Center for Pelvic Medicine ♦ Urogynecology ♦ Incontinence & more ♦ Prolapse ♦ Diagnosis & Treatment ♦ Resources

Anal incontinence – accidental loss of solid stool, liquid stool or gas.

Anorectal Manometry — (ARM) a test performed to evaluate patients with constipation or anal incontinence.  This test measures the pressures of the anal sphincter muscles, the sensation in the rectum, and the reflexes that are needed for normal bowel movements.

Anterior colporrhaphy —a vaginal operative procedure done to correct a hernia or bulging of the vaginal tissue between the bladder and vagina.  (AKA:  anterior repair, cystocele repair or the “A” in A&P repair)

Bladder Challenge – test of adequate bladder emptying usually performed postoperatively.  The urinated volume is measured and then the amount remaining in the bladder (post-void residual) is measured either via a bladder scan or by urine obtained from a catheter passed through the urethra into the bladder. 

Bladder Training  - this behavioral training is a treatment for urge incontinence.  Patients are advised to urinate according to a schedule/timetable rather than in response to an urge.  Gradually, the scheduled time between trips to the bathroom is increased as bladder control improves.   (AKA: timed voiding, bladder retraining drills)

Biofeedback — this term refers to a variety of techniques used to teach patients bladder and pelvic muscle control by giving positive feedback when a desired action is performed. This feedback can be from an electronic device or directly from a health professional.

Catheter — a small hollow tube, similar to a straw, used to drain the bladder or fill the bladder for testing. 

Colpocleisis — surgical obliteration or closure of the vagina for the treatment of pelvic organ prolapse.  This procedure is offered only to older patients with no future intention of utilizing the vagina for intercourse.  (AKA:  LeFort, subtotal colpectomy, vaginal obliteration)

Colporrhaphy — this is the term used  to describe a surgery to repair a prolapse in the vaginal wall (e.g., anterior colporrhaphy, posterior colporrhaphy).

Cystocele — a prolapse, herniation or bulging of the anterior (front) vaginal wall into the vagina.  The bladder is behind the vaginal wall in a cystocele.

Cystoscopy — the use of a lighted scope to view the inside of the bladder.  Flexible scope curves to view the entire inside surface of the bladder.  Rigid scopes are angled (30 or 70 degree) to view the inner surface of the bladder.  Zero degree (straight) is used for urethral inspection.  Some incontinence treatments are administered via a cystoscope (for example:  urethral bulking agents like Coaptite®)

Detrusor Instability — (“DI”, urge incontinence, overactive bladder [OAB]) urodynamically proven uncontrollable bladder contractions/spasms causing loss of urine before reaching the toilet. 

Dyspareunia — painful sexual intercourse.

Dysuria — painful urination.

Electrodiagnostic testing of the pelvic floor muscles — (Electromyography, EMG) — a test that evaluates nerve and muscle function of the pelvic floor.

Enterocele — prolapse or bulging of the small intestine into the space between the vagina and most commonly the rectum (less commonly between the vagina and bladder).

Fecal Incontinence — accidental uncontrollable loss of liquid or solid stool.

Fistula — an abnormal connection from one organ to another. For example, an abnormal tract between the bladder and the vagina, resulting in uncontrolled loss of urine from the vagina is called a vesicovaginal fistula.  An abnormal tract between the rectum and vagina, which may result in uncontrollable passage of gas or fecal material into the vagina is called a rectovaginal fistula.

Frequency — increased daytime urinary frequency is defined as the need to urinate more frequently than normal (more frequently than 7 times per day).

Graft Material – Refers to material used by some surgeons for prolapse repair to help additionally support the surgical repair.  Most frequently used is a medical grade material called polypropylene.  This graft material is also used for other hernia repairs.  (See FDA link regarding graft use in prolapse surgery).

Hematuria — the presence of blood in the urine. 

Insensible Incontinence – refers to urinary incontinence in which the woman is unaware of how it occurred.

Intermittent self-catheterization – a technique utilized by patients who are unable to adequately empty their bladders in which a short urethral catheter is passed through the urethra and into the bladder in order to empty the bladder of retained urine.

InterStim® — a common brand-name of neuromodulation (see neuromodulation)

Interstitial Cystitis —“IC”, also called painful bladder syndrome, is a disorder that is typically associated with symptoms of bladder pain related to bladder filling and accompanied by symptoms of urinary frequency and urgency in the absence of infection.  Symptoms may include pressure, discomfort and/or burning in the area of the urethra or vagina.

Intrinsic sphincter deficiency — (ISD) a condition diagnosed with urodynamic testing in which the urethra no longer retains an adequate seal, is quite weak and urine can easily leak out of the bladder involuntarily.  (AKA: low pressure urethra [LPU]).

Kegel Exercises — see pelvic floor muscle exercises

Low Pressure Urethra — (LPU) a condition diagnosed with urodynamic testing in which the urethra no longer retains an adequate seal, is quite weak and urine can easily leak out of the bladder involuntarily.  (AKA: intrinsic sphincter deficiency [ISD]).

Midurethral Sling – (MUS) a minimally invasive surgical procedure designed to correct stress-related urinary incontinence.   A strip of material (synthetic mesh, usually polypropylene) is placed in the space between the urethra and vaginal tissue and its purpose is to support the urethra and prevent leakage of urine with physical activity.

• There are two main types of MUS:  retropubic and transobturator.  The retropubic sling is placed under the urethra and the ends are passed up toward the pubic bone.  The transobturator sling is also placed under the urethra but is passed out toward the creases of the legs (via the obturator foramen). 

Minimally Invasive Surgery –  a term used to describe surgical techniques that are used to reduce the impact and recovery for patients undergoing surgical procedures.  Examples include laparoscopy, robotic surgery and many types of vaginal surgery.

Mixed incontinence — having both stress and urge incontinence.

Neuromodulation — this is a treatment offered for severe overactive bladder, urinary retention and urinary frequency.  Neuromodulation can be accomplished either through permanent placement in the lower back of electrodes (surgically inserted) into the nerves that control the bladder (InterStim®) or via stimulation through very fine needle electrode placed near the ankle for 30 minute sessions weekly for 12 weeks (UrgentPC® – Percutaneous Tibial Nerve Stimulation) .

Nocturia — waking up frequently (more than once) during the night to urinate

Nocturnal enuresis – urinary incontinence during the night while asleep (bedwetting).

Overactive Bladder — (OAB) uncontrollable leakage of urine preceded by or with a strong urge to urinate.

Pelvic Floor Electrical Stimulation — the use of vaginal or anal probes to deliver a mild electrical current to the pelvic floor muscles and nerves.  This treatment may be useful in the reduction of urge incontinence, stress incontinence and/or other pelvic floor disorders.

Pelvic Floor Muscle Exercises — (PFME) also known as “Kegel exercises”, PFME are an effective treatment option for urinary incontinence.   Performing these regularly will strengthen the pelvic floor muscles.  The first step is being able to contract and relax the correct muscles.  Key to success is performing PFME regularly.

Pelvic Floor Muscles — these are hammock-like muscles of the pelvis that help to control and support the vagina, the uterus, the bladder, the urethra, and the rectum. 

Perineorrhaphy —  a surgical procedure to reconstruct and strengthen the perineum (the tissue between the opening of the vagina and the anus).  This tissue contributes to the support of the pelvic structures and may become thinned or weakened after vaginal childbirth or with aging. 

Pessary — this is a silicone device (similar to a diaphragm) which is worn in the vagina to support prolapsing or relaxed vaginal tissue and/or to support the urethra to prevent stress incontinence.  Pessaries are available in a variety of shapes and sizes – fitting takes place in the office.  Once inserted these devices must be removed and cleaned regularly by either the patient herself trained in removal and insertion or by the healthcare provider. 

Pelvic Organ Prolapse — (POP) this is a general term for relaxed, dropped, poorly supported or herniated areas within the vagina.  The uterus itself and/or any area of the vagina may drop resulting in bulges, pressure or vaginal fullness.  

Posterior Colporrhaphy — this is a vaginal surgical procedure used to repair a rectocele or reestablish the supports between the vagina and rectum.  (AKA:  rectocele repair; the “P” in A&P repair)

Post Void Residual — (PVR) this measurement is used to determine the amount of urine left in the bladder after voiding.  This measure is performed immediately following a void either by draining the bladder with a small catheter (flexible hollow tube) or by placing a bladder scanner above the pubic bone.

Procidentia – the term used to describe a complete prolapse or eversion (externalization) of the uterus and vagina.

Rectocele — a prolapse, herniation or bulging of the posterior (back) vaginal wall into the vagina.  The rectum is behind the back vaginal wall.

Robotic Surgery — this is an advanced technology available for surgeons to perform minimally invasive surgery in specific cases.  The da Vinci® robotic system allows much of the precision, dexterity and control of traditional open surgery but uses tiny incisions.  

Sacral Colpopexy — a procedure (abdominal, robotic or laparoscopic) in which the surgeon attaches the top of the prolapsed vagina to the sacrum using a piece of synthetic mesh.

Stress Incontinence — involuntary loss of urine at the moment of an activity that puts “stress” or pressure on the bladder such as laughing, coughing, sneezing, lifting, etc.  “Stress” does not refer to emotional stress.

Suburethral Sling — a surgery designed to correct stress urinary incontinence. A sling or hammock of material (synthetic mesh or organic material) is used to support the urethra and prevent leakage of urine with activity.

Suprapubic Catheter — a catheter (flexible hollow tube) that is placed into the bladder through the abdomen above the pubic bone. This catheter is sometimes put in place to drain the bladder after surgery.

Urethral Bulking – the injection of material into the wall of the urethra via a cystoscope (a thin rigid scope used to allow the bladder and urethra to be seen up close by the doctor).  Urethral bulking helps a urethra which is very weak to have a better seal and avoid involuntary leakage of urine.

Urethral Diverticulum —(or suburethral diverticulum) an abnormal opening along the length of the urethra which creates a bulge or a small pocket into which urine can collect and become stagnant.   Patients with this problem may have incontinence, dribble urine after voiding and/or have frequent urinary tract infections.

Urge Incontinence — an involuntary loss of urine preceded by or with a strong urge to urinate (also known as “overactive bladder”).

Urgency — a powerful desire to urinate immediately.

Urinary Incontinence —inadvertent or involuntary leakage of urine.

Urinary Retention – an inability to empty the bladder completely. This problem can result from pelvic organ prolapse, surgery in the pelvic area, and other reasons. With retention, patients may store increasingly larger volumes of urine.  In some instances, the kidneys may be damaged by a back-up of urine from the bladder.  Depending upon the situation, this is relieved by catheterization or surgery.

Urodynamics — a series of tests that use a small catheter inserted in the bladder to study the function of the bladder during filling, leakage and urinating.

Uroflowmetry — a test used to evaluate how well the bladder empties. This test involves sitting on a commode and emptying your bladder as you normally would.   A computerized device under the commode measures the amount of urine voided, rate of urine flow and the flow pattern.

Urogynecologist — a physician who, following medical school has completed a residency in Obstetrics & Gynecology or Urology and an additional extensive fellowship training in Female Pelvic Medicine and Reconstructive Surgery (FPMRS).  These subspecialists are dedicated to the care of women with pelvic floor disorders.

Uterine Prolapse — prolapse or dropping of the uterus into the vagina.  Complete prolapse is called, “procidentia.”

Vaginal dilators – a set of graduated cylindrical devices useful for patients with vaginismus (tight contraction of vaginal muscles), vaginal stricture or postop scarring and dyspareunia.

Vaginal Vault Prolapse — (vaginal eversion) a condition that may occur in women who have previously undergone hysterectomy, in which, the supports of the upper vagina have torn or weakened and allow the upper vagina to sag down the vaginal tube and eventually bulge or protrude through the vaginal opening.

Vaginal weights – (vaginal cones, vaginal weighted cones) are cone shaped plastic objects of increasing weight that can be used at home.  The heaviest weight able to be kept in the vagina is placed and held in the vagina for a short time (15-30minutes). By gripping or hugging the cones to keep them in place, women are contracting their pelvic muscles.

Voiding Cystourethrogram (VCUG) —  a test that uses x-rays and contrast material (dye that is visible on x-rays) to create an image of the bladder, ureters, and urine flow during urination.

Voiding Diary –  keeping record of frequency and amount of urination (voids), fluid intake and episodes of incontinence.  

Voiding Dysfunction — a term referring to abnormal bladder emptying.  Symptoms may include difficulty starting urination or intermittent stream flow.