Urogynecology

As a woman, you probably know the difference between a gynecologist and urologist. A gynecologist is a doctor who specializes in women’s reproductive health while a urologist treats problems of the urinary system. However, there are certain problems that affect both the reproductive and urinary systems in women. In such cases, a specialist with the combined skills and experience of urology, gynecology and reconstructive surgery is in a better position to provide diagnosis and treatment.

What is Urogynecology?

Urogynecology is a surgical subspecialty of both urology and gynecology. Also called female pelvic medicine and reconstructive surgeon, a urogynecologist treats all conditions of the female urinary and reproductive tract, as well as the pelvic floor. The difference between urologists and urogynecologists is that while urologists treat disorders of the urinary system in both men and women, urogynecologists only treat women. Equally, urologists do not treat problems of the reproductive system and the pelvic floor in women, while urogynecologists are experts in treating issues of the female reproductive system and pelvic floor.

Urogynecologists care for women with pelvic floor disorders using a blend of gynecology, urology and reconstructive surgery techniques. The physicians undergo special training in urology, gynecology and obstetrics, complete medical school, and do a four-year residency in obstetrics and gynecology before taking specialized training in urogynecology for an additional three years. This gives them the requisite expertise to evaluate and treat non-cancerous conditions of the female reproductive, urinary and pelvic organs, their supporting tissues and muscles, as well as perform constructive surgery. Women who needed to see multiple specialists for reproductive, urinary and gastrointestinal problems in the past can now see one specialist—the urogynecologist

Why should you see a Urogynecologist?

Working with a physician who specializes in the anatomy and function of the female pelvis ensures the area is treated as a unit as opposed to addressing one problem at a time. In turn, you get a complete view of all the conditions you may have, including how the issues relate to each other and with your sexual and reproductive health.

Likewise, while pelvic floor disorders are not usually life-threatening, they do have adverse effects on quality of life. For instance, a urogynecological problem can cause serious pain and discomfort, lead to difficulty with voiding, physical activity, sexual function and defecation, and disruption of social life and relationships. Your self-confidence may also be affected due to urine or fecal leakage, or problems with your menstrual cycle. 

Urogynecologists design treatments tailored toward improving the pelvis as a whole. Being experts in the area of pelvic medicine and surgery, they not only provide minimally invasive treatments—such as state of the art robotic surgery (da Vinci) and laparoscopic surgery—but also offer a variety of vaginal approach surgical procedures.

What are the common conditions treated by urogynecologists?

1. Pelvic organ prolapse (uterus, bladder)
2. Post-hysterectomy prolapse
3. Urethral diverticulum
4. Congenital anomalies of the lower reproductive tract (such as vaginal septum, imperforate hymen, uterine anomalies)
5. Pelvic floor dysfunction
6. Incontinence (fecal and urinary)
7. Severe constipation or obstructed bowel
8. Overactive bladder
9. Bladder or urethral pain
10. Chronic pelvic pain
11. Vaginal dryness
12. Vaginal pain
13. Fistulas and fibroids
14. Ovarian cysts
15. Endometriosis
16. Abnormal bleeding
17. Infertility
18. Sexual pain
19. Urinary tract infection
20. Interstitial cystitis

The signs and symptoms of the disorders include:

1. Strong, uncontrollable urge to urinate
2. Burning sensation while urinating
3. Frequent urination
4. Chronic pelvic or bladder pain
5. Pain during intercourse
6. Difficulty emptying your bladder
7. Trouble with bowel movements
8. Loss of bowel or bladder control
9. Bladder pressure
10. Frequent urinary tract infections (UTI)
11. Bulge or heaviness in the vagina
12. Unusual bleeding or spotting
13. Miscarriages and infertility

Treatment of urogynecologic disorders

Urogynecologists offer precise and effective treatment of reproductive, urinary and pelvic floor disorders. A urogynecologist will listen to your concerns, answer your questions, and help you choose the right treatment. But the best treatment for every patient depends on the patient’s age, history of previous surgeries and treatments, level of physical activity, sexual activity, and the patient’s goals.

The urogynecologist may recommend dietary changes, urge suppression, relaxation techniques, and muscle training to help manage symptoms. Pelvic floor muscle exercises, also called Kegel exercises, involve squeezing and relaxing the pelvic floor muscles in order to improve symptoms.

Depending on the condition, the doctor may also prescribe medications to help with symptoms. For incontinence and bladder control problems, injections can be administered. For instance, calcium or silicone-based bulking agents can be injected into the urethra to treat stress incontinence while botulinum toxin (Botox) can be injected into the bladder muscle to treat overactive bladder and urge incontinence. 

If you have a prolapse, your urogynecologist may recommend pessaries. A pessary is a soft, removable device fitted into the vagina in order to support the bladder and uterus. The physician will show you how to use the pessaries properly, including how to clean and re-insert them. In addition to pessaries, your doctor may also recommend nerve stimulation as treatment for overactive bladder and other conditions.

When other options are unhelpful or unsuitable, your urogynecologist may recommend surgery. There is a wide range of surgical options, from minimally invasive, laparoscopic and robotic to reconstructive procedures.

Prolapse surgeries help repair prolapse and build pelvic floor support. The options vary depending on the organs that have prolapsed, but common ones include vaginal wall repair, uterus removal, bladder support and control surgery, and surgery to boost support of rectum and small bowel.

Incontinence surgeries help to treat incontinence caused by pressure on the bladder.  For instance, sling procedures are performed using a patient’s own tissue or by placing a “hammock” to support the urethra. A bladder pacemaker—a device implanted to treat difficulty urinating and overactive bladder—can also be surgically implanted.

Prompt treatment, better outcomes

Urogynecologic disorders may feel embarrassing, but that should not stop you from talking about your problem with a urogynecologist. This specially-trained doctor has the skill, experience and compassion to help you overcome your problem. In fact, the doctors see many patients with similar issues on a daily basis and so have what it takes to diagnose and treat your condition. Moreover, many of the conditions can be treated or cured, and the results are usually good for most patients. 

At Advanced Urology Institute (AUI) we treat women with pelvic floor and urogynecological conditions through a range of comprehensive and integrated surgical and non-surgical approaches. We offer non-surgical approaches like medications, pessaries, pelvic floor physical therapy, biofeedback, electrical stimulation, urge suppression, pelvic floor re-education, and behavioral and medical management of incontinence. 

Our surgical approaches to pelvic floor disorders include sacral nerve stimulation, anal sphincteroplasty, artificial anal sphincter, minimally invasive hysterectomy, and urethral reconstruction. We are leaders in patient education and always available for women struggling with the stigma and symptoms of pelvic floor conditions.

If you visit AUI with concerns about a pelvic floor disorder, you will have the benefit of a coordinated, multidisciplinary approach to diagnosis and treatment. Our experts will give you care tailored to your needs and ensure you completely understand your condition and the risks and benefits of various treatments. For more information on urogynecologic conditions and treatment options, visit the Advanced Urology Institute website.