Many women, particularly after giving birth, think an overactive bladder or urinary incontinence are just part of life.

Maybe they cross their legs when they sneeze so they don’t leak urine. They might forego activities such as running. Or they avoid situations with limited bathroom access.

Likewise, they may think that vaginal prolapse, when the uterus falls down or comes out, is not worth treating or is unable to be treated, even though it is uncomfortable, limits physical activity and can cause urine leakage. 

Johns Hopkins urogynecologists Daniel David Gruber and Shannon VanderPas Lamb, based in the greater Washington area, say patients don’t have to accept these conditions.

Urogynecologists diagnose and treat conditions related to the pelvic floor, including leaky or overactive bladders, fecal incontinence, vaginal or pelvic organ prolapse, frequent or recurring urinary tract infections, and vaginal fistulas.

Nonsurgical Treatments

Even with major surgeries, patients rarely require overnight stays, says Gruber. “Advances in treatment mean that we’re sending a lot more patients home the same day.”

Close to 70% of urogynecology patients do not need surgery, says Lamb, and can be helped with physical therapy and/or medications. For the remainder, surgeries are almost always minimally invasive.

An overactive bladder can be treated with Botox and physical therapy. Stress incontinence, often caused by weak muscles around the bladder due to aging or childbirth, can be treated with a pessary, inserted through the vagina to support the urethra. Patients rarely experience pain and can go back to normal activity right away, though they are urged to refrain from sex for a month.

A new therapy for overactive bladder is a neuromodulation device that sits at the ankle instead of being implanted in the buttock, as is the traditional approach.

The newer device, which looks like an ankle bracelet, consists of a small capsule inserted behind the ankle bone, and sends an electrical stimulus through the tibial nerve to interrupt signals in the sacral nerve that affect bladder function, says Lamb. Patients can adjust the settings and replace batteries without going to a doctor, says Lamb. 

Gruber and Lamb came to Johns Hopkins from the Walter Reed National Military Medical Center. 

Lamb operates at Sibley Memorial Hospital and sees patients at the Johns Hopkins Community Physicians location in Arlington, Virginia. Gruber sees patients at Sibley and at the Johns Hopkins Health Care & Surgery Center — Bethesda.

On-site pelvic floor physical therapists also practice at Sibley and Arlington. Both doctors work closely with these therapists, who can help patients strengthen or relax their pelvic floors, sometimes before and after surgery, and sometimes help them avoid surgery altogether.

More Collaborations Means Fewer Procedures

Both Gruber and Lamb note that being part of a large academic medical center means they can collaborate with other Johns Hopkins surgeons.

“We have such good relationships with other surgeons,” says Gruber. “That’s why we can do things simultaneously. For example, if it’s an early cancer, a surgical oncologist can perform a hysterectomy and then I can do a sling procedure to help with leaking. Occasionally, we’ll even have three surgeons involved, which takes a lot of logistical coordination. But if it’s the right thing to do, we do it.”