What is urogynecology?
Urologists commonly treat conditions specific to the lower urinary tract (bladder and urethra) as well as the upper urinary tract (ureters and kidneys). Whereas gynecologists specialize in the health of the female reproductive system, which includes the uterus, cervix, vagina and ovaries. Urogynecology is a specialized field focusing on the diagnosis and treatment of conditions that affect the female pelvic organs as well as the pelvic floor – the tissues and muscles supporting the pelvic organs.
This specialty is a unique combination of gynecology, urology and reconstructive surgery. Urogynecology is also known as female pelvic medicine and reconstructive surgery because it addresses a variety of conditions that can affect the female pelvis.
The difference between a urologist and a urogynecologist
A urologist is a physician who specializes in the diagnosis and treatment of urinary tract disorders of both male and female patients and the reproductive system of males. They have specialty training in both conservative and surgical management of the kidneys and urinary tract.
A urogynecologist is a physician who specializes in treating women with complex benign pelvic conditions, pelvic floor dysfunction and lower urinary tract disorders. Urogynecologists are trained in the comprehensive management of pelvic floor conditions, most commonly pelvic organ prolapse (see below) or urinary incontinence (see below).
Urogynecologists complete medical school, a four-year residency program in obstetrics and gynecology (OB/GYN), and three years of post-residency fellowship training in urogynecology/female pelvic medicine and reconstructive surgery.
What do urogynecologists treat?
Urogynecologists provide care for women suffering from pelvic floor disorders (PFDs). The pelvic floor is a system of ligaments, muscles and tissues that supports the uterus, vagina, bladder, urethra, small bowel and rectum. PFDs include the various types of incontinence and pelvic organ prolapse. PFDs occur when the vaginal walls become relaxed and the support structures of the pelvic floor weaken.
The most common types of PFDs follow.
- Overactive bladder syndrome (OAB) is when women have bothersome urinary urgency and/or urinary frequency and sometimes nighttime wakings due to a need to urinate. This condition can, but does not always, result in uncontrollable leakage of urine known as urinary incontinence.
- Urinary incontinence (commonly referred to simply as incontinence) is also known as uncontrollable leakage of urine. There are several types of urinary incontinence, the most common of which are stress urinary incontinence (SUI) and urge urinary incontinence (UUI). SUI is the leakage of urine associated with coughing, sneezing, laughing, jumping or other similar activities. UUI is leakage of urine associated with the sudden need to urinate.
- Pelvic organ prolapse (POP) is one of the most common PFDs. Commonly referred to simply as prolapse, POP occurs when one or more of the organs in the pelvis, such as the uterus and the cervix or the inner vaginal walls, become relaxed to the point of dropping close to or beyond the vaginal opening. The prolapse causes women to feel a pressure, fullness or a bulging sensation in the vagina, though some women with POP feel no discomfort at all. In some cases, the vaginal tissue may begin to protrude from the vagina, which can be physically uncomfortable, conceptually bothersome and emotionally distressing.
- Fecal incontinence, which is also known as bowel or anal incontinence, is the inadvertent loss of stool. This can result in leakage of liquid, solid or gas bowel contents.
- Pelvic pain can arise from any of the organ systems housed within the female pelvis. Urogynecologists specialize in the diagnosis and treatment of most pain syndromes that originate in the pelvis.
Causes of and treatments for urogynecology PFDs and incontinence
Pelvic organ prolapse and urinary incontinence are generally not dangerous. It is estimated that 41 percent of postmenopausal women over age 60 years, who have not had a hysterectomy, will experience POP. However, younger women as well as women who have had surgical removal of the uterus and cervix can also experience POP. The most common risk factors for PFDs include age, genetics, childbirth and other lifestyle considerations.
A urogynecologist works with patients to identify the proper treatment for their condition. Treatments range from lifestyle changes to surgery.
Treatments for pelvic organ prolapse
- Lifestyle changes: A urogynecologist may suggest that an individual make modifications to her lifestyle such as dietary changes or weight loss. This type of change can help improve prolapse symptoms.
- Physical therapy: Kegels (also known as pelvic floor muscle strengthening) can help those suffering from pelvic floor disorders. A urogynecologist can assess an individual’s pelvic floor muscle strength and potential for success with this type of therapy.
- Pessary: These intra-vaginal support devices hold up the organs or vaginal walls that are falling. They can be removed and replaced by a physician. In conjunction with her physician, a patient can also be taught how to manage her own pessary.
- Surgery: Suspension procedures and surgeries can be performed, which involve restoring normal anatomy to the vagina. This may or may not involve surgical removal of the uterus.
Treatments for stress urinary incontinence
- Lifestyle changes: This type of change can help improve incontinence symptoms.
- Physical therapy: Kegels can help those suffering from incontinence.
- Pessary: This can be used for incontinence by compressing the urethra to prevent urinary leakage.
- Procedures: Urethral bulking is a procedure whereby the physician can inject a material into the muscle of the urethra to help prevent urinary leakage.
- Surgery: A urethral sling can be surgically placed under the urethra to help prevent urinary leakage. The most common type of slings used for SUI are made from synthetic material. However, slings can also be created from patients’ own tissues, called fascial slings.
Treatments for overactive bladder and urge urinary incontinence
- Medications: Antispasmodic or anticholinergic drugs may be prescribed to minimize the effects of an overactive bladder.
- Nonsurgical devices: Percutaneous tibial nerve stimulation (PTNS) provides indirect electrical stimulation to the nerves responsible for bladder function. In this procedure, an acupuncture-type needle is placed near the ankle.
- Injections: Botox causes the bladder muscle to relax and reduces bladder muscle spasms.
Treatment for fecal incontinence and severe OAB & UUI
- Implantable devices: Sacral neuromodulation is using an implantable device to send electrical stimulation to the sacral nerves, which control the bladder and the rectum.
When to seek out a urogynecologist
Incontinence and POP can be bothersome, embarrassing and significantly impact the lives of women who suffer from these conditions. But because they are sensitive topics to discuss, many women do not bring up these urogynecologic problems with their physicians, foregoing treatments that could significantly improve their quality of life. Those experiencing PFDs should contact their urologist, OB/GYN or primary care provider to discuss whether seeing a urogynecologist is the appropriate next step.