Dr. Adam C. Steinberg

HARTFORD – Urinary incontinence afflicts an estimated 20 million Americans. Approximately one-quarter of women of childbearing age experience the condition, and the number of those affected rises sharply as estrogen levels drop at menopause and muscles lose their elasticity.
A urogynecologist is an expert in disorders that effect the pelvic floor. Bottom line: “It’s never normal for a woman to involuntarily leak urine,” says Dr. Adam Steinberg, one of the three fellowship-trained Female Pelvic Medicine and Reconstructive Surgeons at Hartford Hospital’s Division of Urogynecology, part of Women’s Services.
The division was formed in 1997. Steinberg and his colleagues are active on a regional, national and international level, publishing research and presenting findings at meetings.
Dr. Steinberg spoke with the Ledger about the causes of, and treatments available for, urinary incontinence and pelvic organ prolapse.

Q: How long has the field of urogynecology been active?
A: Urogynecology has been around since the late ‘70s and has gained popularity over the past 20 years, in terms of awareness and understanding. Currently there are less than 30 approved fellowships in the country one of which is at Hartford Hospital. The specialty takes a holistic approach to the pelvic floor by applying knowledge from multiple specialties – gynecology, urology, colorectal surgery, physical therapy – as it pertains the organs of the pelvis – bladder, bowels, and vagina. The goal of the specialty is to restore normal function and anatomy to the pelvis.

Q: What does urogynecology address?
A: We deal with restoring normal anatomy and function to the pelvic floor which includes the bladder, bowels, and vagina. There are different components of those functions, and our main focus is improving symptomatic complaints.
There are different types of urinary leaking.Stress incontinence can be caused by coughing, sneezing, jumping, and anything else that increases pressure on the abdomen. Leakage can also result from an overactive bladder, where you are unable to control when and where you urinate and may be related to environmental situations such as coming into a house with a full bladder or hearing running water. Both of these types of urinary incontinence result in urine leakage but have different causes and treatment options

Q: What are the treatment options for urinary incontinence?
A: Up to 15 or 20 years ago, we didn’t have great treatments, but we now have some effective surgical and non surgical treatments, for both types of leaking.
When a woman has symptomatic prolapse, there are multiple options: Do nothing and observe the condition; in the office place a pessary in the vagina,  a very effective device that helps support the pelvic organ; or surgically correct the prolapse.
There are different ways prolapse can be surgically fixed: vaginally, where all surgery is done through the vagina; abdominally, via an abdominal incision,  laparoscopically, with small incisions in the abdomen, and laparoscopically with the assistance of the robot. [Hartford Hospital was the first medical center in the Northeast to use the da Vinci surgical robot for uro-gynecological surgery and continues to lead in volume and research.]
All are good modalities of treatment and have their right place for the right patient. There is no cookie-cutter treatment, where you come in with a problem and we only address it in one way.
It behooves patients with issues dealing with the pelvic floor to find a fellowship-trained uro-gynecologist to assist them in coming up with the best plan of action for their problem. There has been a lot of press on robotics, which is a great modality but not the only one. If you desire a surgical correction of your prolapse and the physician is only offering one option, you should question if there are any other techniques which can be used. There is a body of literature demonstrating evidence for each of the surgical modalities and comparing them to each other.

Q: What are some of the factors that contribute to a weakened pelvic muscular structure, and what can women do to counter the phenomenon?
A: Contributing factors include pregnancy, age, menopause, smoking, excess weight, chronic constipation, genetics, and trauma. Excessive weight training with excessive strain over a long period of time can also be a cause.
A woman can perform the Kegel exercise [contracting and relaxing the muscles that form the pelvic floor], and maintain good health and a normal body mass index. Studies show that even a weight loss of 10 percent often reduces incontinence.

For more information about the Hartford Hospital Urogynecology Division: www.harthosp.org/women/ GynecologyServices / (860) 545-2795