Frequently Asked Questions

Below are some answers to questiosn you might have about urogynecology.

What Is a Urogynecologist?

A Urogynecologist is an Obstetrician/Gynecologist who has specialized in the care of women with Pelvic Floor Dysfunction. The Pelvic Floor is the muscles, ligaments, connective tissue, and nerves that help support and control the rectum, uterus, vagina, and bladder. The pelvic floor can be damaged by childbirth, repeated heavy lifting, chronic disease or surgery.

Some problems due to Pelvic Floor Dysfunction and their symptoms are:

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. Pelvic (or Bladder) Pain:
   Discomfort, burning or other uncomfortable pelvic symptoms, including bladder or urethral pain.
5. Overactive Bladder:
   Frequent need to void, bladder pressure, urgency, urgency incontinence or difficulty holding back a full bladder.

What Kind of Training Does a Urogynecologist Have?

Urogynecologists have completed medical school and a four-year residency in Obstetrics and Gynecology. These doctors become specialists with additional training and experience in the evaluation and treatment of conditions that affect the female pelvic organs, and the muscles and connective tissue that support the organs. The additional training focuses on the surgical and non-surgical treatment of non-cancerous gynecologic problems including pelvic reconstructive surgery, the evaluation of bladder with cystoscopy and urodynamic testing.

When Should I See a Urogynecologist?

Although your primary care physician or OB/GYN 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 incontinence such as frequency and urgency of urination or getting up at night to urinate, 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, and the need for special expertise in vaginal surgery.

How Can I Prevent Urinary Incontinence and Prolapse?

We don't fully understand all the factors that cause urinary leakage and prolapse, so it is difficult to recommend ways to prevent these problems. Pelvic Floor Exercises (Kegel's) - are probably the best way to prevent stress incontinence and prolapse. Other things that might help include not smoking, avoiding repetitive strenuous activities that involve very heavy lifting (for example lifting 50lb boxes onto a truck several hours a day) and avoiding the use of forceps or vacuum assistance during childbirth.

There is much discussion among urogynecolgists about how much vaginal childbirth (as opposed to cesarean section) and pregnancy itself predisposes to the development of urinary incontinence and pelvic organ prolapse. It is clear that being pregnant and delivering babies are important contributors. However, it is important to remember that there are women who have never been pregnant who leak urine or have prolapse - and women who have delivered many times who do not. There is no clear answer at this time.

If you are troubled by your uncontrolled urine loss or prolapse you should consider seeing your primary care physician or a urogynecologist who can evaluate the problem and recommend appropriate treatment. Seeing a specialist does not mean that you will have to have surgery. Other suggestions are listed below:

• Get yearly pelvic exams to watch for changes or problems.
• Call between visits if you have increasing symptoms

Follow these suggestions:

• Avoid heavy lifting (no more than 20 pounds).
• Watch your weight. Being over weight increases pressure on your pelvic floor.
• If you smoke, try to quit. Smoking decreases circulation to your pelvis and a chronic cough will aggravate pelvic floor prolapse.
• Avoid constipation. Straining with bowel movements increases prolapse. If constipation is a problem for you, talk to us about treatment.
• Learn and practice pelvic floor exercises.
• Hormone replacement may be an option to increase the circulation to your pelvic, and restore some tissue tone.
• Be sure your doctor is measuring your prolapse in a systematic way – so that he/she will be able to notice subtle changes over time. The most commonly used system of measure for prolapse is called the “pelvic organ prolapse quantification” or POP-Q system.

For general information about women's health issues, please visit The American Urogynecologic Society (AUGS).