Women's Pelvic Health in Salt Lake City
Bladder leaks, sudden urgency, and pelvic pressure are among the most common health concerns women bring to a doctor, and among the least treated. Elisabeth Ferlic, MD, is a board-certified urologist with fellowship training in voiding dysfunction and female pelvic medicine, one of only two urologists in Utah with that training. Her practice offers women in Salt Lake City complete care for these conditions, from first evaluation through treatment.
Elisabeth Ferlic, MD
Board-certified urologist · Fellowship-trained in voiding dysfunction and female pelvic medicine
Conditions we treat
Each condition is described below in plain language, with the medical term alongside it.
Leaking and urgency
- Leaking urine & stress incontinence
Leaking urine with laughing, coughing, sneezing, lifting, or exercise is called stress incontinence. The support around the urethra has weakened, most often after childbirth and sometimes simply with age, so pressure on the abdomen pushes urine out. Stress incontinence treatment ranges from pelvic floor therapy to a short in-office procedure (Bulkamid) to outpatient sling surgery. Most women never need the surgical option.
- Overactive bladder & urgency
Overactive bladder causes a sudden, hard-to-defer urge to urinate, frequent bathroom trips, waking at night, and sometimes leaking before reaching the bathroom (urge incontinence). Overactive bladder treatment now extends well beyond medication. Bladder retraining, pelvic floor therapy, medication, bladder Botox, and sacral nerve stimulation form a stepwise series of options. Dr. Ferlic offers all of them, including the advanced therapies many clinics refer out.
Other pelvic floor problems
- Pelvic organ prolapse
Pelvic organ prolapse is a feeling of heaviness, pressure, or a bulge, as if something is falling. It occurs when the bladder, uterus, or rectum shifts downward after the pelvic floor has been stretched or weakened; a prolapsed (dropped) bladder is the most common form. It can be corrected. Options range from a pessary, a small removable support fitted in the office, to surgical repair, and the choice between them is made together with your doctor.
- Recurrent UTIs
When urinary tract infections keep returning, repeating the same antibiotic is not a plan. Recurrent UTIs in women warrant a thorough evaluation to identify why the infections keep happening, whether incomplete bladder emptying, anatomy, or the estrogen changes of menopause, followed by prevention built around that cause. Treating each infection as it appears, without asking why, leaves the underlying problem in place.
- Nerve-related bladder problems
Bladder symptoms that stem from multiple sclerosis, Parkinson's disease, spinal cord injury, stroke, or diabetes are known as neurogenic bladder. This condition is a focus of Dr. Ferlic's fellowship training in voiding dysfunction. Few pelvic health practices in Utah treat it; her practice does.
Pelvic floor problems are common and treatable
As many as one in three women will experience a pelvic floor problem during her lifetime, whether leaking urine, an overactive bladder, or pelvic organ prolapse. Most wait years before raising it with a doctor. Many who do are told it is simply part of getting older or part of having children. That answer is incomplete.
These are medical conditions with identifiable causes and established treatments. Leaking with a sneeze or a workout can be corrected. So can the urgency that dictates your schedule and the pelvic pressure that builds by the end of the day. None of these symptoms has to be permanent.
Many women cope instead of seeking care: locating restrooms before every outing, carrying pads as a precaution, giving up activities they enjoy. Coping is not treatment. Treatment begins with a physician who takes these symptoms as seriously as you do.
Why see a urologist for pelvic floor care
A search for pelvic floor care in Salt Lake City returns mostly two kinds of clinics: pelvic floor physical therapy practices, and gynecology practices with additional pelvic training. Both do good work, and both have limits.
Physical therapy strengthens the pelvic floor muscles and is often the right first step; Dr. Ferlic prescribes it regularly. A physical therapist, however, cannot diagnose the cause of bladder dysfunction, order testing, or provide Botox, nerve stimulation, or surgery when therapy alone is not enough. Gynecology-based pelvic specialists can go further, but their scope generally ends at the conditions that overlap with gynecology.
Dr. Ferlic approaches these conditions as a board-certified urologist, fellowship-trained in voiding dysfunction and female pelvic medicine, one of only two urologists in Utah with that combination. She treats the full spectrum of bladder dysfunction, including the nerve-related conditions (neurogenic bladder) that other pelvic practices refer elsewhere.
For patients, the difference is continuity: one physician who can carry you from the first conversation through diagnosis, testing, non-surgical care, and surgery if it is ever needed, without hand-offs to another office.
What are my options?
A starting point for the conversation, not a prescription. Your evaluation decides what fits.
Leaking with a cough, sneeze, or workout
Stress incontinence, most often after childbirth or with age
Pelvic floor therapy, Bulkamid, or a sling
From therapy to an in-office gel to outpatient surgery
Urgency that medication hasn't fixed
Or the side effects outweigh the benefit
Bladder Botox or nerve stimulation
Botox calms the bladder; InterStim steadies the nerve signals
Heaviness, pressure, or a bulge
Pelvic organ prolapse, most often a dropped bladder
A pessary or surgical repair
A removable support fitted in the office, or repair if you choose it
Infections that keep coming back
Repeating the same antibiotic isn't a plan
An evaluation of the cause
Then prevention built around why the infections keep happening
Overactive bladder and incontinence treatment, step by step
Overactive bladder treatment for women follows a stepwise approach, and the first steps are conservative: bladder retraining, dietary adjustments, and pelvic floor therapy resolve many cases on their own. Medication helps some women as a next step. When those measures fall short, or the side effects outweigh the benefit, the advanced options below are where fellowship training matters.
The same stepwise approach applies to stress incontinence treatment and prolapse. The least invasive option that works comes first, and surgery enters the conversation only if you need it and choose it. Each plan is built around the activities you want to return to.
Pelvic floor therapy: guided, specialized physical therapy to retrain and strengthen the muscles that support the bladder. It is often the first step, and sometimes the only one needed.
Bladder Botox: a brief in-office treatment that calms an overactive bladder when medication is not enough or causes side effects. Results typically last several months, and the treatment can be repeated.
Sacral nerve stimulation (InterStim): a small implanted device, similar to a pacemaker for the bladder, that steadies the nerve signals behind urgency and frequency.
Sling procedures: a short outpatient surgery that supports the urethra and provides durable relief from stress incontinence.
Bulkamid: a minimally invasive in-office alternative to a sling. A soft gel helps the urethra close properly, with minimal downtime.
Pessary fitting: a small removable support for pelvic organ prolapse, sized and fitted in the office. For many women it is a long-term solution; for others, a comfortable interim step while considering surgery.
| Pelvic floor therapy | Bulkamid | Sling procedures | |
|---|---|---|---|
| How it works | Guided physical therapy retrains and strengthens the muscles that support the bladder | A soft gel helps the urethra close properly | Surgery that supports the urethra |
| Setting | Specialized physical therapy, which Dr. Ferlic prescribes regularly | A minimally invasive in-office treatment | A short outpatient surgery |
| Where it fits | Often the first step, and sometimes the only one needed | A minimally invasive alternative to a sling | Only if you need it and choose it; most women never need surgery |
| What to expect | Stronger support for the bladder from the pelvic floor muscles | Minimal downtime | Durable relief from stress incontinence |
Pelvic floor therapy
- How it works
- Guided physical therapy retrains and strengthens the muscles that support the bladder
- Setting
- Specialized physical therapy, which Dr. Ferlic prescribes regularly
- Where it fits
- Often the first step, and sometimes the only one needed
- What to expect
- Stronger support for the bladder from the pelvic floor muscles
Bulkamid
- How it works
- A soft gel helps the urethra close properly
- Setting
- A minimally invasive in-office treatment
- Where it fits
- A minimally invasive alternative to a sling
- What to expect
- Minimal downtime
Sling procedures
- How it works
- Surgery that supports the urethra
- Setting
- A short outpatient surgery
- Where it fits
- Only if you need it and choose it; most women never need surgery
- What to expect
- Durable relief from stress incontinence
Benefits and risks, side by side
Every treatment has trade-offs. Your history and your goals decide which ones matter most.
What treatment can address
- Leaking with laughing, coughing, sneezing, lifting, or exercise
- Sudden urgency, frequent trips, and waking at night
- Pressure or a bulge from pelvic organ prolapse
- Urinary tract infections that keep returning
- Bladder problems from a nerve condition such as MS or a spinal cord injury
What to weigh first
- The least invasive option that works comes first
- The activities you want to return to
- Whether medication helped, or its side effects outweighed the benefit
- A proper diagnosis of the cause comes before any prescription
What happens at the first visit?
The visit starts with what has changed and what you want help with. Any treatment and follow-up plan is specific to you.
Talk through your symptoms
Bring your concerns, medication list, and relevant medical history.
Decide what needs checking
Testing depends on your symptoms and history, and some concerns need a separate workup.
Discuss a plan and follow-up
Review benefits, risks, alternatives, and what to watch for.
Before you schedule
Ask which appointments are available and whether your concern suits a video visit or needs an in-person evaluation.
Here’s what our great patients say
Is bladder leakage normal after childbirth?
Leaking after childbirth is common. Pregnancy and delivery stretch the pelvic floor, and for many women some leaking follows. If it has not resolved on its own within a few months, it is worth treating: options begin with pelvic floor therapy and progress to short procedures with excellent results. It should not be accepted as a permanent consequence of having children.
What is the main cause of overactive bladder?
Most often, the bladder muscle contracts when it shouldn't, sending a "go now" signal even when the bladder isn't full. Contributing causes include changes in the nerve signals that control the bladder, estrogen loss after menopause, urinary tract infections, and certain medications. Often no single cause is found. When there is an underlying driver, such as a neurologic condition, it changes the treatment plan entirely. That's why a proper diagnosis comes before any prescription.
What is a pessary?
A pessary is a small, removable silicone device that sits in the vagina and supports the pelvic organs, similar to a brace for prolapse. It is fitted in the office and involves no surgery. For many women it relieves the pressure and bulge symptoms of pelvic organ prolapse entirely, either as a long-term solution or as an interim step while deciding about surgical repair.
Can overactive bladder be treated without medication?
Yes. Medication is one option among several. If it has not worked for you, or the side effects were not worth the benefit, other proven treatments remain: bladder retraining, pelvic floor therapy, bladder Botox, and sacral nerve stimulation (InterStim). Dr. Ferlic offers the full range.
Do I need a referral?
No referral is required to be seen. You can reach out directly. Some insurance plans do prefer or require one, so it's worth checking your specific plan. If your primary care doctor is involved, we're happy to coordinate with them either way.
When can I make an appointment?
Contact the practice to ask which visit types are available and when in-person appointments and procedures can be scheduled.
Our team is ready to help you
Serving the Salt Lake Valley.