About Urogynecology

What is a Urogynecologist?

A urogynecologist is a surgeon who has specialized in the care of women with pelvic floor disorders.

The pelvic floor is a set of muscles, ligaments and connective tissue in the lowest part of the pelvis that provides support for a woman’s internal organs, including the bowel, bladder, uterus, vagina and rectum.

A pelvic floor disorder occurs when women have weakened pelvic muscles or tears in the connective tissue due to excessive strain on the pelvis due to childbirth, repeated strenuous activity, menopause, chronic disease, or pelvic surgery. Other factors that can weaken the  pelvic floor include repetitive heavy lifting, tobacco use, and genetics.

The following are some problems that arise from damage to the pelvic floor:

  1. Incontinence: loss of bladder or bowel control, leakage of urine or feces.
  2. Prolapse: descent of pelvic organs; a bulge and/or pressure; ‘dropped uterus, bladder, vagina or rectum.’
  3. Emptying Disorders: difficulty urinating or moving bowels.
  4. Pain: discomfort to the lower back, pelvis or bladder and/or urethra.
  5. Overactive Bladder: frequent need to void, bladder pressure, urgency, urge incontinence (difficulty holding back urine when having the urge to urinate)
  6. Fistulas: abnormal hole between the vagina and rectum (rectovaginal), vagina and urethra (urethrovaginal), or vagina and the bladder (vesicovaginal)

What Kind of Training Does a Urogynecologist Have?

Urogynecologists are physicians who have completed medical school and a residency in Obstetrics and Gynecology or Urology. These physicians become specialists with additional years of fellowship training and certification in Female Pelvic Medicine and Reconstructive Surgery1. The training consists of providing expertise in the evaluation, diagnosis, and treatment of conditions that affect the muscles and connective tissue of the female pelvic organs. These physicians are also knowledgeable on the latest research in the field pertaining to these conditions.

When Should I See a Urogynecologist?

Although your primary care physician, OB-GYN, or urologist may have knowledge about these problems, a urogynecologist can offer additional expertise. You should see (or be referred to) a urogynecologist when you have problems of prolapse, and/or troublesome urinary or fecal incontinence or when your primary doctor recommends consultation. Other problems for which you or your doctor might think about consulting a urogynecologist include: problems with emptying the bladder or rectum, pelvic pain or bladder pain, fistulas, and the need for special expertise in vaginal surgery.

What Treatment Options are Available from a Urogynecologist?

A urogynecologist can recommend a variety of therapies to cure or relieve symptoms of pelvic floor disorders. You should choose the one that works best for your lifestyle and meets your goals.

Sometimes simple changes and interventions can have a significant impact on daily quality of life. He or she may advise conservative (non-surgical) or surgical therapy depending on your wishes, the severity of your condition and your general health. Conservative options include medications, pelvic exercises, behavioral and/or dietary modifications and vaginal devices (also called pessaries). Pelvic Floor Therapy with Biofeedback and Electric Stimulation are also treatments that your urogynecologist may recommend. Safe and effective surgical procedures are also utilized by the urogynecologist to treat incontinence and prolapse.

1After 2015, Female Pelvic Medicine and Reconstructive Surgery will be an accredited subspecialty by the American Board of Medical Subspecialties.


SOURCE:  American Urogynecologic Society