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The Center for Female Pelvic Medicine and Reconstructive Surgery (FPMRS) at Loma Linda University Health is at the forefront of the new and growing field of female pelvic reconstructive medicine. Offering the Inland Empire's only female pelvic medicine and reconstruction surgery center and the only center in the southwestern states to provide our wide range of diagnostic and medical services under one roof, our center utilizes the latest advances in technology to provide diagnosis, minimally invasive and robotic-assisted surgical treatments to patients.
Non-surgical treatments help our patients combat urogynecological dysfunction without the invasive and physically draining aspects of surgery.
Pelvic floor problems such as urinary incontinence, interstitial cystitis and pelvic pain can be treated in a variety of ways including injected medication, Botox or collagen. Our doctors regularly diagnose, treat and consult women struggling with pelvic floor conditions and tailor treatments to best suit each patient.
Bladder Botox injections are used to treat patients struggling with overactive bladders or interstitial cystitis. The Botox injection effectively paralyzes the overactive nerves that were repeatedly signaling the bladder. This outpatient treatment is not permanent and each injection usually lasts three to six months. Bladder Botox injections are typically offered to patients who do not respond to medicinal treatments.
Medication Injections or Instillations
For patients suffering from pelvic pain, there are several medication cocktails that have proven successful in patients. Depending on the cause of the pelvic pain, a physician will inject different sets of medications into the afflicted area. While these injections do not work for all patients, they are a less invasive treatment option than surgery.
For women suffering from stress urinary incontinence but who also have normal anatomic support of the bladder, collagen injections can be a valuable treatment option. Treating urethral dysfunction, the collagen injections narrow the urethral opening and reduce urine leakage. This minimally invasive treatment is not permanent and usually lasts six months to several years.
Pelvic Muscle Rehabilitation
Pelvic muscle rehabilitation combines physical therapy with biofeedback therapy and electrical stimulation to help patients retrain their pelvic floor muscles. These treatments help the patient take an active role in the healing process and work to prevent urinary incontinence and other troublesome pelvic floor conditions.
Patients suffering from the following conditions may benefit from pelvic muscle rehabilitation:
- Urinary incontinence
- Urinary retention
- Painful urination
- Painful sexual intercourse
- Interstitial cystitis
Pelvic floor biofeedback therapy is a treatment that is designed to help patients learn to strengthen and relax their pelvic muscles. During biofeedback therapy, computer sensors accurately measure and indicate pelvic floor muscle activity, teaching patients how to control the right muscles to prevent urinary incontinence or pelvic pain.
Pelvic floor muscle electrical stimulation works to help increase a patient's awareness of pelvic floor muscle contractions. In this procedure, an electrical current stimulates the pelvic muscles and causes them to contract. Combined with pelvic floor muscle exercises (Kegels) and biofeedback therapy, electrical stimulation can be very beneficial for patients who are unable to contract these muscles on demand.
A small device that is placed in the vagina to support the uterus, bladder and/or rectum in cases of prolapse symptoms. These devices come in different shapes and sizes.
Hormone replacement therapy to help with the thinning of the vaginal walls. This treatment may assist with incontinence and pain.
Percutaneous Nerve Stimulation
Performed at the physician’s office, can be used to assist with urge incontinence.
Medications (oral, topical, and/or vaginal/rectal suppositories)
It can be beneficial to combine medications with pelvic floor physical therapy to retrain the bladder and pelvic floor muscle coordination.
Medications (oral, topical, and/or suppositories)
These can be prescribed to treat pelvic pain and are often very beneficial when combined with pelvic floor physical therapy.
Minimally Invasive Surgery
We offer minimally invasive treatment options that allow a rapid return to normal activities.
We offer cutting-edge treatment to repair damage caused by pregnancies, aging, aggressive cancer treatment or previous surgery. This intensely specialized procedure requires a multidisciplinary approach with surgeons utilizing years of experience in a combination of urological, gynecological and colorectal training.
For most women, there are significant benefits of minimally invasive surgery, including:
- Significantly less pain
- Less blood loss and need for transfusions
- Less risk of infection
- Less scarring
- Shorter hospital stay
- Shorter recovery time
- Quicker return to normal activities
When a patient experiences urinary incontinence or leaking, our team works to diagnose and treat the problem via the most sophisticated means possible. While some patients may regain urinary control through the regular use of Kegel exercises, lifestyle changes or small vaginal inserts, surgery may be required in the more serious cases.
The mini sling forms a hammock of support under the urethra that mimics the normal position of the ligament that would typically provide the required support to help prevent urinary leakage when stress is placed on the pelvic region during coughing, laughing, sneezing, exercising, etc. When this ligament is damaged or stretched out due to childbirth, aging or chronic straining, stress urinary leakage may occur. The position of the mini-sling reproduces the natural position of this ligament and in a sense replaces the damaged ligament with a permanent mesh tape that provides the support needed to prevent leakage
The surgery to insert the mini sling is typically performed through a small incision in the vagina and requires only a local anesthetic. In this procedure, risks and complications are rare and patients are usually able to return to normal activities very quickly. This procedure requires less than 15 minutes operative time and is performed on an outpatient basis.
Cosmetic Pelvic Surgery
We have specially trained surgeons who are experts in the multidisciplinary field of urogynecology who treat women suffering from a variety of urogynecological conditions.
Conditions requiring cosmetic pelvic surgery:
- Labial hypertrophy, in which the labia minora are extremely large and cause irritation and rubbing on clothing, sweating, rash, rawness, pain during sexual intercourse, or psychological discomfort.
- Extreme laxity of the vaginal opening due to multiple vaginal births (6 or more). Surgery to reverse this laxity requires only a one-night stay in the hospital.
- Distortion of external genitalia from previous trauma such as childbirth, surgery or cultural practice or ritual.
Providing the highest standards in patient care and education, our team diagnoses, consults and treats patients in our state-of-the-art facility. We work to ensure that every woman who walks through our doors feels comfortable and confident in our years of experience as the area's leader in pelvic medicine.
Pelvic reconstruction is a major surgery offered for patients who are experiencing urogynecological dysfunction due to previous surgery. Our patients are often cancer survivors or have undergone other major surgeries in the pelvic region.
Pelvic reconstruction may be required in patients who have undergone other surgeries and are experiencing some or all of the following symptoms:
- Urinary incontinence
- Pelvic pain
- Prolapsed pelvic organs
- Bowel incontinence
- Discomfort during sexual intercourse
Our pelvic reconstruction specialists are experts in their multidisciplinary field, utilizing expertise in gynecology, urology and colorectal treatments, resulting in an unprecedented level of skill in managing and healing urogynecologic disorders. When full pelvic reconstruction is required, our team works to ensure that the patient receives compassionate and comprehensive care.
Sacral Nerve Modulation
Depending on a patient's cause of urinary incontinence or other urogynecologic conditions, sacral nerve modulation may provide relief.
Helping the Nervous System
Sacral nerve modulation, also known as sacral neuromodulation or sacral nerve stimulation, helps redirect wrong or misdirected messages sent along neural pathways. These sacral nerves control the muscles in the pelvic area, including the pelvic floor, bladder, urethral sphincters and anal sphincters. When these nerves are misfiring, incorrect information is sent to the brain, often causing urinary or bowel incontinence or pain during urination.
Sacral nerve modulation is conducted through an implanted device with a neurostimulator that works much like a cardiac pacemaker. The device is inserted in a pocket in the patient's lower abdomen or buttock, first during a testing phase, and if successful, it is permanently implanted.
Our team uses the latest technological advances to provide accurate and precise diagnosis for our patients.
Complex urodynamics testing allows a physician to properly diagnose the cause or causes of urinary incontinence. This series of tests look at how well a patient's bladder, urethra and sphincters (the muscles that control voiding) work.
The complex urodynamics study is a series of tests that may include:
- Multi-channel cystometrogram (CMG)
- Urethral pressure profile (UPP)
- Pressure flow study
- Uroflowmetry (VFR)
- Post-void residual volume study
The Study Process
During a complex urodynamics study, the physician will be looking at bladder pressure, urethra pressure, urinary flow and bladder capacity. When the bladder is working normally, it relies on neural reflexes to keep the sphincter muscles closed when filling and to relax them when it is time to urinate. The complex urodynamics tests look at each step in the urinary process to determine the cause of incontinence.
MRI, or magnetic resonance imaging, is a non-invasive medical technique used to visualize the internal structures and functions of the body. When a patient is experiencing bowel incontinence, a MRI may be required to obtain a picture of the anal sphincter and determine the amount and location of damage.
We utilize the imaging power of the MRI to properly diagnose bowel incontinence and to recommend the appropriate healing treatments. Bowel incontinence is not a natural part of aging and many forms of treatment are available.
The MRI Procedure
A MRI machine uses powerful magnets and radio waves to take internal pictures of the body. During an MRI, a patient wears a hospital gown or other clothing without metal, and lies on a table. This table is slid into the MRI machine and the patient lies within the tube in the center of the machine. Depending on the number of images needed, an MRI can take up to an hour and patients who experience claustrophobia (fear of confined spaces) should notify their doctors and will be given a mild sedative.
Urethrocystoscopy, also known as cystoscopy, is a procedure that is used to diagnose the causes of several different urogynecologic afflictions. This study allows a doctor to visually examine the interior of the urethra and the bladder, checking for structural abnormalities, inflammations or masses that might not show up in an x-ray.
The urethrocystoscopy study may be advised for patients experiencing:
- Urinary incontinence
- Pelvic pain
- Recurrent urinary tract infections
- Painful urination
- Blood in their urine or hematuria
In a urethrocystoscopy, a patient is given a light anesthetic cream or gel. Then, a cystoscope, a small, specialized tube with a camera at the end, is inserted through the urethra into the bladder. The doctor then fills the bladder with water through the cystoscope. This stretches the bladder wall and makes inspection possible.
The pelvic muscles and surrounding nerves control many aspects of urinary and bowel function. When a woman experiences urinary incontinence, bowel incontinence, pelvic pain or other problems in the pelvic region, our specialists can diagnose the underlying condition through a series of testing procedures.
Anal manometry, EMG and pudendal nerve motor latency are types of electrophysiology studies used to determine the cause of bowel incontinence or constipation. Bowel incontinence can be caused by the weakening of the anal sphincters, the pelvic floor muscles or by other urogynecologic conditions.
Anal Manometry Procedure
During this study, a soft balloon is placed in the rectum. In order to measure the sensitivity of the rectum and anus, the balloon is slowly inflated with fluid. This also tests the proper function of the rectal reflexes. To measure the pressure in the various parts of the rectum and anal canal, a catheter is slowly pulled through the anus. The patient is asked to squeeze, relax and possibly to try and expel the balloon.
EMG Procedure (Electromyography)
During the EMG, a small electrode is placed in the anal canal to record sphincter and pelvic floor muscle activity. The patient is asked to relax, squeeze and push at different times and the muscle activity is recorded and displayed on a computer screen. This study tests for proper muscle contractions in the anus.
Pudendal Nerve Motor Latency Procedure
The pudendal nerve motor latency test determines whether or not the patient's pudendal nerve is functioning properly. The pudendal nerve is located in the pelvis and, when malfunctioning, may cause urinary or bowel incontinence. During the procedure, an electrode pad is placed on the patient's buttock or thigh. The physician administering the procedure wears a rubber glove with an electrode on the finger. This is inserted into the patient's rectum and a mild electrical stimulus is sent through the electrode on the finger to the pudendal nerve. A computer records the nerve's response and the test results will show if there are any problems in the nerve's communication system.