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Washington Colorectal Surgery Virginia Hospital Center

Providing the Washington, DC Area's Best Care for Colon and Rectal Diseases and Disorders

Pelvic Floor Center

"Pelvic floor disorder" is a general term used to describe a number of conditions originating in the pelvic region, including constipation, urinary or fecal incontinence, interstitial cystitis (chronic bladder infection) and sexual dysfunction. Left untreated, pelvic floor problems can eventually become socially debilitating for some men and women, prompting them to avoid public places and become prisoners in their own homes.

Through the Center for Pelvic Floor Disorders at Virginia Hospital Center, many are finding relief. The multidisciplinary program unites specialists in urogynecology, urology, colorectal surgery, and abdominal/pelvic imaging in a single unit, creating a comfort zone for patients that ensures they don't have to drive to multiple locations for tests or procedures.

"Many pelvic floor conditions are interrelated, so a person may come in to see one specialist and be referred to another," says urogynecologist Luis E. Sanz, MD, who has written textbooks and extensive journal articles on gynecologic surgery. "Having all three practices in a central location is more efficient from a clinical standpoint, and more convenient for the patient."

The majority of pelvic floor disorders stem from damage to the muscles between the pubic bone and the coccyx bone at the tip of the spine. Normally, these muscles act as a sling to support the bladder and pelvic organs, but when they become weakened or stretched, problems can occur. Incontinence is a common condition in men who have undergone prostatectomy, as well as in women over 55. "Forty percent of women who have had two or more vaginal deliveries end up with a pelvic muscle defect that becomes symptomatic later in life," says colorectal surgeon Othon Wiltz, MD. Muscle trauma is often exacerbated after menopause when tissues become thinner.

In some cases, treatment for urinary or fecal incontinence may be as simple as physical therapy. Rehabilitation can include Kegel or rectal sphincter exercises; or retraining the bladder by adjusting fluid intake and decreasing consumption of irritants such as caffeine and alcohol.

"Any leakage or loss of urine is abnormal, but people often don't seek medical care until their quality of life is affected," observes physical therapist Marta Hahn, MS, PT, noting that with early intervention, 80 percent of patients are cured by pelvic floor rehabilitation without needing surgery.

"Some see improvements in just one or two visits." Other cases do call for surgical intervention. One procedure that has proven life-changing for women suffering from stress urinary incontinence is the TOT (transobturator tape) sling, in which a hammock-like strip of synthetic mesh is inserted underneath the urethra to provide support and prevent leakage from coughing or sneezing. The procedure is completely painless, requiring only local anesthesia, and can be performed on an outpatient basis, explains Dr. Sanz, who has performed more than 250 TOT surgeries.

The Center's elite specialists also excel in more complicated procedures, including vaginal, rectal and bladder reconstructive surgery, and robot-assisted laparoscopic hysterectomy.

Colorectal surgeon Othon Wiltz, MD; urogynecologists Maria P. Canter, MD, MSc and Luis E. Sanz, MD; urologists Robert M. Mordkin, MD, Andrew B. Joel, MD and Ash V. Kshirsagar, MD
Colorectal surgeon Othon Wiltz, MD; urogynecologists Maria P. Canter, MD, MSc and Luis E. Sanz, MD; urologists Robert M. Mordkin, MD, Andrew B. Joel, MD and Ash V. Kshirsagar, MD


Dr. Othon Wiltz and Dr. Jennifer McQuade

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