Urogynecology, Female Pelvic Medicine and Reconstructive Surgery

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Welcome! I am honored that you have chosen Advanced Physician Associates for your health care needs. Our goal is to deliver the highest quality care to you and your loved ones by providing personalized, compassionate, and advanced treatments.

We are uniquely trained to provide specialty consultation and management of the full spectrum of Female Pelvic Floor Disorders including pelvic organ prolapse, urinary incontinence, overactive bladder, incomplete bladder emptying, accidental bowel leakage, difficult defecation, painful bladder syndrome, recurrent urinary tract infections, fistula and urethral diverticulum. Our commitment to you is to perform a multidisciplinary and comprehensive office evaluation in a welcoming environment.We take the time to understand your specific problem and work together to come up with a tailored and personal treatment plan. We have the most advanced treatment options for all pelvic floor disorders. We offer a wide range of treatment options which are tailored to your specific problem ranging from conservative to medical or surgical management. We offer various minimally invasive office-based and surgical approaches tailored to your specific condition.

We work closely with our colleagues in General Gynecology, Pain Management, Radiology, Urology, Gastrointestinal Internal Medicine, and Physical Therapy.

We thank you for the opportunity to care for you and your loved ones. We are committed to providing you the very best personalized and compassionate care!

Sincerely,

Cara Grimes, MD, MAS, FACOG
Chief

Pelvic Organ Prolapse – a bulge or pressure feeling in the vagina that results from descent of the bladder, rectum, uterus and/or vagina. This is also called uterine/vaginal vault prolapse, anterior vaginal wall prolapse (“cystocele”), and posterior vaginal wall prolapse (“rectocele”). Some women have to use their fingers or tissue paper to push the bulge in to urinate or defecate.
Incontinence - loss of bladder or bowel control, leakage of urine or feces.
- Stress Urinary Incontinence – leaking urine with coughing, sneezing, laughing, exercise
- Overactive Bladder or Urgency Incontinence –need to go to the bathroom urgently and/or frequently, and sometimes leaking urine before you can make it in time
- Accidental Bowel Leakage/Fecal Incontinence – losing stool accidentally
Difficult defecation- difficulty with emptying bowels. Having to strain, push on the vagina or around your rectum, or dig stool out from your rectum in order to have a bowel movement.
Urinary Retention/Voiding dysfunction – difficulty emptying bladder and/or not emptying it enough with voiding.
Recurrent Urinary Tract Infections – two or more culture proven infections in the last 6 months.
Hematuria – blood in your urine.
Fistulas - abnormal hole between the vagina and rectum (rectovaginal), vagina and urethra (urethrovaginal), or vagina and the bladder (vesicovaginal).
Pain/Painful Bladder Syndrome/Interstitial Cystitis - discomfort in the lower back, pelvis or bladder and/or urethra.
Urethral diverticulum or Periurethral Cysts.

Behavioral modification training for incontinence or prolapse
Medications for incontinence
Pessary for incontinence or prolapse
Pelvic Floor Muscle Strengthening
Office percutaneous tibial nerve stimulation for incontinence
Office urethral bulking agents for incontinence
Office bladder Botox injections for incontinence
Office trigger point injections for pain
Office cystoscopy
Urodynamic (bladder function) testing
Ultrasound
Minimally invasive surgery (cystoscopic, vaginal, laparoscopic, robotic approaches)
- Vaginal hysterectomy and pelvic reconstruction (uterosacral ligament suspension, sacrospinous fixation)
- Hysteropexy
- Native tissue and mesh procedures
- Sacrocolpopexy
- Sacral neuromodulation for incontinence
- Midurethral sling surgery