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Overlake Medical Clinics Pelvic Health Clinic offers innovative female pelvic medicine and reconstructive surgery, urology, and physical therapy services for women of all ages.

What is a Urogynecologist?

A urogynecologist is a physician who specializes in the care of women with pelvic floor disorders. The pelvic floor comprises the muscles, ligaments, connective tissues and nerves within the pelvic bones that help support and control the normal function of the rectum, uterus, vagina and bladder. The pelvic floor can be inherently weak, or damaged by childbirth, repeated heavy lifting, some chronic diseases, smoking or surgery.

Some symptoms women with pelvic floor disorder may experience include:

  • Incontinence - loss of bladder or bowel control, leakage of urine, flatus or feces.
  • Prolapse - descent of the uterus, bladder, vagina, or rectum; a bulge and/or pressure from the uterus, bladder, vagina or rectum.
  • Emptying disorders - difficulty urinating or moving bowels.
  • Pelvic (or bladder) pain - discomfort, burning or other uncomfortable pelvic symptoms, including bladder or urethral pain or pain with sex.
  • Overactive bladder - frequent need to void, bladder pressure, urinary urgency and/or difficulty holding a full bladder.

What Kind of Training Does a Urogynecologist Have?

Urogynecologists have completed medical school (4 years) and a full residency in obstetrics and gynecology (4 additional years), or urology (an additional 5-6 years), followed by additional fellowship training after residency. Urogynecology sub-specialty training focuses exclusively on the evaluation and treatment of conditions that affect the female pelvic organs and the muscles and connective tissues that support these organs.  Urogynecologists are trained in clinical pelvic medicine, as well as surgical reconstruction to restore pelvic anatomy and bowel, bladder, and sexual function.

The field of urogynecology has been in evolution for the last 20 years. Historically, physicians who wanted to specialize in urogynecology would be mentored by a senior surgeon, much like an apprenticeship, that would last 1-2 years. There was no governing body to assure these fellowships were consistent or comprehensive until the late 1990s when the two governing boards of urology and obstetrics/gynecology formed a joint accrediting board to approve 3 year accredited urogynecology fellowship training programs.

Accredited urogynecology fellowship training assures urogynecologists have had comprehensive, complete training in female pelvic medicine and surgical reconstruction, Although there are many urologists and gynecologists practicing urogynecology, only those physicians who’ve completed an accredited fellowship programs have the highest credentialing standards in their field.

When Should I See a Urogynecologist?

Although your primary care physician may have knowledge about these problems, a urogynecologist can offer expertise in treating women’s pelvic health problems. You should see (or be referred to) a urogynecologist when you have one of the following problems:

  • organ prolapse.
  • emptying the bladder or rectum.
  • pelvic pain.
  • urethral masses.
  • sexual dysfunction.
  • or the need for special expertise in surgery involving the uterus, vagina, bladder or labia/vulva/perineum.

If you are considering a hysterectomy for non-cancerous reasons, you should consult with a urogynecologist for counseling about uterine-sparing options, and the different options for pelvic suspension procedures.

Urogynecologists are expert surgeons in reconstructing the pelvic floor to restore optimal bowel, bladder, and sexual function. If you are considering any pelvic reconstructive surgery, you should have a consultation with a urogynecologist so that you are able to make an informed decision about your options.

What Treatment Options are Available from a Urogynecologist?

A urogynecologist can recommend a variety of therapies to cure or relieve symptoms of prolapse, urinary or fecal incontinence, or other pelvic floor dysfunction symptoms. Your urogynecologist may advise conservative (non-surgical) or surgical therapy depending on your wishes, the severity of your condition and your general health. Conservative treatment options include:

  • medications
  • pelvic exercises
  • behavioral and/or dietary modifications
  • vaginal support devices (also called pessaries).

Biofeedback, electric stimulation, or neuromodulation are newer treatment modalities that your urogynecologist may recommend. Safe and effective surgical procedures are also used by urogynecologists to treat incontinence and prolapse. Your urogynecologist will discuss all of the options that are available to treat your specific problem(s) before you make your treatment decision. 

Other disorders treated by urogynecologists include fistulas.  A fistula is an abnormal connection between two organs. It can occur between the bladder and vagina, or between the rectum and vagina, for example.  A fistula that develops between the bladder and vagina will result in continuous loss of urine through the vagina.  A fistula that develops between the rectum and vagina will result in seepage of stool through the vagina. The primary cause of fistula in underdeveloped countries is obstetrical. In the United States obstetrical fistulas are rare, and common causes of fistulas are post-surgical (after hysterectomy, for example) or due to inflammatory bowel conditions.

Understanding Prolapse

Pelvic organ prolapse is a weakness in the fibrous tissue (fasciae) that prevents bulging of our internal organs.  It is essentially a vaginal hernia.  For the most part, pelvic organ prolapse is not dangerous, but can have a significant impact on a woman’s quality of life.  How is prolapse similar to a hernia?  If you first think of the abdomen, we have muscles and connective tissue (called fasciae) that make up a "girdle" to keep our small and large intestines in place.  When there is a weakness in the abdominal wall, bulging of our intestines can occur.  Other than when the intestines become incarcerated (stuck), the intestines are not affected by a hernia, it is essentially a weakness in the abdominal wall.  Treatments for abdominal hernias focus on repairing the integrity and support of the muscle and fasciae (girdle) of the abdominal wall.  Similarly, pelvic organ prolapse can occur when there is a weakness in the connective tissue of the vaginal walls and those tissues supporting the uterus. 

There are different types of prolapse and they can occur singly, or together. 

A weakness of the anterior vagina is often called a cystocele. A weakness of the posterior vagina is known as a rectocele.  When the uterus loses support, we refer to that as uterine prolapse.  After hysterectomy, the top of the vagina can lose support, referred to as apical prolapse.

Prolapse is common with estimates of prolapse identifiable in 19-34% of women during gynecologic examination. The risk factors for pelvic organ prolapse include:  genetic factors, childbirth, hormonal (menopause), tobacco use, or anything that leads to chronic increases in intra-abdominal pressure that is transmitted to the pelvis (obesity, heavy lifting, constipation). 

Prolapse is staged with stage 0 = no prolapse and stage 4 = advanced prolapse. Most women will have minimal or no prolapse symptoms until the prolapse advances to stage III or greater.  The types of symptoms women may experience include:

  • A feeling of a lump, a bulge or a heavy sensation in the vagina.
  • Lower back pain that eases when you lie down.
  • Pelvic pain or pressure.
  • Decreased sensation during intercourse.