain, pain with sex, incomplete bladder emptying, urinary urgency and frequency, difficulty having a complete bowel movement, constipation.
There are surgical and non-surgical options for the treatment of prolapse.

What is Stress Urinary Incontinence?
Stress urine incontinence is a type of involuntary urine leakage that occurs with certain types of movements (typically coughing, sneezing, laughing, lifting, bending or running). So the stress it refers to is not mental, it is stress (pressure) on the bladder.
Normally we don’t leak because there are muscles around the urethra (the “bladder tube”) that are engaged automatically when the bladder is stressed (with cough, sneeze, etc) and block the involuntary passage of urine. But that mechanism of continence can weaken and fail leading to those bothersome urine accidents.
The main risk factors to develop stress urine incontinence are age (more likely the older you get), childbirth (more likely the more children you deliver) and obesity (more pressure on the bladder).
Fortunately there are many treatment options for stress urine incontinence.  These are:
*Kegel exercises
*Pelvic floor muscle training with biofeedback
*Pessaries for incontinence
*Periurethral injections
Dr. Treszezamsky will tell you the pros and cons of each method based on a personalized assessment.

What is overactive bladder? / What is urgency urinary incontinence?
Overactive bladder (OAB) is a condition in which the patient has to go to the bathroom very frequently and usually with a very strong sense of urgency (“gotta go now!”). A lot of patients with overactive bladder are awaken up at night (sometimes several times) with the strong desire to empty their bladder which can prevent them from having a good sleep.
Depending on how sudden that feeling is, how far the toilet is or how fast the patient is, the urge to urinate can end up with an episode of incontinence, that is, leaking urine in the way to the bathroom or as the pants are being pulled down. That is called urgency (or urge) urine incontinence.
OAB is a very common condition (although a lot of people are embarrassed to talk about it). It affects 8% to 50% of women It is more prevalent in the elderly than in the young and in multiparous women (the more children, the more likely women are to develop its symptoms).
“Straighforward” OAB can be initially evaluated and treated (usually with medication) by general gynecologists, and primary care physicians. If the initial treatment doesnot work or if there are symptoms of urinary obstruction (difficulty emptying the bladder), blood in the urine, recurrent urinary tract infections, bladder pain or if the symptoms have gotten worse after a C-section, hysterectomy or bladder surgery (a “bladder lift” or a “sling”), I would recommend prompt and more thorough evaluation by a Urogynecologist.

What is a fistula?

A fistula is an abnormal communication between two organs. Pelvic fistulas cause incontinence. Incontinence of urine if it is a vesicovaginal fistula (communication between the bladder and the vagina) or a ureterovaginal fistula (communication between a ureter and the vagina), or incontinence of stool if it is a rectovaginal fistula (communication between the rectum and the vagina). Fistulas can form as a result of multiple causes. The most common ones are complications of childbirth or pelvic surgery. 

Some fistulas can be managed with conservative measures and a few can close spontaneously. But most of them require surgical treatment. 

What is a “bladder lift”?

It is a confusing term!

A lot of patients come to us saying they had a "bladder lift". That's what they heard form their Gynecologist or Urologist. However that is a very imprecise term that is used to name a wide variety of different procedures, some of them to lift part of the vagina (rather than the bladder) or some of them to treat urine incontinence. And sometimes patients don't have a very good understanding of what was done and why. 

The only way of knowing for sure what that "bladder lift" was is to get the operative report from the facility where the procedure was done. 

What is a pessary?

Pessaries are medical devices designed to support the vaginal walls (along with the uterus, the bladder or the rectum) to treat prolapse and for urinary incontinence. They are placed in the vagina in a similar way as a diaphragm or a tampon. They come in many different shapes and sizes and you may need to try more than one before finding the one that is best for you. That is the process of pessary fitting (just like when you buy clothes or shoes you need to try them on to see if they fit you well). Once the pessary is placed, they should be so comfortable they should not even be felt. Some pessaries allow for vaginal intercourse when they are in place.

Occasionally pessaries may fall out, which just means that you should probably try another pessary (another size of shape that fits you better) or consider other options. Pessaries should always be fitted by someone who has experience with different types (a Urogynecologist, a physician assistant, a nurse). Pessaries need to be cleaned from time to time. This can be done by the doctor that first fitted it, or by patients themselves, depending on their comfort and dexterity.