A urogynecologist and reconstructive pelvic surgeon is a doctor who has special training in caring for women with pelvic floor disorders.

Dr Mohini Agrawal is a certified urogynecologist completed her two year training in Urogynaecology and Pelvic Reconstructive Surgery from AIIMS New Delhi under mentorship of Prof J B Sharma.

The pelvic floor refers to the muscles, ligaments, connective tissue and nerves that help support and control the functioning of your bladder, uterus, vagina and rectum.

Loss of support may lead to loss of bladder or bowel control, difficulty emptying your bladder or bowels and bulging of your pelvic organs. Your pelvic floor can be affected by many things, but most common causes include childbirth, repeated heavy lifting, straining for bowel movements (like chronic constipation), some chronic diseases, and surgery.

Pelvic floor disorders often interrupt everyday activities such as exercise, sleep, outdoor activities, shopping, travel, and intimate relations.

Urinary incontinence is the loss of bladder control. It is a common and often embarrassing problem, affect your quality of life.

Urinary leakage has many possible causes, but it most commonly falls into two main categories:

• Stress urinary incontinence (SUI) is the loss of urine as a result of physical activities that increase abdominal pressure. These activities include sneezing, coughing, laughing and straining when performing exercises like abdominal crunches or lifting objects. This increase in abdominal pressure leads to an increase in the pressure within the bladder, which behaves like a balloon filled with liquid. The rise in bladder pressure then forces the urethra open and urine loss occurs. Common risk factors for stress incontinence include having had a vaginal delivery, previous abdominal & pelvic surgery, radiation treatment to the pelvis, increased abdominal pressure due to respiratory conditions like chronic coughing, constipation, obesity and heavy lifting.
• Overactive bladder is urgency and frequency of urination either with or without actual urine leakage. Overactive bladder may awaken you from sleep more than once or twice a night. This condition may be due to actual spasms of the bladder muscle or increased sensitivity of the bladder. Urge incontinence is usually associated with a strong, almost overpowering sense of a need to urinate with concern that you will not be able to make it to the bathroom in time. These bladder spasms often happen when your bladder is not very full and can be triggered by hearing or feeling running water, cold air or even arriving at home and putting your key in the door. Occasionally it is caused simply by a particular amount of urine in the bladder. Overactive bladder typically leads to leakage of larger amounts of urine and is harder to control than stress incontinence.

No – that is why it is important to distinguish between the two main types of urinary leakage.

Both types can be helped if you strengthen your pelvic floor muscles by doing Kegel exercises. In addition, there are a variety of treatment options, including surgical procedures, available for each. However, if you have stress incontinence, it’s often managed by surgery, while medication is generally used for urge incontinence. Fortunately, there are now highly effective, minimally invasive procedures available to diagnose and treat these conditions appropriately.

As you age, it is quite common to experience relaxation of pelvic floor support of your bladder, vagina, uterus or rectum, especially if you have had children by vaginal delivery.

This can be normal, but if it becomes bothersome it may cause a sense of pressure or bulging in your vaginal area. Sometimes you can even feel or see a bulge outside of your vagina.

• Loss of support for your bladder, known as a cystocele may contribute to urinary leakage, difficulty in starting your urine flow or even trouble emptying your bladder.
• A rectocele occurs when your rectum presses into the space of your vagina and can cause similar symptoms of difficulty starting or completing a bowel movement.
• Uterine prolapse, or vaginal prolapse if you have had a hysterectomy, can affect your bowel or bladder function or simply cause sensations of pressure.

If you have any of these conditions, visit us and get yourself evaluated for suitable treatment.

Urogynecologists are experts in treating many different causes of loss of stool control.

Commonly, you can manage this by paying attention to your diet, bowel habits and muscle strength. Although in some cases, your loss of control may be due to actual damage of your anal sphincter muscle that occurred at the time of a vaginal delivery. If you experienced a known tear to this muscle at childbirth, you may need surgery to repair the muscle. There are conditions where we need to evaluate the functioning of anal sphincter (endoanal ultrasound) to correct the loss of bowel control.

On your visit, we will inquire to get a better sense of your pelvic complaints, how much they bother you, and how they are affecting your life and activities. We will also ask that you complete a bladder diary that keeps track of your fluid intake and urinary output. This helps us better understand how your bladder functions on a typical day and is an important part of your evaluation. Also, we will review your health history, comorbid conditions and specific concerns.

Specialized evaluation

Your physical examination will be much like a typical gynecologic exam but with a more detailed focus on the support of your bladder, uterus, vagina and rectum. We also will test your pelvic floor muscle strength and evaluate your muscle and bladder for painful sites. If your pelvic organs are falling or bulging, we may examine you both lying down and standing as our loss of support may be more obvious when you are standing. Depending on your history and physical examination findings, we may also suggest testing. As specialists in the evaluation of pelvic floor disorders, there are several tests we perform in our office that may help more fully diagnose your condition.

Treatment Options

Urogynaecologist may advise conservative (non-surgical) or surgical therapy depending on the seriousness of your condition and your general health. Conservative options include medications, pelvic exercises, behavioral and/or dietary changes and vaginal devices (also called pessaries). Surgical procedures may also be discussed to treat incontinence and prolapse.

Unfortunately there are several pain conditions that can affect the function and sensation of your bladder and pelvic floor. One of the more well known is interstitial cystitis (IC), or painful bladder syndrome (PBS).

This is a condition where your bladder is inflamed, but you do not have a urinary tract infection. IC causes you to urinate frequently due to pain within the bladder as it fills. We do not entirely understand what causes this condition, so treatment involves relieving your symptoms. Treatment often requires several different approaches including consultation with physical therapy and pain management specialists.

There are also some foods and drinks that can cause bladder discomfort. Sometimes the problem that is causing your pain is not within your bladder itself, but rather occurs outside of your bladder and affects its function. A common source of this type of pain occurs in the muscles of the pelvic floor such as the Kegel muscles. If you have muscle pain, it is best treated by a physical therapist who specializes in this type of therapy. Often the first step in obtaining relief is identifying the source of your pain so that it can be appropriately treated.