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result, the urethra becomes hypermo- bile, and urine leakage occurs when women cough, laugh or exercise. Upper vaginal prolapse and enteroceles usually transpire because of weak or damaged uterosacral and cardinal ligaments. Women who have children most commonly develop pelvic f loor dis- orders resulting from ligament and fascia damage due to uterine growth and distention during pregnancy and/ or childbirth. Normal aging, obesity, genetic predisposition and, rarely, a histor y of chronic coughing due to smoking or smoking-related respiratory conditions may also play roles in fascia and ligament weakness. Most women develop pelvic floor disorders in middle to late adulthood, but Dr. Press has treated stress incontinence in women as young as 30. Pa t ient s w it h bl a dder, v a g i n a l and rectal prolapse often complain of chronic pelvic pain and a sense of vaginal heaviness, pressure or discom- fort. Dr. Press recommends referring patients for evaluation if they have these symptoms or have prolapse that is visible upon examination. Other indications for referral to a female pelvic medicine and reconstructive surgery specialist include frequent urinary tract infec- tions, the presence of blood in the urine, and stress or urge incontinence that has not responded to conservative therapies, such as medication or Kegel exercises. Advanced Diagnostics Following patient referral, Dr. Press performs a f ull physica l exa m a nd reviews each patient's chief complaint and past medica l histor y. To grade the severity of pelvic organ prolapse, Dr. Press uses the Pelvic Organ Prolapse Quantification system, which bases prolapse severity on the bladder's posi- tion in relation to the hymen. Urethral A technician conducts a urodynamic test at Dr. Press's Port Jefferson office. Physicians use urodynamic testing to determine bladder capacity and identify the pressure at which the bladder begins to leak. Dr. Press explains the findings of a bladder ultrasound to a patient. hy permobility is also assessed, and a rectal exam is performed to gauge rectal muscle tone. Urodynamic testing, such as a post- void residual measurement, evaluates the urinar y tract system's ability to store and release urine and may follow the physical examination. The post- void residual measurement quantifies output during urination to determine if patients have difficulty emptying their bladder, as bladder prolapse can lead to urethral obstruction. Dr. Press may also perform further urodynamic testing, which involves using a catheter to fill the bladder with water and measuring both bladder contraction at low volume and the bladder's ability to hold urine as it fills. This helps determine symptom cause and predict the potential success of surgical treatment. A Glimpse at Conservative Therapies Pelvic f loor disorders a ren't life- or- deat h sit u at ion s, so t reat ment indications revolve around the degree to which symptoms impact a woman's lifestyle. When women see their pri- mary care provider for a referral to a female pelvic medicine and reconstruc- tive surgery specialist, concerns often center on how symptoms of prolapse or incontinence affect their ability to remain active. M D N E W S . CO M ■ MD NEWS Long Island | 7