Urogynecology

A urogynecologist is a physician who specializes in treating women with a variety of disorders to the pelvic floor. This specialist is also sometimes called a female urologist.

Before the urogynecology specialty was created, women with pelvic-floor disorders typically had to visit multiple specialists and receive treatment for problems in the urinary, gastrointestinal and reproductive systems separately. A urogynecologist can manage all these conditions comprehensively.

In addition to completing medical school, a urogynecologist must have completed a four- or five-year residency program in urology or obstetrics and gynecology, plus an intensive three-year fellowship in female pelvic medicine and reconstructive surgery.

The pelvic floor is the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum and help these pelvic organs function.

The National Institutes of Health estimate one-third of women in the United States will experience pelvic-floor disorders in their lifetime. Childbirth, repeated heavy lifting, chronic diseases and surgery can weaken the pelvic floor. Inherited factors also can contribute.

While pelvic-floor disorders become more common as you get older, they are not inevitable. Depending on the severity of your condition, a range of treatments are available to minimize the symptoms or repair the damage.

In addition to a comprehensive history and physical examination, our physicians may also rely on several types of evaluations, including:

Urodynamics: A small catheter is placed into the patient’s bladder to measure pressure in the bladder and urethra while the bladder is filled with water. The patient answers a series of questions to help determine how much her bladder can hold, after which she urinates, and the amount or urine is measured. The test is not painful and lasts approximately 20 minutes. The patient may stop the test at any time.

Cystoscopy: A small tube-shaped camera is inserted through the urethra to view the bladder for details that are difficult to see with an X-ray. The cystoscope is flexible and no larger than a catheter. The camera is attached to a monitor so that the patient can view the inside of her bladder as well. The test is not painful and lasts approximately 5 minutes. The patient may stop the test at any time.

Urinalysis: A patient’s urine is checked at each visit to ensure that she does not have an infection.

Bladder ultrasound: An image of the patient’s bladder is taken at each visit to ensure you she is emptying it completely. This is not invasive or painful.

Endo-anal ultrasound: A small ultrasound probe is gently inserted one inch into the rectum to see if the anal sphincter is intact.

Pelvic-muscle evaluation: A physical exam or an electronic monitoring device is used to measure the patient’s ability to contract her pelvic muscles.

Anorectal manometry: A small balloon is placed in the rectum to measure the strength and ability of the rectum to contain the bowels. While awkward, this test is not painful and lasts only a few minutes. The test may be stopped at any time.

Radiology: A variety of X-rays may be used as appropriate to aid diagnosis.

Once our doctors determine the cause of your pelvic-floor disorder, they may provide a variety of treatment options, including:

• Medications.
• Physical therapy.
• Behavior modification.
• Alternative medicine.
• Reconstruction of the pelvic floor using both minimally-invasive and more complicated surgical techniques. Specialties include vaginal, abdominal, laparoscopic and robotic surgery using da Vinci technology.