Urogynecology

We prioritize your well-being and health at Lompoc Health – North Third Center. Our expert Urogynecologist, Dr. Eugene Kaplan, is dedicated to diagnosing and treating pelvic floor disorders. These disorders encompass conditions such as urinary and bowel incontinence, pelvic organ prolapse, and related symptoms.

The pelvic floor is a complex network of muscles, ligaments, connective tissues, and nerves that support essential organs such as the bladder, uterus, vagina, rectum, and bowels. Drawing from his rich experiences in Northern California, Philadelphia, and as a co-founder of the Women’s Continence and Pelvic Medicine Center at California Pacific Medical Center, Dr. Kaplan is experienced in managing these disorders while providing compassionate care.

Pelvic Floor Disorders Explained

Pelvic floor disorders arise from weakened pelvic muscles or connective tissue damage, leading to complications with bladder or bowel control and pelvic organ prolapse. Symptoms include frequent urination, pelvic pressure, discomfort during sex, urinary leakage, bowel incontinence, and recurrent Urinary Tract Infections (UTIs). If you’re experiencing any of these, our Urogynecologist can help.

Approximately 25% of women, ranging from young adults to seniors, experience pelvic floor disorders at some point in their life. We strive to reduce these disorders' medical, social, physical, and psychological impacts through our comprehensive, multidisciplinary treatment program.

Potential Causes of Pelvic Floor Disorders

Factors that may increase the risk of pelvic floor disorders include vaginal or C-section births, multiple births, obesity, strenuous activity or heavy lifting, aging, genetic predisposition, previous pelvic floor surgery, and chronic constipation. Pelvic floor disorders can affect women of all ages.

Understanding Urinary Incontinence

Urinary Incontinence is the involuntary loss of urine. Incontinence can be embarrassing and may interfere with life’s routines. The most common types of incontinence are Stress, Urge, and Mixed. Overflow incontinence that occurs less frequently.

If you have a trouble controlling our bladder you are not alone. Loss of bladder control is shared by millions of people worldwide. Incontinence affects people’s everyday life, reducing their physical and social activities. Many women also decrease their intimate relations due to urine loss during sexual activity. Help is available.

Stress Incontinence

This is the most common type, affecting 30 to 75 percent of incontinent women. In stress urinary incontinence (SUI), the urethra may be abnormal from either of two basic problems. First, the urethra may be poorly supported. The urethra should have strong support from ligaments, tendons, and muscles so that it remains in the proper position during exercise, coughing, and straining. These structures can be injured or weakened by childbirth, pelvic surgery, obesity, frequent prolonged straining and strenuous exercise such as weightlifting, long distance running, high impact aerobics, for example. It is frequently associated with loss of support for the other pelvic organs, particularly the bladder. There may also be prolapse of the uterus, rectum or small intestines. This condition is sometimes referred to as “dropped bladder” and the operations to correct it are often generically referred to as “bladder lifts.”

The second cause of SUI is poor urethral function, or intrinsic sphincter deficiency. (ISD) Stress incontinence can occur when the urethra is in a perfectly normal and well-supported position or in combination with lack of support. This is a common condition that may be associated with aging or previous surgeries. Patients with stress incontinence will report leakage with coughing, sneezing, laughing, and lifting heavy objects, bending over, and other physical activities such as playing tennis. The leakage tends to be drops or small amounts of urine that spurt out quickly.

Urge Incontinence

This condition is associated with abnormal, undesired and uncontrollable bladder contractions. This abnormal contraction pushes urine out through the urethra and causes leakage because urethra is unable to stay closed (the bladder should not contract until a person is at the toilet ready to urinate). In this situation the abnormality is in the bladder muscle itself and therefore it contracts inappropriately. It affects up to 33 percent of incontinent women, with the incidence increasing with advancing age. You may have stress and urge incontinence and the term is known as mixed incontinence.

Overflow Incontinence

Overflow incontinence is urine loss associated with over-distension of the bladder due to poor evacuatory function of the bladder. It may be caused by an hypoactive bladder and or by bladder outlet or urethral obstruction, frequently due bladder support.

Treatment for Incontinence

Treatment starts with an accurate diagnosis. Evaluation starts with the detailing of a meticulous medical history followed by a thorough urogynecologic/pelvic exam. Additional tests may include urine analysis, culture and urine cytology. Some patients may require urodynamic testing and/or cystoscopy to understand the problem better and offer you most appropriate treatment plan.

These may include diet changes, fluids management, behavioral modifications, pelvic floor muscles exercises and other physical therapies to help you to control urine. Certain medications and/or surgery may be beneficial for some patients depending on their specific situation. Incontinence can be controlled, and in many cases, cured.

• Diet - There is no “diet’ cure for incontinence. However, there are certain dietary irritants that may be excluded from a diet to improve symptoms significantly. If your bladder symptoms are related to dietary factors, eliminating these foods should bring significant relief in about 10 days. Try avoiding all alcoholic beverages, apples and apple juice, coffee and tea, spicy foods, carbonation, chocolate, vinegar, strawberries, grapes, plums, tomatoes and citrus fruits. Instead, seek out low acid fruits, non-citrus herbal or sun-brewed tea, KAVA or cold brew.
• Water Intake - Many people drink either too much or too little fluid. Either situation may produce urinary frequency and urgency. Drinking a lot of fluids will produce more urine, hence more frequent urinations. With insufficient fluid intake, urine is more concentrated and will produce irritation of the bladder and may encourage the growth of bacteria.
• Pelvic Physical Therapy - Physical Therapy involving strengthening pelvic floor muscles to improve bladder control is not a new concept. Female pelvic muscles are often damaged during childbirth and may lose even more strength as hormone levels decrease during menopause. When used by trained therapists, biofeedback and Kegel exercises are effective in the treatment of urge or stress incontinence.
• Medications - Medications can control bladder muscle contractions or increase tone of the urethral sphincter muscles, improving bladder function. Medications may also relieve symptoms. If infection is present, antibacterial drugs may also be used.
• Surgical Options - When non-invasive treatments don’t suffice, surgical options may be explored. Our team will recommend the most suitable procedures for alleviating Stress Urinary Incontinence or treating Pelvic Organ Prolapse depending on the specific patient’s needs.

Urogynecology Terminology

We provide the following glossary of urogynecological terms to help you better understand your condition and treatment options.

• Anterior Colporrhaphy – an operation involving placating (folding) and suturing of the anterior wall of the vagina. This surgical technique can provide support to the anterior wall of the vagina and the bladder. This is also known as an anterior repair.
• Bladder Retraining – Behavioral techniques used in order to gain control of urination.
• Cystoscopy – a diagnostic procedure using a small tube which works like a telescope. It allows the doctor to look inside of your urethra and bladder for any structural abnormalities.
• Functional incontinence – incontinence due to a person’s inability to gain access to a toilet. This can be due to mental or physical impairment. Incontinence – the involuntary/uncontrolled loss or leakage of urine or stool.
• Manometry - a diagnostic test to obtain pressure measurements. Anal Manometry evaluates the function of the rectum and anal sphincter.
• Overflow urinary incontinence – urine leakage from the bladder because the bladder does not empty properly or completely due to overfill of the bladder. Associated symptoms include frequent voiding, dribbling, or hesitancy in the initiation or flow of urine.
• Pelvic Floor Muscles – muscles located between the back, front and sides of the pelvic bones. These muscles support the pelvic organs. They are involved in the control of urination and bowel elimination, as well as the sexual response.
• Pelvic Floor Muscle Exercises – the repetitive contraction and relaxation of the pelvic floor muscles. These exercises have been shown to improve the supportive function of the muscles, as well as control in urination and bowel elimination.
• Sphincteroplasty – A surgical technique designed to restore integrity and function to a circular muscle or sphincter, such as the anal sphincter.
• Prolapse – the displacement of an organ from its normal position.
• Stress Incontinence – the involuntary/uncontrolled loss of urine during activities that increase abdominal pressure, such as lifting, coughing or sneezing.
• Urethra – a structure in the pelvis located above the vaginal opening in the female. It is a tube-like structure that extends from the bladder. It functions to carry urine to the outside of the body. The outer opening of the urethra is surrounded by circular muscle called a sphincter.
• Urethrolysis – a surgical procedure to “loosen” a prior suspension of the urethra.
• Urge Incontinence – incontinence that occurs when urine leaks after a person is aware of the need to urinate, but they are unable to control the loss of urine before they reach the toilet. It is sometimes called an overactive bladder. Uterine Prolapse – the “falling” or the displacement of the uterus from its normal position and sometimes beyond vaginal introitus. Uterus – a muscular organ located in the female pelvic cavity. It is the place where an embryo and fetus develops, also known as the womb.
• Vagina – a canal of smooth muscle in the female pelvic floor that is normally located between the bladder and rectum. The outer opening of the vagina is located between the urethra and anus and called introitus. Vagina functions as the birth canal. It is a smooth muscle canal for sexual intercourse as well.
• Vaginal Vault Suspension – a surgical procedure to provide support for the apex/vault of the vagina to various pelvic structures.
• Void – to urinate or expel urine from the bladder. "