The pelvic floor is composed of muscles and connective tissues that act as a foundation to support the pelvic organs, including the vagina, anus and rectum, uterus and bladder. It is shaped like a hammock, and when it becomes weak or damaged, it cannot support the pelvic organs, resulting in pelvic floor disorders that can manifest as urinary or fecal incontinence or obstruction, pelvic organ prolapse, sexual dysfunction and other problems. Instead of looking at each organ separately, we've developed a multidisciplinary approach that allows us to treat the pelvic floor as one unit. Relying on advanced pelvic imaging like three-dimensional anal ultrasound and three-dimensional high-resolution anal manometry units, we study both anatomy and function in patients with bowel control problems. The results of these tests allow us to plan minimally invasive treatments, including the newest sacral nerve stimulation techniques. By collaborating with urologists, gynecologists and other specialists, we can achieve a common goal: correcting the entire pelvic floor disorder, easing as many coexisting symptoms as possible and improving quality of life—with just one trip to the operating room.

• More than 50% of women ages 55 and older suffer from at least one of the problems caused by pelvic floor dysfunction.
• 1 of every 9 women will undergo surgery for a pelvic floor disorder.
• Women who have delivered several children vaginally and those who suffer birth injuries are at higher risk for pelvic floor disorders, as are overweight women.
• 0% of women with overactive bladder or urinary incontinence also suffer from fecal incontinence.

In 2017, with 47,000 American deaths attributed to opioid misuse (up from 18,000 just 10 years earlier), the national opioid crisis was declared a public health emergency. While opioids are an important part of post-surgical pain management, they are no longer the mainstay. Our research focuses on Enhanced Recovery Pathways (ERPS) and protocols for colorectal cancer and pelvic floor surgeries. Coupled with minimally invasive procedures, our methodology is centered on strengthening the body for surgery, decreasing stress response and surgical complications, and easing the opioid burden. We start with increased physical activity to strengthen the body before surgery and supplements to boost the immune system. Then, post-procedure we reintroduce liquids and feedings shortly after surgery to accelerate gut recovery and encourage walking by that same night. We also use combinations of non-opioid pain medications know as multimodal analgesia to not only reduce pain, but to decrease the need for breakthrough opioid use. The results are shortened hospital stays, accelerated recovery and improved outcomes.