Strong Woman with text POP is not life-threatening, but it can be life-altering

According to the National Association for Continence, approximately 200,000 women in the United States undergo surgeries for pelvic organ prolapse (POP). 

POP is a herniation (protrusion) of the pelvic organs to or through the vaginal opening. A woman’s pelvic organs, which include the bladder, uterus, and rectum, are supported by a complex “hammock” of muscles and ligaments that attach to the bony anatomy of the pelvis. When these are weakened, those organs can drop. The history of POP dates back to 2000 BC, and was commonly associated with the physical trauma of vaginal childbirth. In addition to childbirth, risk factors also include a family history of POP, obesity, advancing age, menopause, prior hysterectomy, and conditions that result in ongoing elevation of intra-abdominal pressure, such as chronic coughing due to smoking or asthma, or constipation.

Some women have symptoms associated with pelvic organ prolapse, and some do not. Usually, a woman starts having symptoms if the protrusion extends to or beyond the vaginal opening. 

POP is not life-threatening, but it can be life-altering, significantly affecting a women’s life quality. Women who experience symptoms of POP describe a feeling of heaviness or pressure in the vagina, painful intercourse, problems with urination, constipation, and urinary or stool incontinence. Frequently, women feel an increase in pressure after a long day of standing or following physical exercise. In severe cases, women describe constantly feeling a “ball” or “bulging” from the vagina.There are different forms of POP. Weakness at the front of the vaginal wall near the bladder can cause a cystocele (dropped bladder). A weak spot in the vaginal ceiling causes uterine prolapse. A defect at the backside vaginal wall, near the rectum results in a rectocele. Very often, several areas are involved. Determining the exact location of the problem is important in identifying the best course of treatment. 

The good news is that we have several options for caring for patients with pelvic organ prolapse. Conservative management include pelvic floor strengthening through exercise and pessaries. A pessary is special device placed vaginally to provide organ support. It should be comfortable, but requires upkeep, removal, and cleaning on a regular basis. A local vaginal estrogen is often prescribed along with using a pessary.

Pelvic reconstructive surgery is another option for correcting the anatomy and restoring bowel, bladder, and vaginal functions. Using a minimally invasive approach, the surgery typically achieves positive long-term results. It can be performed vaginally, laparoscopically, or robotically as a same day or overnight stay procedure. Hysterectomy (removal of the uterus) may be performed as a part of pelvic reconstructive surgery, but is not always required.

Dr. Armen Kirakosyan, a board-certified urogynecologist with General Physician PC, cares for patients using the most advanced surgical procedures and technologies. This includes minimally invasive gynecology, advanced laparoscopy, single port laparoscopic surgery and robotic surgery. To make an appointment to see Dr. Kirakosyan, call 716-656-4077. Learn more at

Primary Care Provider

Primary care physicians (PCPs) form the backbone of medical care for most individuals. They help people maintain overall health, catch problems early with screening, can refer patients to specialists, and more. In addition, with the surge of telehealth capabilities, a PCP is more accessible than ever. Therefore, it’s essential to understand the role of a PCP in your healthcare to prevent medical problems and stay in good health.


History of Primary Care Physicians

Primary care sometimes referred to as internal, general, or family medicine, is a longstanding specialty. The first PCPs were smalltown doctors fully integrated with the communities they served, often visiting patients in their own homes. These early medical providers provided care for a spectrum of illnesses and injuries and even performed surgery when necessary.

National institutions developed the practice to outline universal standards and improve access to medical resources. Modern primary care physicians train for years to practice their specialty and have access to modern resources. They operate with a clear purpose. Dr. Richard Charles, a PCP with General Physician PC, states, “We serve as the initial touchpoint to patients in the community – a great analogy is a quarterback. PCPs get the ball first and direct the play, including testing, referring patients to specialists, and providing treatment plans to keep patients healthy.”


Why is Having a PCP Important?

Dr. Charles elaborates on the importance of seeing your PCP, saying, “It matters for everyone in the community to have a home base. We provide that home base.” Primary care doctors monitor your baseline and help you stay on top of your health. They provide medical diagnoses and preventative care, refer you to behavioral health services, or aid you in getting social benefits. 

It’s recommended everyone sees their primary care once a year for proper continuity. Dr. Charles states, “People’s lifestyles can change in a year. For instance, during the pandemic, people didn’t go out, they didn’t exercise, and they didn’t go to the gym. So that can impact your cholesterol, blood sugar, and blood pressure – it can make a tremendous difference.” 

A more significant result of not seeing your PCP annually is that many people may miss critical medical screenings, which are crucial to finding diseases before they advance or become symptomatic. Dr. Charles says, “Routine screenings such as mammograms, colorectal screening, lung cancer screening, bone density screening – have fallen to the wayside. Screening… saves lives.”, so a visit to the primary care physician can change your life.

In addition to screenings, there are also vaccinations to consider. For example, children need help preparing their immune system for life, and adults can prevent severe illness with annual flu vaccinations. PCPs can also test for ophthalmologic issues, refer patients to therapists or rehabilitation centers, or help patients compile a set of health goals for the year.

Annual visits also mean more comprehensive care. For example, some people may need to see specialists for chronic disorders, injuries, diet, etc.; these specialists do an excellent job in their field. However, they focus on one area and aren’t monitoring total health as your PCP will. PCPs keep an eye on everything and form a holistic picture of the patient’s health.

To help patients know what to expect, Dr. Richard Charles of General Physician, PC put together this list.

  1. Does the patient need screening for cancer? For example, colon/prostate cancer and mammograms.
  2. Is the patient up to date on vaccinations? Such as COVID, the annual flu shot, and shingles.
  3. Is there anything else the patient needs to monitor? The doctor will take height, weight, and BMI. 
  4. Review and discuss medical history. Depending on family history and prescriptions, they may test the renal and liver function. A PCP will also check for comorbidities. 
  5. Does the patient have a solid lifestyle plan? Your PCP will review their sleep schedule, diet, and exercise routine. 
  6. Are there OTC or prescription supplements/medications the patient needs? 
  7. Does the patient need help to manage multiple prescriptions? 
  8. Are there other providers the patient may need to see? For example, rheumatologists, psychologists, audiologists, ophthalmologists, etc.
  9. Are there home resources the patient may need? The doctor will help ensure their patients have proper heating, electricity, and transportation.


Telehealth – Is That an Option?

According to Dr. Charles, seeing a PCP in person for an annual visit is a must, but Telehealth has opened the door to patients who need prompt access to care but don’t have an appointment. 

“Telehealth can be very valuable when people wind up in an emergency room or urgent care center where there’s a lot of high-cost, low-value care going on.” Instead of going to an urgent care facility or the ER, the patient can contact their PCP and schedule a video call. The doctor can briefly evaluate them and figure out what to do next.

Telehealth also allows patients a new medium to review test results and new prescriptions. Dr. Charles says, “Telehealth may be used to discuss test results, blood pressure, and diabetes issues. In addition, Telehealth has a tremendous value to have ancillary medical professionals, [like] clinical pharmacists, reach out about diabetics.” For example, you can speak with your PCP or a clinical pharmacist as a substitute for some appointments you have during the year. 

The PCP also knows their patients’ medical history better than any urgent care clinic or ER. Urgent care or ER physician may not realize one of the prescribed medicines won’t help and may harm a person. Dr. Charles says, “I would much rather have a patient reach out to me and say, ‘Hey Dr. Charles, I have X, Y, and Z going on, rather than going to an urgent care center and getting five prescriptions when they only need two. Or a diagnosis isn’t made because they don’t know the patient or their history.” A PCP will know what medicines their patient can and can’t take. They will help individuals avoid over-prescription and pave the best road to recovery for you.


A PCP is Your Healthcare Foundation

From house visits at the turn of the century to modern telehealth appointments, primary care physicians are established as the most foundational piece of anyone's healthcare. They provide the most comprehensive and timely care for you and your family. There's no other provider that offers you the opportunity to build such a trusting relationship, either, since they will be there year after year. If you're looking for a consistent, compassionate, and accessible primary physician, turn to General Physician PC. Call today or schedule an appointment through our website to get started. 

Check out our Primary Care offices and Providers.

Do you leak when you laugh? You are not alone

It happens to many more women than you realize — you’ve taken pains to get dressed, feel great, and suddenly you cough, laugh, sneeze, lift something heavy, and find that you’ve wet your pants. Fear not. You are definitely not alone. According to the National Association for Incontinence, Stress urinary incontinence is the most common form of incontinence, affecting roughly 25 million women in the United States. Leakage for these women can occur with any physical activity that puts pressure (stress) on the bladder, and especially if the bladder is full. If it happens frequently, women can feel so embarrassed that they hesitate to engage in social activities.

Stress incontinence occurs when muscles and ligaments supporting the pelvic floor weaken. The most common cause is childbirth, during which tissue or nerve damage occurs during delivery. Other contributing factors are chronic coughing due to illness, obesity, smoking (which causes coughing), years of high impact activities such as running or jumping, age, and previous pelvic injury or surgery, such as having a hysterectomy. Fortunately, there are options for improving and treating stress incontinence.

Pelvic Floor Physical Therapy (PT). Pelvic Floor PT can help improve or alleviate stress incontinence by utilizing kegel exercises, electrical stimulation, and biofeedback. Some over the counter devices are available for PT at home.

Pessary. An incontinence pessary is an FDA-approved silicone or rubber device that is placed vaginally to support the urethra and bladder wall and help with leakage.

Over the Counter Device. They are similar to tampons, but instead of a wad of absorbent fibers, they are collapsible silicone structures with a non-absorbent polypropylene covering. Once inserted into the vagina, the support expands to lift and support the urethra to help stop leaks from coughing, sneezing, or exercising.

Surgical Options. 

1) Mid-urethral sling is a minimally invasive surgical procedure that treats urinary incontinence by placing a synthetic tape under the urethra to lift it back into a normal position. The sling is placed via vaginal approach and prevents urinary leakage by supporting the urethra during any physical activity.

2) Burch colposuspension surgery involves attaching the tissue near the urethra to the pectineal ligament (also called Cooper’s ligament) using sutures instead of synthetic tape. The procedure is performed laparoscopically, and requires placing tiny instruments through the belly.

3) Urethral bulking is another effective surgical treatment for stress incontinence, especially when incontinence is recurrent and related to weakness of the urethral sphincter muscle. This procedure can be performed very quickly in a physician’s office.

If you are experiencing stress incontinence, and would like to make an appointment to see Dr. Kirakosyan, call 716-656-4077, and visit

Dr. Armen Kirakosyan is a board-certified urogynecologist who uses the most advanced medical procedures and technologies in treating patients with stress urinary incontinence, urge incontinence, endometriosis, vaginal laxity, painful bladder syndrome, fecal incontinence, vaginal bulging, vaginal mesh pain and complications, overactive bladder, atrophic vagina sexual dysfunction, pelvic/vaginal pain, recurring urinary tract infections, and incomplete bladder emptying.


Printed in Buffalo Healthy Living Magazine 2022

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