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Category: Incontinence

May 9, 2017

postoperative careThe physicians at Cherokee Women’s Health Specialists are committed to ensuring that your experience after surgery is as comfortable as possible. The following information will help answer frequently asked questions and will help you understand some of the common experiences that may occur after your surgery. Please do not hesitate to call the office with any additional questions about your recovery.

  • Call the office to schedule a post-operative appointment two to four weeks after your surgery.
  • If an ER visit is necessary post-operatively, go to Northside Hospital Cherokee if possible, but if you are an out of town patient or live in another state, then your closest hospital is appropriate.

Call the office at 770-720-7733 right away if you experience:

  • Fever higher than 100.4 degrees
  • Shortness of breath
  • Dizziness
  • Heavy vaginal bleeding
  • Severe pain not relieved with your pain medication
  • Persistent nausea or vomiting
  • Increased pain, redness, or swelling at the incision


How Much Activity Can I Do After Surgery?

General – There are no standard limitations with regards to activity after gynecological surgery except for driving and sexual activity (see below). If you stayed in the hospital overnight, you should plan to rest with minimal activity for at least a week. If you were sent home the same day you should plan to rest with minimal activity for three days. If you had a procedure with no incisions (such as a D and C or endometrial ablation) then you probably only need to rest for a day. Use common sense and listen to your body. Every patient is different, and different patients will have differing degrees of recovery. Gradually advance your activity. If the activity you are doing increases your discomfort, then STOP. If you are feeling well during increased activity but have increased pain the next day you need to decrease your activity.

Adequate rest and nutrition is required to heal from surgery. LISTEN TO YOUR BODY.

Stairs – Apprehension about stairs or weakness in mobility may require help when climbing up and down stairs. You are allowed to use the stairs if you feel you are able. It’s a good idea to put both feet on each step to not lessen the strain on your body for a week or longer after surgery.

Exercise – If you had incisions on your body wait until you get clearance from your surgeon. Use common sense when starting an exercise routine after surgery. Start out slowly and gradually increase time, distance and speed. Once you are cleared to exercise a general recommendation is to start out at 25% of what you were doing before surgery for a week or two and increase by 25% at each one or two week interval.

Driving – Driving should only begin only after you have stopped taking narcotics, and if you feel strong enough to be able to stop the vehicle in an emergency. At this point you should be able to walk up and down stairs comfortably and sit down and stand up without experiencing discomfort. Have someone drive you if you are still experiencing discomfort.

What Should I Eat After Surgery?

After surgery, your body needs enough calories and nutrients to fully recover from the procedure. Eating the right foods after surgery can decrease risk of infection, speed healing of the incision and increase strength and energy. The best post-surgery foods to eat are packed full of vitamins and minerals.

Here are some foods and nutrients you should focus on in your post-surgery diet:

Fiber – A common complaint after surgery is constipation. To avoid this uncomfortable post-surgery complication, eat plenty of fiber. Some high-fiber foods include fresh fruit and vegetables. Whole grain breads and oatmeal are other great sources of fiber. To prevent constipation, avoid foods like dried or dehydrated foods, processed foods, cheese and dairy products, red meats and sweets.

Protein – The amino acids in protein help with wound healing and tissue regeneration. Protein can also help with strength and energy following surgery. Lean meats such as chicken, turkey, pork and seafood are excellent sources of protein. You can also get protein from eggs, nuts, beans and tofu. Dairy also contains protein, but if you’re struggling with constipation, go for the other sources of protein instead of dairy options. If you have trouble getting enough protein in your diet after surgery, try adding protein powder to drinks or smoothies. Several Physicians at Cherokee Women’s recommend a Vegan diet which is absence of animal products including meat, dairy and eggs. Eat to Live by Joel Furman MD gives excellent recipes and recommendations for those inclined.

Carbohydrates – Fatigue is common following any surgical procedure, but eating the right kinds of carbs can help restore your energy levels. Get carbs from high-fiber foods like whole grains, fruits and veggies, and beans and legumes. These foods will boost energy levels without causing constipation.

Fat – Healthy fats from olive oil, avocados, coconut oil, nuts and seeds will improve immune response and aid the body’s absorption of vitamins. Fat will also help increase energy levels after surgery.

Vitamins and Minerals – Perhaps the most important nutrients in your post-surgery diet are vitamins and minerals. Vitamin A (found in orange and dark green veggies like carrots, sweet potatoes, kale and spinach) and vitamin C (found in citrus fruits, berries, potatoes, tomatoes, melons, and sweet bell peppers) help with wound healing. Vitamin D (found in milk, fish, eggs, and fortified cereals) promotes bone health. Vitamin E (found in vegetable oils, nuts, beef liver, milk and eggs) protects the body from free radicals. Vitamin K (found in green leafy veggies, fish, liver and vegetable oils) is necessary for blood clotting.

Zinc – (found in meat, seafood, dairy and beans) and Iron (found in meat and poultry, beans, apricots, eggs, whole grains and iron-fortified cereals) are also helpful for wound healing and energy following surgery.

Water – In addition to eating foods that are rich in fiber, protein, healthy fats, carbohydrates, vitamins and minerals, you must stay hydrated after surgery. Proper hydration isn’t only necessary for healing, but may also be necessary to help your body absorb medications following surgery. Be sure to drink at least eight glasses of water every day after surgery to stay hydrated.

The foods you should and shouldn’t eat can vary depending on the type of surgery and any medications you may be on so speak with your surgeon about your specific post-surgery dietary questions.

When Can I Take a Shower?

You may take a shower the day after surgery. Baths are typically fine the day after surgery if you desire. Make sure you have someone around to help you should you need assistance. If you are experiencing discomfort a sponge bath is a fine substitute.

How Should I Care For My Incisions?

Keep your abdominal incisions clean and dry. No special creams or ointments are needed. Your incisions are closed with a suture underneath your skin, which will dissolve on its own. It is then covered with a surgical-grade liquid band-aid. This protects the incision and will stay in place for up to two weeks or longer. The glue can be removed after two weeks by applying some Vaseline to the glue for several minutes and then using soap and water and gentle scrubbing with a washcloth after two weeks. A small amount of bleeding at the incision sites is not uncommon. If it persists, call your doctor. Once the glue is removed it is OK to apply Neosporin to the incisions if they are red or inflamed. If you notice sutures poking through the skin you can trim them with nail clippers and/or see your surgeon.

How Long Will I Have Bleeding After Surgery?

Vaginal spotting may last for several weeks after gynecological surgery. Call the office if you have heavy bleeding, increasing bleeding, a foul odor, or if you have urinary or rectal bleeding. Removal of ovarian cysts or other gynecological procedures may cause your period to come within a few days after surgery.

I Have Large Bruise Near My Incision, Is That Normal?

Some patients will develop bruises at the incision sites. The incision sites are made by “trocars”, a plastic sleeve that is used for access during the surgery for the camera and for instruments. Sometimes these trocars cut tiny vessels just beneath the skin that cause limited bleeding. Even under the best of circumstances, it is sometimes impossible to see these small vessels. A bruise will develop that will resolve. Those patients with very large masses or fibroids may also develop bleeding at the incisions that can be more extensive due to longer manipulation of the trocar sites. Rarely, this bleeding can be very extensive, leading to a large bruise that tracts to the groin area. Please note that this type of bleeding almost always resolves. Pain or warmth may develop from the blood under the skin. Use Motrin 600 mg every six hours or 800 mg every eight hours to relieve the pain.

How Much Pain Will I Have After Surgery?

Incision – Pain around the incision sites is not uncommon, and will resolve over several days. Most patients describe pain as minimal or moderate, and will improve daily.

Pelvic and Rectal – Some patients describe pressure and pain with urination or with bowel movements. These symptoms resolve and are due to irritation to the rectum and bladder from the surgical procedure, and will resolve with time.

Chest and Shoulder – If you had laparoscopic surgery, the carbon dioxide gas used to insufflate the abdomen during the procedure (so the surgeon can see) will irritate the phrenic nerve in some patients, leading to mild to severe pain. This nerve tracks pain impulses from the lining of the chest cavity. The pain can occur during deep breaths. This resolves within two to three days, and is not worrisome. If the pain is extreme or does not resolve, a visit to the local ER is important to rule out other causes of chest pain, such as heart or lung issues.

Sore Throat – Some patients will have a sore throat from the tube that is placed during anesthesia. Throat lozenges or warm tea will help soothe the discomfort, and this will resolve within a few days.

General – Pain should resolve over time, and will get better every day. If pain persists or becomes worse, a visit to the ER at the hospital where the procedure was performed is recommended.

How Should I Manage My Pain After Surgery?

You will be given a prescription for Motrin and a narcotic (Percocet, Norco or Dilaudid) at the hospital prior to your discharge. To be effective, Motrin should be used in doses of 600 mg every six hours, or 800 mg every eight hours. Narcotics should be used sparingly since they will cause constipation. The first several days following surgery, most patients use mainly Motrin during the day, with use of a narcotic sometimes at night to help with sleep. Using a heating pad on the lower abdomen is safe. Coughing can be uncomfortable initially because of abdominal discomfort. Placing a pillow on the abdomen to support your abdomen while coughing can be helpful.

Is It Normal to Have Swelling?

Abdominal – Some degree of abdominal distension (swelling) is to be expected after surgery. This is due to distension of the intestines, and resolves over time. It is usually mild to moderate only.

Extremities – Swelling of the legs and sometimes arms is not uncommon after surgery. This is due to increased fluid given during the procedure. This will resolve over several days. If you notice persistent or increasing swelling, tenderness to the calf or calf pain, please call the office immediately. If one leg is more swollen and red than the other you should be evaluated by your surgeon or in the emergency room because of the risk of a blood clot in your leg (DVT) that can be life threatening.

I Have Constipation, What Should I Do?

Constipation is common after surgery and usually resolves with time and/or treatment. Constipation means that you do not have a bowel movement regularly or that stools are hard or difficult to pass. Constipation can be made worse by narcotic pain medications or decreased activity or decreased fluid intake.

If you are having vomiting in addition to constipation, or if your surgery involved the stomach or intestines, call your surgeon before using medications to treat constipation.

A common approach to constipation after surgery is to take a laxative (eg, magnesium hydroxide [milk of magnesia]) or fiber supplement (eg, psyllium [Metamucil, Hydrocil] or methylcellulose [Citrucel]); this can be taken with a stool softener (eg, docusate [Colace]).

If the initial treatment does not produce a bowel movement within 24 to 48 hours, the next step is to take a stimulant laxative that contains senna (e.g,, Black Draught, Ex-lax, Fletcher’s Castoria, Senokot) or bisacodyl (e.g,, Correctol, Doxidan, Dulcolax). Read the directions and precautions on the package before using these treatments.

If these treatments do not produce a bowel movement within 24 hours, you should call your healthcare provider for further advice.

Once the bowels begin to move, you may want to continue using a stool softener (e.g., docusate (Colace) or a non-stimulant laxative (e.g., MiraLAX/GlycoLax) on a daily basis to keep the stools soft. This treatment may be taken for as long as needed.

I Have Diarrhea, What Should I Do?

Diarrhea sometimes is caused by antibiotics and will resolve once the antibiotics are stopped. A probiotic such as lactobacillus can help with this process. Rarely, severe diarrhea can develop. Call your doctor if you have severe diarrhea, bloody diarrhea, or if your diarrhea is accompanied by fever or worsening pain.

I’m Nauseated, What Can I Do?

Anesthesia is the main cause for nausea immediately after surgery. After the first 24 hours, nausea is more likely caused by either your narcotic pain medication or your antibiotics. You will be sent home with nausea medication such as Phenergan or Zofran. If you are experiencing severe nausea, please call your doctor.

Will I Have Problems With My Bladder?

Is it normal if it hurts when I urinate? — If you have had vaginal surgery, you may feel a pulling sensation during urination or you may feel sore if the urine falls on vaginal stitches. It can be normal to urinate frequently after surgery. Call your surgeon if you have any of the following:

  • Burning with urination
  • Needing to urinate frequently or urgently and then urinating only a few drops
  • Temperature greater than 101ºF or 38ºC (measure with a thermometer)
  • Pain on one side of your upper back that continues for more than one hour or keeps coming back
  • Blood in your urine (you can check to see if this is just vaginal blood falling into the toilet by holding toilet tissue over your vagina)

What Should I Do if it is Difficult to Urinate?

Most women urinate at least every four to six hours, and sometimes more frequently. If you have not urinated for six or more hours (while you are awake) or if you feel the need to urinate and it will not come out, you should call your healthcare provider. Urinary retention is the inability to pass urine through the bladder.

A very small number of patients will develop this problem due to the anesthetic used for the surgery or if they had incontinence surgery. If you are sent home and are not able to pass urine, please go to a local emergency room. A catheter may be placed to allow the bladder to “rest” after the surgery, and will be removed several days later in the office. It is important to have this catheter placed to avoid injury to the bladder. If you have a self cath kit and instructions how to use it, you may do this instead of seeking medical care. (You can look at a video by Bard on Youtube called “Female Self-Cath Instructional video (animated) Magic3” or watch other available videos on cherokeewomenshealth.com or on YouTube.)

When Can I Resume Sex?

Intercourse should be avoided until cleared by your surgeon. If your surgery did not involve the vagina or cervix, intercourse can typically resume in two to three weeks. If you had a hysterectomy or surgery in the vagina, you should avoid intercourse for a minimum of eight weeks to allow the top of the vagina to fully heal. Make sure you are examined by your surgeon and cleared. Avoid deep penetration initially until you are completely comfortable. Clitoral orgasm (stimulating the clitoris without vaginal penetration) is typically fine after gynecological surgery if you desire unless you had surgery on your labia minora or majora (in which case you need to get clearance from your surgeon.)

January 3, 2017

Since you were a teenager, or maybe even younger, you were probably aware that gynecologists existed. You knew that, as you matured, they were there for your basic women’s health issues, annual checkups, Pap smears and other feminine physical needs. It probably wasn’t until you began experiencing problems that you learned about different specialists and subspecialists. Polysyllabic words like ‘Female Pelvic Medicine Reconstructive Surgeon’ (FPMRS), ‘Urogynecologist’ and ‘Urodynamic testing’ may have begun to litter your doctor’s vocabulary, and though they may sound daunting, they’re very simply explained.

From the time you were potty trained, the exercise of urinating was something you did automatically. Your body told you when it was time to go and, depending on the intensity of the message your bladder was sending you, you either strolled, trotted, or ran to the bathroom to take care of business.

However, as you age, you may have noticed some changes – unexpected involuntary leaks when you laugh or cough, sudden urges that leave you very little time to make it to the toilet, recurring infections, discomfort and maybe even the need to rush right back into the bathroom.

When your quality of life becomes compromised, our experts are here to step in. Our FPMRS accredited specialists are intensely educated Urogynecologists and experts in the field of women’s pelvic health issues. One of the many things we do is recommend and administer urodynamic testing to study, and subsequently, correct your urinary problems or disorders.

What is Urodynamic Testing?

Urodynamic testing is a series of tests that are run in order to evaluate exactly how well the bladder, sphincter and urethra are functioning in their job of storing and emptying the urine in your body. These tests can accurately pinpoint the reason for your particular problem.

incontinent woman photoWhy Might You Need Urodynamic Testing?

You may need one or several different urodynamic tests if a routine pelvic examination does not reveal a visible reason for your problem. Your doctor may then recommend further testing if you have experienced any of the following:

  • A pressing need to urinate without any flow
  • Difficulty in starting urine flow
  • Difficulty emptying your bladder completely
  • Recurring urinary tract infections
  • Burning or painful urination
  • Unexpected and sudden urge to urinate
  • Slow urine flow
  • A need to urinate immediately after voiding
  • Frequent urination (polyuria): You suddenly need to void more often than is normal for you, or find that you need to use the bathroom two times or more nightly (nocturia).
  • Urge incontinence or overactive bladder (OAB): This is an uncontrollable leakage resulting from the inability to reach a restroom in time.
  • Stress incontinence: You experience bladder leakage while lifting, exercising, laughing, coughing or sneezing.

How Can You Prepare For These Tests?

You will probably be asked to stop any bladder medications you are currently taking. Some tests may require that you arrive with a full bladder, while in other cases, you will be asked to arrive earlier and drinks at the testing site. Your doctor will give you this information. Complete testing should take approximately 2 to 3 hours, but again, this depends entirely on what tests are required for your particular issue.

What Will Happen During the Test?

The first part of urodynamic testing deals with emptying your full bladder, checking for any residual urine, and monitoring your urine flow.

The second part examines how your bladder behaves as it fills up. Catheters are used for this and may cause some discomfort or pinching, but the experience is not intolerable.

Leakage is common and expected, so there is absolutely no need to be embarrassed by this. It is an important part of the testing. Your input as you answer questions throughout the process is also important. You will be asked to shift positions, stand and cough. Again, your body’s reaction is important to your diagnosis and subsequent treatment.

When testing is complete, you will be required to void again while the catheters are still attached, after which they will be removed and the testing will be complete.

What Tests are Performed During Urodynamic Testing?

There are several tests. Depending on your particular case, you may need one or more of the following:

  • Video urodynamic test: While your bladder is filling and emptying, a technician will take pictures of the process, either through X-rays or via ultrasound. These are then studied, enabling your physician to make a diagnosis of your bladder function.
  • Uroflowmetry: This test measure both how quickly you empty your bladder (free uroflowmetry) and the amount of pressure exerted (pressure uroflowmetry) while doing so. The purpose is to assess why there may be a problem voiding, and to check for any possible blockages or muscle weakness.
  • Postvoid residual measurement: This measures any urine that is left in the bladder after you’ve finished urinating. Measurement can be obtained through either catheter tube drainage directly from the bladder or through an ultrasound scan. Depending on how much urine is extracted or scanned, anything over 100 milliliters may indicate inefficient bladder evacuation.
  • Multichannel Cystometry: Under local anesthesia, two pressure catheters are placed in the rectum and the bladder to gauge bladder capacity, and to determine the amount of pressure buildup as the bladder fills with warm water. You will be required to indicate when the urge to urinate begins. This procedure can also determine if there are contractions while the bladder fills, or it can pinpoint the bladder muscle (detrusor) that may not be contracting as it should.
  • Leak Point Pressure Measurement: During the cystometric test, while the bladder is filling, a sudden contraction may occur resulting in some of the water squirting out. This test, where one of the previously mentioned catheters is equipped with a pressure sensor called a manometer, measures the pressure at that leak point moment. You may also be asked to cough, or hold your nose and mouth while trying to exhale (Valsalva maneuver) at this time to check for any urine leakage that may indicate stress incontinence, and for any sphincter deficiency.
  • Electromyography: This test determines if the bladder neck and sphincters are working correctly by using special sensors to measure bladder and sphincter electrical activity. Depending on where the sensors are placed, the procedure may or may not require local anesthesia.
  • Cystoscopy: a camera is inserted through the urethra and into the bladder to check for any bulge, (diverticula) tumors, enlarged kidneys, or foreign bodies.
  • Fluoroscopic Urodynamics Study (FUDS): This is a sophisticated computerized study that measures the pressure readings of both the bladder neck and urethra while you are voiding.

How Long Does It Take to Get Results?

Uroflowmetry and Cystoscopy results can usually be given to you the same day. Several other tests may take up to a few days, but you should have all your results within two weeks.

What Can I Expect After Testing is Complete? Are There Any After Effects?

You may feel a little burning upon urination for a few hours. In order to minimize this discomfort, drinking a glass of water every half hour may help. A warm bath, or even a warm washcloth held against the sensitive site helps as well.

Avoid caffeine or any strong beverages for about 48 hours to minimize irritation upon urination. Take your time urinating to make sure your bladder is empty, and try voiding again after about a minute to make sure it is.

It is normal to see a small amount of blood in the urine after urodynamic testing. However, this should not last more than 24 hours.

Infections rarely occur, but should you experience any of the following, contact your doctor immediately:

  • Fever
  • Chills
  • Excessive bleeding
  • Pain that exceeds mild discomfort
  • Foul smelling, bloody or cloudy urine
  • Lower back pain in the area of your kidneys
  • Burning or stinging while urinating even several hours after testing
  • An urgent need to urinate
  • Frequent urge to urinate at night.

What Are My Treatment Options?

Once the results are reviewed and a diagnosis is made, your treatment plan may vary. A simple exercise regimen may be all you need. Medication, if necessary, will be prescribed. If a pessary, a mesh or even surgery is warranted, your doctor will discuss this with you and arrangements will be made. You will be informed of all your options, and any questions you have will be answered frankly, openly and honestly.

Voiding orders are very common in women, especially after giving birth or as you age. Early recognition, prevention and treatment are extremely important in order to avoid more serious problems or further pelvic health damage. We can help you.

If you are experiencing bladder problems, make an appointment today at 770.720.7733.


December 6, 2016

Perineoplasty, also referred to as perineorrhaphy, is plastic surgery that focuses on the deformities, imperfections, damages and defects of a woman’s anus and vagina. The surgery specifically removes scar tissue, unsightly bulges and unwanted skin, and then tightening or loosening the perineal muscles and vagina. An added benefit of perineoplasty is that, by making these adjustments, the surgery also serves to restore a woman’s confidence, and physically increase her levels of sexual pleasure.

What is the Perineum?
The perineum is the area located between the anus and the vagina. Small as it is, the perineum has the important job of being a structural support for several surrounding organs, and it encapsulates muscles that play a large part in vaginal tightening and loosening.

What Can Cause Damage to the Perineum?
Childbirth: Giving birth vaginally, especially during a difficult delivery, is the most common cause of perineal damage. Even an uncomplicated delivery can cause physical trauma to the vaginal and perineal muscles. Sometimes, an incision is made (episiotomy) in the perineum to ease baby out more easily. Sloppy stitching by a less experienced physician to mend either the natural tearing or planned cut may result in improper healing of the tissue, muscles and perineum. This may leave heavy scarring, pain and discomfort. Multiple births, of course, may worsen these problems. Perineoplasty can rectify them by opening the stitched area again and re-suturing it correctly, enabling proper healing.

Obesity: Excess weight can put strain on the entire body, including the perineum and the structures that it supports. It can also stretch the muscles, causing them to lose elasticity, much the way a mattress becomes concave in places as it conforms to the weight of your body sleeping on it night after night, providing less support as time goes on.

Extreme weight loss: We’ve all seen the ravages of sagging, flaccid, excess skin on someone who has thinned rapidly due to illness or binge dieting. Just as these unsightly effects are visible outside of the body, they can also happen internally, causing the perineal and other muscles to droop permanently even though the pressure of weight is gone. Think of that mattress again. It may regain its shape again during the day for a while, but eventually, after several years, the indentations and depressions become permanent.

What Other Conditions Does Perineoplasty Treat?

  • Vaginal itching
  • Vaginal laxity: (looseness of the vaginal opening that can cause decreased sexual sensation)
  • Vaginismus: (involuntary contractions of the vagina during attempted intercourse)
  • Vulvar vestibulitis: (severe pain during attempted penile or tampon entry)
  • Genital wart removal
  • Incontinence: (involuntary loss of urine)
  • Intraoital vaginal stenosis: (narrowing of the vagina, often caused by cancer treatment)
  • Dyspareunia: (painful intercourse due to a small vaginal opening)
  • Cystocele: (protrusion of the bladder into the vagina)
  • Rectocele: (protrusion of the rectum into the bowel)
  • Aesthetic enhancement: (tightening of loose or flaccid tissue or bulges to give the area a more attractive visual appearance).

What to Expect
Perineoplasty is an out-patient procedure that usually takes about an hour under general or local anesthetic. Rarely is hospitalization required.

A ‘V’ shaped incision is made to the posterior vaginal wall. Scar tissue, bulges and other damages are removed. Depending on the reason for the surgery, the muscles are then either tightened or loosened to correct the problem, then stitched carefully. After a brief recovery time, the patient is permitted to go home.

Patients are cautioned to refrain from having sex for six weeks. It is recommended that any strenuous activity such a bicycling, horseback riding, heavy lifting, or stretching be avoided during this time as well. Tampons should not be used. Most patients should be able to return to work after several days.

Pain and discomfort is usually minimal to moderate and can be treated with over the counter pain medication, or a prescription supplied by the doctor. Minor bleeding and some discharge can occur, and this is normal.

There may be some dizziness or nausea for a day or two as a result of the anesthesia, but this should disappear after forty-eight hours.
The incision must be kept clean and dry. Stitches will dissolve by themselves in about two weeks. It is important to drink lots of water and increase fiber intake during this time to avoid constipation.

Generally, there are few risks associated with perineoplasty. However, the doctor should be contacted if any of the following occur:

  • Excessive bleeding
  • Signs of infection
  • Constipation not relieved through fiber intake
  • Vaginal discharge accompanied by a foul odor.

Childbirth can cause a great deal of trauma and physical change to the body, and women have accepted this as part of the reproductive process since the beginning of time. Today, however, there are procedures that can virtually restore your body to its pre-pregnancy state.

There is no need to suffer quietly and resign yourself into assuming that nothing can be done to ease the pain or embarrassment associated with any of the conditions mentioned above, or to dread intimacy because of possible discomfort or lack of sensation. We can help you. To make an appointment with one of our specialists, please call 770.720.7733.

August 16, 2016

Symptoms to bring to your doctor photoOftentimes women accept minor gynecological or urinary symptoms as a normal part of being a woman. The truth is those minor symptoms may be indicative of a more serious condition.

It is important to take charge of one’s health, stay up to date on annual visits, and make sure to speak with a doctor about any concerns, no matter how minor they may be. By recognizing and disclosing these symptoms early, doctors may be able to diagnose and treat underlying pelvic or urinary conditions.

If a woman is unsure whether to call her doctor, here are some symptoms that may go unnoticed but can be cause for concern:

  • Urinary Incontinence – Leaking urine is commonly seen in women who have had multiple pregnancies, or who are advancing in the aging process. However, urinary incontinence is not something a woman should take lightly. Leaking any amount of urine while laughing, sneezing, coughing, or exercising can be a sign of several urinary conditions, including bladder prolapse. Don’t wait until an annual exam to bring this to a doctor’s attention. There are treatments and lifestyle changes one can make to minimize the symptoms of incontinence.
  • Unexplained Bleeding Bleeding that is not associated with a monthly cycle should be brought to a doctor’s attention immediately. While one shouldn’t stress about the worst case scenario, possible conditions that could cause the bleeding range from fibroids and cysts, to ectopic pregnancies, anemia, or even cancer.
  • Pelvic Pain – Any pelvic pain whether it is during sex, or any other time should be mentioned to a doctor. There could be underlying causes that may need to be examined further and/or treated such as a sexually transmitted disease, endometriosis, or uterine fibroids.
  • Changes Anything seem out of the range of normal, lately? A change in discharge, itching, visible bumps or bulges, or burning while peeing are definite reasons to call your gynecologist immediately. These unpleasant symptoms may be signs of vaginal infections, sexually transmitted diseases, urinary tract infections, or other vaginal conditions that require a doctor’s diagnosis and treatment.

At Cherokee Women’s Health, we are here for any concerns you may have about your gynecological health. Make an appointment at one of our two locations where our highly specialized doctors can diagnose and treat any worrisome symptoms.

Pelvic Organ Prolapse (POP) refers to the sagging or drooping of any pelvic organs due to damage, trauma, childbirth or injury.

The pelvic floor consists of a group of cradle-shaped muscles that hold pelvic organs in place. The pelvic organs include the uterus, bladder, cervix, vagina, rectum and intestines. Like any other part of the body, these muscles, with their surrounding tissues (fascia), can develop problems.

If you fill a small plastic bag with grocery items, say for instance, a box of cereal, a few cans of vegetables, some jars and a package of rice —the bag should hold the items with no problem. But if you hang that full bag on a wall hook and leave it suspended, you’ll start to notice the items in it begin to bulge against the membrane of the bag as it takes on the shape of its contents.

After a while, depending on how heavy the items are, the corner of the cereal box or rim of a can may start to bulge and even poke through as the bag stretches, weakens and eventually tears from the weight of the items in it. The groceries may even begin to protrude and dangle outside of the bag as the tears get larger.

Pelvic pain photoPelvic prolapse happens much the same way. As the muscles and tissues holding the pelvic organs weaken, degrade or tear, the pelvic organs slip or drop through, sometimes forming a small hanging internal bulge. At other times, depending on the damage, they may actually dangle externally from the vagina or anus, causing problems and inhibiting their function. This is called prolapse.

Who is at Risk for Pelvic Organ Prolapse?

One in three women suffer from POP. Any activity that puts undue pressure on the abdomen can cause pelvic floor disorders. Typically, labor and childbirth are the leading causes of prolapse, especially when a woman has had several children, a long, difficult labor, or has given birth to a larger child.
Pelvic organ prolapse becomes more common with age, usually around menopause when tissues damaged during a woman’s childbearing years begin to lose strength. Other causes are:

  • Obesity: Excess weight places increased pressure on the abdomen.
  • Pelvic organ cancers: Tumors can also put additional pressure on the abdomen.
  • Constipation: The bowel puts increased pressure on the vaginal wall when constipation is a chronic problem.
  • Uterus removal (hysterectomy): During surgery, there is always a possibility of inflicting damage on pelvic organ support, resulting in dislocation of any organ within the pelvis.
  • Smoking and respiratory problems: Excessive coughing, especially if chronic, can put extra strain on the abdomen.
  • Genetics: Pelvic connective tissue weakness may be hereditary. Often, if immediate female family members have suffered from prolapse, there is a greater possibility that you will too.
  • Heavy lifting: Excess abdominal pressure from heavy lifting may cause POP.
  • Diseases of the nervous system: There is a greater risk of developing pelvic organ prolapse for women who suffer from multiple sclerosis, spinal cord injury or muscular dystrophy.

What are the Symptoms of Pelvic Organ Prolapse?

It is entirely possible not to have any symptoms at all. Sometimes pelvic organ prolapse is only discovered during a routine gynecological examination. Minor symptoms are a feeling of annoying pressure of the uterus or other pelvic organs against the vaginal wall, minimal malfunction of those organs, and mild discomfort. Other symptoms are:

    • Painful intercourse
    • Vaginal bleeding or spotting
    • A sensation of pelvic pressure
    • Feeling as if something is falling out of the vaginal opening.
    • Bowel movement problems such as constipation.
    • Urinary problems such as needing to void frequently, especially if this interrupts sleep (overactive bladder) or involuntary urine release (incontinence).
    • Stretching or pulling sensations in the groin or pain in the lower back.

Symptoms may be aggravated by jumping, lifting or standing. Relief is usually found after lying down for a while.

When Should You See Your Doctor?

If you have increased sensations of pelvic pressure or pulling which is exacerbated by lifting or straining, but relieved when you lie down.

  • If sexual intercourse has become painful or difficult.
  • If lower back pain or pelvic pain interferes with daily living.
  • If you can feel a bulge inside your vagina or see one protruding.
  • If you have irregular spotting or bleeding.
  • If urinary problems have developed, such as leakage, an urgent need to void, or more frequent urination, including two or more times a night.
  • If you suddenly develop bowel movement problems.


At times, pelvic organ prolapse may be hard to diagnose, especially if a patient does not complain of any symptoms. Patients might be aware there’s a problem but cannot actually pinpoint its location.After asking questions regarding symptoms, medical history, past pregnancies, and other health problems, your doctor will perform a physical examination. Then, if organ prolapse is suspected or discovered, the following additional tests may be ordered:

    • Urodynamics test: Results will indicate how your body stores and releases urine.
    • Intravenous Pyelogram (IPV): An x-ray that reveals position, size and shape of the bladder, kidneys, ureters and urethra.
    • Cystoscopy: This lets your doctor see the interior lining of your bladder and urethra.
    • Computed Tomography Scan (CT scan): X-rays showing details of interior pelvic area structures.

The doctor will then use a classification system to decide the organ prolapse level so he can best decide treatment options. Often, only simple non-invasive treatments and lifestyle changes are recommended for minor prolapse. If surgery is warranted, the following may be suggested:

  • Cystocele repair: Repair of the bladder
  • Urethrocele repair: Repair of the urethra
  • Hysterectomy: Removal of the uterus
  • Rectocele repair: Repair of the rectum
  • Enterocele repair: Repair of the small bowel
  • Vaginal vault suspension: Repair of the vaginal wall
  • Vaginal obliteration: Closure of the vagina.

What Can You Do?

  • Eat fiber: Try to get at least 20mg daily to prevent constipation. Regular elimination is essential to good pelvic health.
  • Kegel exercises: These strengthen and tighten pelvic floor muscles and can be done anywhere, any time—on the sly.
  • Maintain a healthy weight: Your abdominal muscles will thank you.
  • Avoid heavy lifting: If you have to grunt to lift, it’s too heavy.
  • Gentle exercise: Walking is great. Put on those sneakers and try to gradually work up to 20 minutes a day.
  • Drink plenty of water: Not gallons, but about 8 cups a day. This also helps with constipation.
  • Bowel training: Try to schedule bowel movements at the same time every day. It may take time, but eventually your body will cooperate.
  • Don’t smoke.

Pelvic prolapse often sounds worse than it is. For many women, there are hardly any symptoms. For those who DO suffer, there is help available, whether it is a simple lifestyle change, surgical repair, cosmetic enhancement or reconstruction.

If you have questions about your gynecological health or would like to consult with one of our pelvic reconstructive surgeons, please call 770.720.7733 or contact us here.

August 2, 2016

Dr. Crigler photo
As an OB-GYN who’s a vegan, husband and father, Dr. Crigler shares his views on diet, exercise, and bringing patients a great health experience. Working in the field of women’s health – as does his wife Lauren – he talks about how they’ve shaped each other’s practices, and how he turns off his “clinical side” at home.

12 Symptoms, One Fix: How Can Patients Experience Better Health?

Q: From your recent blogs, it’s evident that you and your family maintain a proper diet as the foundation for your health. Does going vegan have any advantages for female reproductive health, and if so, what are they?
Dr. Crigler: A plant based diet has multiple benefits for women’s health, including decreased risk of breast, ovarian and colon cancer. Meat and dairy have both been associated with increased risks of each of these cancers. Even for our pregnant patients, a vegan or plant based diet free of dairy and meat can be very healthy for both baby and mother. As we recommend taking prenatal vitamins for all women, supplementing vitamin D and B12 is more important with a vegan diet. This diet has also been associated with a decreased risk of preeclampsia. It also results in a purer breast milk with no added hormones and less risk of food allergies for the infant.

In addition to female health improvements decreasing the cancers I spoke about, I want to mention lupus, acne, high cholesterol, irritable bowel syndrome and heart disease as conditions that are likely improved with plant based diet changes.

Dr Crigler doing situps with patient photo

Dr. Crigler doing situps with his patient and baby!

Q: What percentage of the health problems you deal with regularly would you guesstimate might easily be solved through nutritional changes and exercise? Can you give some examples?
Dr. Crigler: 100%. Plant based diets will assist in losing weight, decreased systemic inflammation of the body, decrease incidence of type 2 noninsulin dependent diabetes, decrease constipation and risk of hemorrhoids (for our pregnant patients) and help decrease exposure to exogenous hormones often found in meat and dairy products. Exercise helps maintain ideal body weight, increase insulin sensitivity (reducing gestational diabetes) and also helps keep mom in shape for the laboring process. After all, they don’t call it labor for nothing! Northside Hospital Cherokee has a good online maternity resource- that’s one place to start.

Q: Now that you’ve been in private practice for several years, are there additional areas of knowledge in women’s health care you would like to explore to better help your patients?
Dr. Crigler: Many of my patients ask me about sexual health including pain with intercourse, decreased sexual desire, inability to climax and vaginal dryness. While a very sensitive topic, this is very important for the health of a relationship and the mental and physical health of the patient.
I plan to explore dietary, natural, non-invasive medical devices, pharmaceutical, and surgical ways to help patients address these important concerns.

Q: Every doctor has his or her own approach to making a patient feel comfortable. How do you personally try to put your patients at ease to encourage open, honest dialogue?
Dr. Crigler: I try to imagine how I would want my two sisters, mother or wife to be treated during a gynecologic visit. I sit down and I listen. I realize these conversations are quite personal and that I may be the only person in the position to address these issues. I attempt to destigmatize these topics; such as painful intercourse, fecal or urinary incontinence or inability to orgasm.

Q: After each patient appointment, what do you want the patient to have or to have experienced when they leave?
Dr. Crigler: I want them to feel they were given the opportunity to express their concerns, they were listened to and that I truly care about helping them. I want them to come out with a better understanding of their health condition or problem and be confident in the treatment plan that we make together.

Q: Can you share an example of a patient where one appointment made a difference in their health decisions or treatment?
Dr. Crigler: I saw an 80 year old diabetic, arthritic patient with complete pelvic prolapse who still lived on her own, cooked for herself, and really valued her independence. Two doctors at other clinics recommended different surgeries that would likely take weeks to months to recover from and put her at risk of infection. I saw her as a 3rd opinion and offered her a pessary to hold everything in place. We happened to have the exact size she needed in stock and she left that day with a cure to her prolapse, no recovery time and I am sure made it home in time to cook her own dinner.

Husband and Father:
A Wide Perspective on Women’s Health

Q: There are many similarities between your profession and your wife’s, in that you both deal with the health and maintenance of the human body by reducing pain and restoring function—you, medically and she, therapeutically. Is that a coincidence, or did one of you inspire the other to select your specialty?
Dr. Crigler: We met in our anatomy class in medical school, so we were already on a path to helping people in the medical field. Our emphasis on the role that diet and exercise play in health, pain, function and disease prevention was mutually inspired with the help of several documentaries and books for inspiration.

Q: How much impact and input do you have on each other’s professions? For example, does your medical knowledge help your wife Lauren understand her patients better—and does Lauren’s input of what her patients go through during therapy (ie; pain, struggle, mental issues, etc.) help you approach your own patients with more enlightenment?
Dr. Crigler: Our professions impact each other’s quite a bit. We talk about the impact of medication, food and therapeutic exercise in all kinds of conditions. Medical doctors tend to emphasize freedom from symptoms while physical therapists emphasize increased function. We both have several techniques that help meet both of those goals for a more holistic treatment plan. We enjoy learning from one another and most definitely provide better care for our patients due to all of these free consults.

Q: Other than the usual ‘how was your day?’, do you normally leave shop talk at work, or do you find it makes for interesting conversation at home?
Dr. Crigler: I might discuss interesting or challenging cases with Lauren, especially if I am looking for a different perspective or physical therapy ideas. When I am on call, I usually just report any number of babies I delivered that night. She gets excited about every one as she reminisces about her deliveries. It makes not having me home worth it when she knows that another woman was having a life changing experience.

Q: After dealing with patient health issues all day, do either of you find it difficult to turn off your clinical sides?
Dr. Crigler: That’s funny. The very first thing I hear when I get home is “daddy, daddy, daddy, huggy, huggy”. After the hugs and kisses, I get to hear about their superheros and construction sites for about 30 minutes until we wind down for bath and our bedtime routine. Having my sons so excited to see me makes it pretty easy to put on my daddy hat and leave work behind…until they go to sleep that is.

Q: You mentioned that you had the privilege of not just seeing your sons being born, but also delivering them yourself. Do you remember your first thoughts as they both came into the world, or did you remain in ‘doctor mode’ until the whole process was over?
Dr. Crigler: I was in residency while both my sons were born so while I had delivered a couple of hundred babies already, I was still nervous. I did my best to play both the supportive husband and skilled obstetrician role at the same time during the labor. As they were crowning, I did tear up in amazement that we had made this miracle, and then simultaneously, as trained, remembered “protect the perineum”, in hopes to limit any vaginal tears. After delivery, I placed them both on my wife’s chest, cut the cords, and then went into complete husband-daddy role. 

Snapshot: Medical Rescue

Q: Almost every medical TV show and movie shows the star physician out somewhere on his day off enjoying a dinner or other relaxing activity. He’s minding his own business, when suddenly some drama occurs that requires the help of a doctor. Has this ever happened to you?
Dr. Crigler: Just last weekend my family and I went up to Cave Spring, GA to take the kids to the springs and cave. On our way back, it was raining and we rode by a serious collision on the opposite side of the road that appeared to have just happened. I immediately pulled into the closest gas station and left the kids and Lauren in the car to run across the median to help out. Fortunately, only one person was injured and she was talking. She did have a large laceration on her head, complained of neck pain, was very anxious and had evidence of a concussion. With the help of a couple of other Good Samaritans, we comforted her, stabilized her neck, and controlled the bleeding until EMS arrived. I then ran back, soaked, to my family as we rode carefully home, thankful everyone was safe and healthy.

June 29, 2016

Every expectant mother has heard jokes about pregnant women running to the bathroom all the time. Overactive bladder is one of the most common symptoms of pregnancy in the first trimester, and it only gets worse as your pregnancy develops. But for some, overactive bladder causes an even more embarrassing symptom: pregnancy incontinence.

What to Know about Pregnancy Incontinence

pregnant woman laughingPregnancy incontinence, or bladder leakage, gets less press than overactive bladder syndrome (possibly because fewer dads-to-be find it a funny road trip joke), but many pregnant women suffer it. Bladder leakage most frequently occurs when coughing, laughing, sneezing, or straining, but it can happen almost anytime. The good news is that pregnancy incontinence is usually temporary. When your hormone levels go back to normal and your body heals, your bladder should return to normal too.

How to Treat Pregnancy Incontinence

Before trying home remedies, make sure you’re leaking urine. If the liquid is clear and odorless, it may be amniotic fluid. It’s rare, but if you are leaking amniotic fluid, contact your obstetrician immediately.

Okay, you sure it’s urine? Here’s what you can do to treat pregnancy incontinence.

  • Do Kegels to strengthen your pelvic muscles.
  • Train your bladder to behave by slowly extending the amount of time between trips to void your bladder.
  • Monitor your weight. Unnecessary weight gain during pregnancy puts undue pressure on your bladder.
  • Try to avoid constipation, which also puts pressure on your bladder.
  • Keep drinking water! Limiting your water intake doesn’t minimize pregnancy incontinence, it only dehydrates your body and increases your risk of UTI (another cause of bladder leakage).
  • Avoid foods that irritate the bladder such as citrus, tomatoes, coffee, and alcohol (which you shouldn’t be having anyway!).
  • Use pads in case of accidental leaks.
  • Brace your pelvic muscles before laughing or sneezing by crossing your legs or doing Kegels.
  • Pay attention to any patterns. If you notice a specific behavior causes bladder leakage, stop that behavior.
  • Talk to your practitioner. Your OB or CNM does this for a living, so you can be sure they have some good tricks for minimizing bladder leakage.

Pregnancy incontinence may be frustrating, but it’s a normal part of pregnancy. If your incontinence lasts up to six weeks postpartum, speak to your physician about treating incontinence before it becomes a long-term issue. For more information on pregnancy incontinence, call Cherokee Women’s Health.

Laughing Mom-to-Be

May 24, 2016

incontinence photoOveractive Bladder Syndrome, also referred to as OAB, is an uncontrollable need to urinate, often at the worst possible times.

For most of us, when the bladder fills to about half its capacity, the urge to void is triggered. Much like a snooze button on an alarm clock that lets us sleep awhile longer, we can hold off until we’re closer to a bathroom, or the timing is more convenient.

Not so for OAB sufferers. Their urgency is more like the constant demand of a malfunctioning alarm clock without that button—intense, shrill and non-stop until it’s turned off. OAB sufferers feel more like their bladders are overflowing. They don’t have the luxury of waiting, needing relief immediately. If they’re unable to void right away, leakage may occur.

OAB is unbiased. Whether you’re at work or play, it disrupts concentration, performance and pleasure, negatively impacting your life. In time, those afflicted with OAB may become depressed, withdrawing socially.

What Causes Overactive Bladder?

No one really knows, but it’s believed that involuntary contractions of the detrusor muscle in the bladder transmits false messages to the brain.


  • A sudden, inconvenient urgency to urinate that is difficult to control: Just as your child is about to blow out those birthday candles or receive that diploma, you suddenly you have to run, not walk, to the nearest toilet.
  • Frequent urination (more than 8 times daily): Your bladder seems to control your life. You need to know where every bathroom is located when you go out. Maybe you even carry a change of clothing, “just in case”.
  • Voiding two or more times nightly, disrupting sleep (nocturia): You awaken during a delectable dream or restful sleep more than once to urinate.
  • Involuntary, uncontrolled leakage (see also urge incontinence): You can usually hold it in, but just barely, and sometimes experience embarrassing drips.

Contributing factors

  • Overweight or obesity
  • Stress
  • Drinking large amounts of caffeine, alcohol and other liquids
  • Nerve related conditions such as Parkinson’s, Dementia, Diabetes, spinal cord injuries, Multiple Sclerosis, and strokes.
  • Chronic pelvic pain
  • Limited mobility (being unable to move freely or quickly)
  • Some medications

Age may contribute to, but does not always cause Overactive Bladder Syndrome. Never assume you’re doomed to live with OAB based on the number of years you’ve roamed the earth. Speak to your gynecologist. Don’t be ashamed. They’ve heard it before—often. They can help.


You will need to provide your doctor with your medical history, including all drugs, vitamins and supplements you are taking. A physical examination will also be necessary.
Sometimes, a urine culture, ultrasound, and neurological tests may be needed to rule out any sensory or reflex problems. If necessary, you might need more extensive analysis such as:

  • Urodynamic testing (studying bladder, sphincter and urethra performance; measuring urine flow, bladder pressure, and residual urine left after voiding)
  • Cystocopy (using a scope to study the bladder and urinary tract).

You may be asked to keep a journal that includes information like fluid intake, urinary outflow, any leakage, and a time chart of bathroom visits to assess your condition more accurately.

Treatment options

  • In milder cases, your doctor may recommend the following:
  • Drink less: Fluid is vital to the body, preventing dehydration and maintaining proper kidney function, but too much can exacerbate OAB symptoms. Try to cut back on diuretic beverages such as coffee, tea and alcohol, limiting yourself to eight cups of water daily. Avoid liquids too close to bedtime so you can finish those happy dreams.
  • Use liners or pads: Annoying, we know, but they help with trickles, stains and odor.
  • Lose a little weight: It’s not easy, but it can make a difference. Extra weight increases pressure on the pelvic muscles, causing more urination.
  • Teach your bladder who’s boss: Bladder re-education is a method that trains you to urinate at certain times, eventually allowing more time between bathroom visits. Your doctor can guide you, teaching your bladder to obey you–not the other way around.
  • Kegel exercises and biofeedback: Kegels strengthen pelvic floor muscles. Recommended biofeedback devices can help you pinpoint those muscles. Kegels can be done anywhere, are painless, sweat-free, and can be beneficial for OAB.
  • Double void: Sometimes trying to urinate again shortly after the first void may coax some shyer little droplets to make an appearance.

Medications and Treatments

Other treatments may include:

  • Prescribed Medication (Antimuscarinics, anticholinergics)
  • Gentle electrical stimulation (ThermiVa)
  • Bladder Injections ( botulinum toxin A)
  • Vaginal weight training

For more resistant cases, surgery, bladder augmentation, or the use of catheters may be necessary.

Overactive bladder does not have to isolate you. Help is available. Speaking to your doctor is always the first step to overcoming the problems associated with this syndrome, restoring your confidence, happiness, and quality of life.

May 17, 2016

woman with incontinence photoOne in five women endures the symptoms of Urinary Incontinence. Yet often, a suffering woman does not acknowledge it as an issue. She may be self-conscious about mentioning the condition to her doctor, or she may assume it’s a normal part of being a woman. Two of the most commonly accepted situations are incontinence after pregnancy and incontinence during exercise.

The truth is, although urinary incontinence is common, it is not considered normal. Needing to urinate frequently, as well as urinary urgency, are signs that one may be dealing with Urinary Incontinence. Fortunately, for a woman experiencing these symptoms, she can find both surgical and non-surgical options in treatment to minimize or even eliminate these symptoms permanently.

What is Urinary Incontinence?
Weakening of the pelvic floor can affect bladder control and urethra function, causing issues with urination. Women suffering from Urinary Incontinence find themselves running to the bathroom frequently. Strong urges to use the restroom, even after urinating, is another sign that a woman may be dealing with Urinary Incontinence. It is important to not brush off the occasional leak experienced while exercising or shifting position, because there are treatments available for women dealing with Urinary Incontinence.

One important step in the diagnosis process is identifying the type of Urinary Incontinence, in order to find the best treatment option.

  • Stress Incontinence
    This type of incontinence occurs when urine leaks out of the bladder during certain strenuous activities. Jogging or other exercising can cause urine leakage. Coughing and laughing can also bring on an unexpected leak. More severe symptoms of Stress Incontinence may include urine leakage during low stress activities such as changing position or walking. Many pregnant women can experience Stress Incontinence as the growing uterus puts pressure on their relaxed pelvic floor and the organs shift to make room for baby. Sometimes the symptoms are dismissed as an annoying pregnancy symptom, but if they do not subside after delivery, they may need medical assistance to prevent symptoms from worsening.
  • Urge Incontinence
    Commonly referred to as Overactive Bladder, or OAB, Urge Incontinence is a continued sensation of needing to urinate. This sensation is often an overwhelming, powerful urge which sends women dodging for the nearest restroom. Urge Incontinence is different from Stress Incontinence in that it occurs suddenly, without pressure on the bladder from strenuous activity. In addition to strong urges to urinate, women with Urge Incontinence may find themselves waking up at night to use the restroom, interfering with a full night’s rest. Sometimes, there may be an underlying condition that is causing the undeniable urges to urinate. An honest discussion about symptoms with a doctor can help them determine any underlying conditions so they can better treat you.

Preventing Urinary Incontinence:
Many situations can result in Urinary Incontinence. There are some factors that do make a woman more prone to the condition, including pregnancy and childbirth. Women who want to lessen the chance of experiencing Urinary Incontinence can follow the advice below:

  • Quit smoking- those who smoke are at a greater risk of developing Urinary Incontinence.
  • Maintain a normal weight-carrying excess weight can cause more problematic symptoms because of the pressure on the pelvic floor.
  • Exercise- regular exercise improves body function. Exercising the pelvic floor as well can keep symptoms at bay.
  • Regular Bowel Movements- pressure from waste can put unnecessary pressure on the organs of the pelvic floor. Women can lessen symptoms by maintaining regular bowel movements.

Leaky Bladder Remedies:
Don’t be ashamed or embarrassed to mention your symptoms to your doctor. Treatment options will be chosen based on the severity of the symptoms but can include:

  • Changes to diet and fitness lifestyle
  • Physical Therapy
  • Medications
  • Minimally-invasive surgical procedures

Don’t accept the meddlesome symptoms of Urinary Incontinence as part of your life. Seek out the advice of one of our specialists in Urogynecology, and discuss treatments options today.

May 3, 2016


By Britton Crigler, MD, FACOG

ThermiVa is a ground-breaking office treatment that helps women address common problems with their sexual health. As an OB-GYN, I’ve seen symptoms such as incontinence, difficulty or pain with sex, and vaginal dryness interfere with my patients’ lives.  The natural aging process, childbirth, and menopause affect vaginal function. ThermiVa is a new technology that has become the standard for in-office, non-surgical vaginal rejuvenation – with no downtime.

Harnessing the power of thermal energy, ThermiVa helps to reduce or eliminate a wide range of the unpleasant symptoms of aging. I’ve witnessed my post-menopausal patients, as well as those who miss their pre-baby body, regain confidence when treated with this innovative system.

I’ll say this directly: ThermiVa means you do not have to accept the effects of aging. It helps you reclaim a more youthful vulvovaginal structure – while lessening any unpleasant symptoms you may be experiencing.


ThermiVa is a temperature-controlled radio frequency system, designed to tighten the internal and external tissues of the vagina. The procedure, which is non-invasive and non-surgical, uses a slim “S” shaped wand to deliver gentle heat to areas of the vagina. This heat restores and tightens vaginal tissue both internally and externally.

A unique feature of the treatment is that you control the level of heat for a comfortable and virtually painless experience. ThermiVa treatments stimulate your own body’s production of collagen, even helping to heal tissue or nerve damage sustained during childbirth.

A typical treatment takes place in the office. It requires no anesthesia, so you can go about your day afterward. There is no stinging or burning: the effects of the procedure are mostly painless.  A bonus feature is its affordability; it’s suited for many lifestyles.


ThermiVa treats the external and internal tissues of the vagina. The result is tighter, smoother skin and a restoration of the vagina’s functionality. ThermiVa is not just an aesthetic procedure: it combats losses and damage from aging or childbirth. I’ve seen symptoms ranging from vaginal laxity to stress incontinence to vaginal dryness, be reduced or eliminated with ThermiVa treatments.

These benefits greatly enhance your basic quality of life – no longer do you have to deal with the negative effects of menopause. Some of the powerful benefits of ThermiVa include:

Vaginal Tightening: Patients suffering from vaginal looseness find that ThermiVa improves vaginal tightness as it shrinks the tissues of the vagina, lending itself to a better sex life.

Vaginal Lubrication: Women who have lost interest in sex due to pain and dryness will find that ThermiVa increases their natural lubrication – making daily life and intercourse more comfortable without any added hormone treatments.

Urinary Leakage: ThermiVa treatments, coupled with Kegel exercises, can help strengthen the vaginal walls. Tighter vaginal walls can help to stop inconvenient or embarrassing urinary incontinence, along with a reduction in urgency and frequency.Dr. Crigler photo

Labia Majora Rejuvenation: ThermiVa treatments result in smaller, smoother, less “saggy” skin. Patients often experience more comfort with sex and less embarrassment with their appearance.

With ThermiVa, you can reclaim your body and enjoy your life to the fullest. At Cherokee Women’s Health, my colleagues and I specialize in delivering ThermiVa to obtain the most benefits from the procedure for our patients. Call or make an appointment to discuss questions and concerns about thermal energy treatments.

You can restore your confidence and youth with ThermiVa!

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