Pelvic Floor Dysfunction

Pelvic floor dysfunction affects millions of women and men of all ages, often compromising their quality of life. At UT Southwestern Medical Center, our multidisciplinary team offers a full range of state-of-the-art diagnostic techniques, as well as nonsurgical, surgical, and robotic treatment options, for pelvic floor dysfunction.

We also have comprehensive rehabilitation programs to treat pelvic-related conditions in a thorough and patient-centered manner.

Restoring Quality of Life Through Effective Treatment

Chronic pelvic pain and its associated symptoms can be truly disabling. Urinary incontinence, chronic constipation, tailbone pain, pain with intercourse, and other types of pelvic dysfunction can severely limit people’s ability to live life the way they want.

It’s possible to significantly minimize symptoms and restore quality of life with proper treatment of pelvic musculoskeletal dysfunction, even if pelvic problems are caused by a disease such as endometriosis or nonbacterial prostatitis.

Our team of specialists takes a multidisciplinary approach to diagnosing and treating pelvic floor dysfunction, working together closely to facilitate care and provide the best possible outcomes.

Among our specialists are nationally recognized experts in the fields of:

• Colorectal surgery
• Female Pelvic Medicine and Reconstructive Surgery
• Gastroenterology
• Obstetrics and gynecology
• Physical medicine and rehabilitation
• Physical therapy
• Psychiatry
• Radiology
• Urogynecology
• Urology

Our collaboration with subspecialists from other fields ensures that patients have some of the best medical minds working for them, from diagnosis through every step of treatment.

Diagnosing Pelvic Floor Dysfunction

Patient care for pelvic floor dysfunction begins with a comprehensive diagnostic evaluation that includes a history, a physical examination, and a thorough discussion of symptoms.

Our physicians might do a postural and structural assessment, a neurological evaluation, and musculoskeletal and neuromuscular examinations. We also offer electrodiagnostic and radiologic evaluations, if necessary, to confirm the diagnosis.

Treatments for Pelvic Floor Dysfunction

We offer nonsurgical, surgical, and robotic treatment options, so patients have access to a broad range of leading-edge care. Among the pelvic floor treatments we offer are:

Nonsurgical Options

• Pelvic floor biofeedback: Muscle retraining to help patients learn to strengthen or relax pelvic floor muscles
• Pelvic floor therapy: Manual therapy to help strengthen or modify the pelvic floor
• Botox bladder injections: A muscle relaxant that can be helpful for urinary incontinence
• Urethral bulking agents: Injections that can help treat urinary incontinence in women
• Pelvic floor electrical stimulation: Electrical stimulations to rehabilitate weak pelvic floor muscles
• Percutaneous tibial nerve stimulation: Minimally invasive form of neuromodulation used to treat overactive bladder
• Bladder instillation: A combination drug therapy to help painful bladder or cystitis symptoms
• Pessary fitting and maintenance: A removable device that can support areas of pelvic organ prolapse
• Pelvic floor trigger point injections: Medication injections into trigger points that help treat chronic pelvic pain syndrome
• Counseling
• Medications
• Physical therapy

Surgical Options

• Vaginal, abdominal, laparoscopic, and robotic repair of pelvic structures
• Periurethral and injectable agents
• Abdominal sacrocolpopexy: A surgery to correct the supporting muscles, ligaments, and tissues of the vagina
• Uterosacral ligament suspension: An operation that restores support to the uterus or vagina
• Sacrospinous fixation: An additional operation that restores support to the uterus or vagina
• DaVinci robot-assisted prolapse procedures: A minimally invasive way to surgically treat prolapse
• Midurethral sling: Provides support under the urethra to prevent it from dropping during physical activity
• Burch urothropexy: A surgical procedure in which support is provided to the urethra
• Pubovaginal sling: A procedure used to manage urinary incontinence
• Anterior and/or posterior repairs: Including repairs to both the vagina and the bladder
• Fistula repairs: Repairs to vaginal fistulas
• Congenital anomaly repairs: Including repairs to many congenital pelvic floor anomalies
• Ureteral stents: A thin tube inserted into the ureter to help obstruction of urine flow
• Mesh removal: Removal of vaginal mesh that was previously placed to treat pelvic organ prolapse or urinary incontinence
• Sacral neuromodulation: An implanted neurostimulator electrically stimulates the sacral nerve to help treat urinary and fecal incontinence

Pregnancy and Postpartum Pelvic Issues

Pregnant women who suffer severe low back or pelvic pain can have trouble working, sleeping, and taking care of their families. Also, after giving birth there can be a host of new physical problems, such as urinary incontinence, pain with sexual intercourse, pelvic muscle injuries, and nerve injuries.

Our Peripartum Evaluation and Treatment Around Labor and Delivery (PETAL) program is dedicated to helping women achieve and maintain pelvic wellness during pregnancy and after delivery.

Proper treatment can alleviate these conditions and help patients enjoy their pregnancy and life with their new babies.

Pregnancy and postpartum conditions we treat include:

Clinical Trials

Research being performed at UT Southwestern shows promising treatments might reduce the recurrence of pelvic floor dysfunction symptoms. In addition, an ongoing clinical trial led by UT Southwestern’s David Rahn, M.D., is examining the effectiveness of vaginal estrogen – a supplemental, nonsurgical therapy – to reduce symptom recurrence and spare more women the risks and financial implications of revisional surgeries. We’re also studying how vaginal estrogen may impact other pelvic floor dysfunction such as overactive bladder, urinary incontinence, sexual dysfunction and painful intercourse, and postoperative bladder infections.