A urogynecologist is a physician with specialized training in female pelvic medicine and reconstructive surgery. They complete a four-year residency in obstetrics and gynecology, followed by two to three years of specialized fellowship training. This dual expertise allows them to address non-cancerous conditions affecting the female pelvic organs and their supporting muscles and tissues, providing comprehensive care for complex pelvic floor disorders.
Key Conditions Addressed
Urogynecologists diagnose and treat conditions impacting the female pelvic floor. Pelvic organ prolapse occurs when weakened pelvic muscles and tissues cause organs like the bladder, uterus, or rectum to descend. Common types include cystocele (where the bladder bulges into the vagina), rectocele (where the rectum bulges into the vagina), and uterine prolapse (involving the uterus moving into the vaginal canal). These conditions often create a sensation of pressure or a bulge.
Urinary incontinence is involuntary urine leakage. Stress urinary incontinence involves leakage during physical activities like coughing, sneezing, or exercising. Urge incontinence, also known as overactive bladder, is characterized by a sudden, intense need to urinate resulting in involuntary leakage. Some individuals experience both, called mixed incontinence.
Fecal incontinence involves the involuntary loss of bowel control, ranging from occasional leakage of gas or liquid stool to complete loss of solid stool. Causes often include nerve or muscle damage, often resulting from vaginal childbirth or chronic constipation.
Urogynecologists also manage pelvic fistulas, abnormal connections between pelvic organs. For instance, a vesicovaginal fistula connects the bladder and vagina, leading to continuous urine leakage. A rectovaginal fistula creates a passageway between the rectum and vagina, potentially causing gas or stool to pass through the vagina. These can arise from prolonged childbirth, pelvic surgery complications, or radiation treatment. They address childbirth injuries, such as perineal tears and pelvic floor muscle damage, which can lead to incontinence or prolapse. Chronic pelvic pain linked to pelvic floor muscle dysfunction is also within their scope.
Recognizing Symptoms That Warrant a Visit
Recognizing specific symptoms can indicate the need for a urogynecology consultation. Involuntary leakage of urine or stool is a common sign, including urine leakage with coughing, sneezing, or exercise, or inability to control bowel movements.
A sensation of heaviness, bulging, or pressure in the vagina or pelvis may suggest pelvic organ prolapse, sometimes described as something “falling out” or a ball-like sensation. Difficulties with urination, such as frequent urges, incomplete bladder emptying, or pain during urination, are relevant symptoms. Issues with bowel movements, including chronic straining or inability to fully empty, can also point to pelvic floor problems.
Persistent pelvic pain, especially if it interferes with daily activities or intercourse, warrants evaluation. Discomfort or pain during sexual activity is another symptom. While these symptoms are common, they are not normal aspects of aging or childbirth and should prompt a specialist visit.
Distinguishing Urogynecology from Other Specialties
Understanding the distinct role of a urogynecologist compared to other medical specialists helps patients seek appropriate care. General obstetrician-gynecologists (OB/GYNs) provide broad women’s health care, including routine exams, reproductive health, and pregnancy care. While OB/GYNs can manage some pelvic floor issues, they often refer patients to a urogynecologist for complex or severe pelvic floor disorders requiring specialized expertise.
Urologists focus on conditions affecting the urinary system in all individuals. Urogynecologists, however, specialize in the female urinary and reproductive systems, especially when issues involve the pelvic floor. Their training integrates both gynecological and urological knowledge, allowing for a comprehensive approach to female-specific urinary problems and their interconnectedness with pelvic organ support.
What to Expect During Your Appointment
A visit to a urogynecologist begins with a detailed review of your medical history and symptoms. The physician will ask about the nature of your symptoms, how they impact your daily life, and any relevant medical background. This discussion helps understand your condition.
Following the history, a physical examination is performed. This includes a general physical assessment and a thorough pelvic examination. During the pelvic exam, the physician assesses pelvic floor muscle strength and organ position to identify prolapse or weakness.
Diagnostic tests may be conducted to evaluate your condition. These include urine tests, or urodynamic studies, which assess bladder function by measuring how well the bladder stores and empties urine. In some cases, a cystoscopy might be performed, involving inserting a small, flexible tube with a camera to visualize the bladder’s interior.
Based on the findings, the urogynecologist will discuss treatment options. These range from conservative management (pelvic floor physical therapy, lifestyle modifications) to medications. Surgical interventions are also considered, with plans tailored to your specific needs and goals.