The Urogynecological and Pelvic Floor Service at Shaare Zedek Medical Center offers diagnosis and treatment for women suffering from bladder control problems and pelvic organ prolapse. The Service operates in partnership with a physiotherapist specializing in pelvic floor treatment, a gastroenterologist, a colorectal surgeon and the staff of the Urological Institute.

The Service offers comprehensive diagnosis of all types of bladder control difficulties, urine and stool emission disorders and pelvic floor dysfunction. It also provides diagnostic tests for these disorders. The Service offers a range of treatments including drugs, physiotherapy and innovative operations when needed.

Urodymamics Testing 
The test is designed to evaluate the functioning of the lower urinary system (bladder, sphincter and urethra) and to assess problems such as an unstable bladder, urine leakage under stress and bladder emptying disorders.

The test is performed only if the current urine culture indicates no active infection in the urinary tract. During the test, the amount of urine and force of the flow are evaluated, a catheter is inserted into the urinary pouch via the urethra to check bladder pressure. Similarly, a thin tube/balloon is inserted into the anal opening to check internal sphincter pressure. The examination lasts about a half hour, at the end of which the catheter and the balloon are removed and the patient is able to function normally for the rest of the day. The patient receives a written report to give to her referring doctor.

Postpartum Perineal Care
The perineum between the anus and the vulva coordinates the termination of the digestive, urinary and reproductive systems. It is a sensitive area close to the birth canal. Approximately 85% of women suffer from some sort of perineal tearing during vaginal birth. Most recover smoothly within a week or two of birth. 

The supervision service offered in the clinic is designed for post-natal patients suffering from perineal disorders connected to the birth process, including:

•    Severe tears
•    Suture healing problems
•    Perineal or pelvic floor pain
•    Difficulties in intercourse
•    Urine retention

The clinic offers every patient diagnosis, counseling and guidance in accordance with the particular situation, and conventional or surgical treatment as needed. The clinic works with a physiotherapist specializing in pelvic floor treatment.

Among other things, the service – within the framework of the Integrated Pelvic Floor Clinic – offers counseling for women with sphincter damage before pregnancy. Women without symptoms of lack of control and with normal evaluation test findings can usually give birth vaginally but for women diagnosed with symptoms, however minor, vaginal birth is liable to worsen the situation and the clinic usually recommends Cesarean section. These recommendations are supplemented by suggested treatment for correcting the problem or easing the symptoms.

Patients can request advice from Integrated Clinic staff (urogynecologist, gastroenterologist, colorectal surgeon and pelvic floor physiotherapist) through a referral from a specialist and only after completing a full preliminary evaluation which usually includes special tests to assess sphincter function and wholeness. The clinic works closely with the hospital's delivery room team. 

During the session with the clinic staff, the woman is given information about the variety of options she has for giving birth, while hearing the advantages and disadvantages of each. She has the final decision and we will support and help her whatever that decision may be.