FAQs About Urogynecology

What is a urogynecologist?

A urogynecologist is a physician with special training in urology, gynecology and obstetrics who focuses on the evaluation and treatment of non-cancerous conditions concerning the female pelvic organs and their supporting muscles and tissues, as well as pelvic reconstructive surgery. The sub-specialty of urogynecology, now known as female pelvic medicine & reconstructive surgery, was created in the 1990s. Urogynecologists complete medical school and do a four-year residency in obstetrics and gynecology. They then go on to do specialized training in urogynecology for three additional years. Women who had to see multiple specialists for urinary, reproductive and gastrointestinal problems can now see one urogynecologist.

What medical conditions do urogynecologists treat?

Urogynecologists treat urinary incontinence, fecal incontinence and pelvic floor disorders such as pelvic organ prolapse. Approximately one in three women will experience one of these conditions. Urinary and fecal incontinences involve a lack of control over those functions.  The pelvic floor is the system of muscles, ligaments and tissues that support the bladder, urethra, uterus, vagina, small bowel and rectum in the pelvic area. Pelvic floor disorders are conditions involving a weakening of support for those organs, often leading to prolapse.

What is pelvic organ prolapse?

Pelvic organ prolapse happens when one or more of a woman’s organs in the pelvic area drops (prolapses) from its normal position to push against the walls of the vagina. Prolapse occurs because the downward pressure of the pelvic organs is greater than the strength of the supporting muscles and ligaments. With pelvic organ prolapse, many women feel fullness in the vagina, and as the prolapse increases, tissue may protrude from the vagina.

What causes incontinence and pelvic floor disorders?

Urinary and fecal incontinence and pelvic floor disorders may be caused by several things, including damage that harms the pelvic floor muscles, nerves or supporting tissues, childbirth and genetics. Smoking and obesity can also contribute to urinary incontinence. Pelvic floor disorders may be caused by aging, repeated heavy lifting, chronic diseases, genetics or surgery.

Can I do anything about incontinence on my own?

Depending on your particular circumstances, there are several things you can do to treat incontinence. Doing pelvic floor muscle exercises (Kegel exercises) to strengthen your pelvic floor muscles can help with your bladder control and can even prevent pelvic floor disorders from occurring. Eating foods that are high in fiber can ease the stress on bowels, and avoiding caffeine and certain other beverages can increase your bladder control. Behavior modification in the form of bladder training can help control the timing of urination.

Maintaining proper weight, not smoking and avoiding excessive stress in lifting can help reduce your risk of pelvic floor disorders.

Should I be embarrassed to talk about my bladder control problems?

Loss of bladder control, or bowel control, can certainly be embarrassing, but talking about it with a urogynecologist shouldn’t be. These specially-trained doctors are both skilled and compassionate in talking to women about such problems, and their goal is the same as yours: to relieve or eliminate your incontinence problems. Women today should not tolerate urinary incontinence, yet many women do so silently, and do not seek the medical help that can greatly improve their lives. It’s important to know that many conditions can be treated or cured, and the first step is talking to a urogynecologist.

What kind of treatments should I expect?

Pelvic floor disorders and urinary and fecal incontinence problems often occur in various degrees, caused by differing factors and conditions. Likewise, treatment options vary, beginning with simple lifestyle changes. Treatment may also involve medications, the use of organ supporting devices, or minimally-invasive surgery to more complex surgeries.

Your physician will recommend treatments that are right for you, and you will be thoroughly involved in what treatments you choose to pursue. 

Is it possible that my pelvic floor problem will just go away over time?

It is not likely that a pelvic floor disorder will go away on its own. In some cases of pelvic organ prolapse, a urogynecologist may suggest doing nothing and observe the situation over time, provided that the symptoms are not too unpleasant for the woman. Depending on the problem, it is also likely that if left untreated, incontinence or pelvic floor disorder will get worse. The result could be that a problem that might have responded to a simpler treatment early on could require a more complex treatment later.

I’ve heard that bladder surgery often doesn’t work. Is this true?

In the past, “bladder lifts” and incontinence procedures had a reputation for high recurrence rates. However, the field of urogynecology has progressed and continues to develop every day. New procedures have evolved, and urogynecologists are more specifically focused on these procedures and conditions, resulting in improved success rates. Your urogynecologist will discuss all aspects of possible surgery so you are well prepared to make the ultimate decision on your treatment.

If I need pelvic floor surgery, how long will it take to recover?

This is a reconstructive surgery and the body should be given ample time to heal without undue physical stress. Many women can return to work or their daily life soon after surgery, as long as they do not bend, lift, squat or otherwise stress their pelvic floor. This period of limited activity may last for up to three months, depending on the surgical procedure, or may be much shorter. Your physician will prepare you with lifestyle changes that will protect your pelvic floor during recovery and afterward.

Can a urogynecologist conduct my annual well woman examination?

Yes. Trained in general gynecology, and obstetrics, a urogynecologist is perfectly suited to conduct a woman’s annual wellness examination.