Do embarrassing leaks make you miss work or keep you from going out with friends? Are you always worried about where a bathroom is? Do you notice pressure or a bulge in the vaginal area? Then you’ll want to get expert help from a urogynecologist. Find out:
- What a urogynecologist is
- What they treat
- What to expect when you see one
What is a urogynecologist?
A urogynecologist is a physician and surgeon who specializes in caring for women with pelvic floor disorders – conditions like urinary or bowel leakage, and pelvic organ prolapse.
How is a urogynecologist different from a gynecologist?
Most urogynecologists have completed a 4-year residency in obstetrics and gynecology. A urogynecologist undergoes additional 3-year training (fellowship) to diagnose and treat specific pelvic floor disorders.
The urogynecologists at UVA Health are all board-certified and have completed additional years of specialty training in managing pelvic floor disorders. UVA Health urogynecologists offer both non-surgical and surgical treatments to improve your quality of life due to symptoms of pelvic floor disorders.
What are pelvic floor disorders?
Pelvic floor disorders are a group of health problems that can cause physical discomfort and affect your quality of life. Pelvic floor disorders often interrupt everyday activities like exercise, shopping, travel, and intimate relations.
The most common ones are:
- Urinary incontinence (leakage of urine)
- Fecal incontinence (leakage of stool)
- Pelvic organ prolapse (loss of vaginal, bladder or uterine support)
What causes pelvic floor disorders?
Many things can affect your pelvic floor. But common causes of damage include:
- Repeated heavy lifting
- Straining for bowel movements
- Some chronic diseases
- Family history of pelvic floor disorders
How commonly do women experience symptoms of pelvic floor disorders?
Pelvic floor disorders impact nearly 1/4 of U.S. women. They can happen at any age but are more common as we age. A study funded by the National Institutes of Health found that pelvic floor disorders affect:
- More than 40% of women age 60 to 79
- About 50% of women 80 and older
When should I seek treatment from a urogynecologist?
Women of all ages can experience a pelvic floor problem. You don't have to live in discomfort or settle for a less active lifestyle. Consider a visit with a urogynecologist if you can answer yes to any of these:
- Leak when you sneeze, cough, lift, run, etc.
- Are feeling isolated, limiting travel, or missing work due to pelvic floor symptoms
- Are consumed with where bathrooms are
- Not exercising
- No longer having sex
When you come to UVA Health, our urogynecology providers will:
- Listen carefully as you describe your symptoms
- Understand your specific treatment goals
- Perform a pelvic exam
- Help you understand what's going on in your body
- Create an individualized treatment plan for you
What is the pelvic floor?
The pelvic floor is a complex and essential group of muscles, ligaments, and connective tissues. It stretches across the bottom of the pelvis. It forms a supportive hammock-like structure. It supports all the organs within the pelvic cavity. This includes the bladder, uterus, and rectum.
The pelvic floor muscles play a vital role in lots of bodily functions, such as:
- Maintaining continence: They help control the release of urine, feces, and gas by closing off the openings to the urethra, vagina (in women), and anus.
- Providing support to the pelvic organs: The muscles prevent the descent (prolapse) of these organs. Prolapse occurs when an organ slips out of its normal position, causing a hernia in the vagina.
- Sexual function: The muscles contribute to sexual sensation and function in both men and women.
- Stability: Your pelvic floor muscles help keep your core stable. They work together with other muscles, such as the diaphragm, abdominal muscles, and lower back muscles.
Maintaining a strong and healthy pelvic floor is essential for overall well-being. You can do pelvic floor exercises (such as Kegel exercises) to strengthen the muscles.
Is incontinence a normal part of aging, especially if you've given birth?
Urinary incontinence is when uncontrolled loss of urine affects your quality of life.
It’s not just a normal part of aging or the result of giving birth to a child. It can affect every aspect of your life and has many different causes. Some are simple and temporary.
Others are more long-term and may require more involved solutions. A urogynecologist can usually treat this condition, and in many cases greatly improve your quality of life.
How is urinary incontinence treated?
Treatment depends on what type of incontinence you have. Stress and urge incontinence are the two main types. Urge incontinence is also called overactive bladder.
Both types can be helped by strengthening your pelvic floor muscles with Kegel exercises, and sometimes with simple behavioral changes like what you drink and how often you void. Lifestyle changes – especially weight loss – are particularly helpful.
Stress incontinence is often managed by surgery. Fortunately, we have highly effective, minimally invasive outpatient surgeries to treat stress incontinence.
Urge incontinence is usually treated with behavioral changes or medication. But if your overactive bladder symptoms don’t improve with lifestyle modification and medications, bladder botox therapy or sacral nerve modulation can help.
Learn more about urge and stress incontinence.
What is sacral nerve modulation & how does it help with urge incontinence?
Sacral nerve modulation is an FDA-approved therapy. It functions much like a pacemaker for your bladder.
It is used to treat urge incontinence or overactive bladder if medication doesn't help or you're unable to tolerate these medications due to side effects.
Sacral nerve modulation is done as a two-step outpatient surgical procedure.
First, the physician places a nerve stimulator at the level of the low back — the location for the nerves that control your bladder function.
The stimulator is then attached to a small battery. This allows you to set the level of nerve stimulation required to control your overactive bladder.
How does bladder botox work?
Botox injections are done in an office setting, using a small lighted camera placed inside your bladder (cystoscopy).
A series of small injections into the bladder wall helps calm down overactivity of the bladder muscle. This procedure sometimes needs to be repeated every 6 months.
For many women with unsuccessful prior medical treatments, this procedure can dramatically cut down on daily urinary leakage episodes.
I leak stool. Can you help this condition?
Urogynecologists are experts in treating many different causes of loss of stool control.
Commonly, you can manage this by paying attention to your diet, bowel habits, and pelvic muscle strength.
In some cases, your loss of control may be due to the damage done to your anal sphincter muscle during a vaginal delivery. If you experienced a known tear to this muscle at childbirth, you may need surgery to repair the muscle.
At UVA Health, we offer comprehensive evaluation and treatment of accidental bowel leakage.
How do you treat loss of support or prolapse of the pelvic organs?
Some women experience loss of the support structure for your bladder, vagina, uterus, or rectum. Pelvic organ prolapse is more common if you’ve had children by vaginal delivery.
If it becomes bothersome, you may feel a sense of pressure or bulging in your vaginal area. Sometimes you can even feel or see a bulge outside of your vagina. We offer multiple surgical and non-surgical alternatives for all types of prolapse:
- Cystocele: Loss of support for your bladder. This may contribute to urinary leakage, difficulty in starting your urine flow, or even trouble emptying your bladder.
- Rectocele: When the rectal wall presses into the space of your vaginal wall, it can become difficult to start or complete a bowel movement.
- Uterine prolapse: or vaginal prolapse if you've had a hysterectomy. This can affect your bowel or bladder function, or simply cause sensations of pressure.
Will Kegel exercises cure most pelvic health concerns?
Kegel exercises are a great way to strengthen your pelvic floor muscles. However, a weak muscle isn't always the cause of the problem. If the pelvic floor muscles are not the source of your problem or if your muscles are already too tight, Kegel exercises won't help.
Kegel exercises didn’t solve my problem. Should I keep doing them?
Definitely yes – as long as you are doing them correctly.
We will check your muscle strength as part of your visit with us. Even though Kegel exercises may not resolve your pelvic floor condition, there is no question that you benefit from maintaining strong muscles.
Your condition could even get worse if these muscles are not strong. Keeping strong muscles is an excellent way for you to participate in your treatment and to improve your treatment results.
Whether you choose a non-surgical or surgical approach to your condition, Kegel exercises help.
What can I expect at a urogynecology appointment?
Before your appointment at UVA Health, we’ll have you complete 2 things:
Patient questionnaire form. This gives us a better sense of your pelvic complaints. We want to know how much they bother you, and how they are affecting your life and activities.
If you have urinary symptoms, we may ask that you complete a 3-day voiding diary. This keeps track of your fluid intake and urine output. An important part of your evaluation, this helps us better understand how your bladder functions on a typical day.
Once you arrive for your appointment, we’ll review your health history and specific concerns. We’ll also request a urine sample.
Get a Specialized Evaluation
Your physical examination will be much like a typical gynecologic exam. But it will be a more detailed focus on the support of your bladder, uterus, vagina, and rectum.
We’ll also evaluate the strength of your Kegel contractions and the overall tone and health of the pelvic floor.
If your pelvic organs are falling or bulging, we may examine you both lying down and standing. Loss of support may be more obvious when you are standing.
We may request that you pee. And then we'll check to see if you are emptying your bladder.
Depending on your history and physical examination findings, we may also suggest testing. We perform several tests in our office. These may help more fully diagnose your condition.
Talk About Treatment Options
Your specialist will then propose and explain a variety of clinical therapies to cure or improve symptoms of prolapse, urine or bowel leakage, or other pelvic floor symptoms.
The specialist may advise conservative (non-surgical) or surgical therapy. This depends on your wishes, the seriousness of your condition, and your general health.
Conservative options include medications, pelvic exercises, behavioral and/or dietary changes and vaginal devices (also called pessaries).
Surgical procedures may also be discussed to treat incontinence and prolapse. We also offer a variety of different surgical procedures. The suggestions for your surgery will be based on your specific condition and testing results. Before you make a treatment decision, your doctor will discuss all of the options that are available to treat your specific problem(s).
What is robotic minimally invasive pelvic reconstructive surgery?
The surgical robot allows UVA Health surgeons to perform most abdominal surgeries without making a large incision. The UVA academic pelvic surgery group was the first to perform robotic-assisted pelvic organ prolapse surgery in Virginia.
We combine the robot with laparoscopic surgery because it usually means our patients have:
- Less discomfort
- Shorter hospital stay
- Faster recovery
Laparoscopic surgery uses a lighted telescope. Most commonly we place it through a small incision at your belly button to visualize the inside of your abdomen. We make additional small incisions to place surgical instruments.
A robot uses surgical instruments that move exactly with the surgeon’s hand. And a 3-D viewing system allows the surgeon to perform these complex surgeries in a minimally invasive way.
If I choose pelvic surgery, do I need to take months off from work?
Typically, we'll get you back to your life and feeling good in weeks, not months. We offer a range of treatment options that we'll discuss during your appointment. If surgery is the best treatment for you, rest assured that your comfort, healing, and speedy recovery are our top priorities.
What will my recovery be like after surgery?
Normal physical activity is expected within hours of your procedure. Start with short walks. Then gradually increase how far and long you walk.
Climbing stairs is fine. But you may need some assistance at first.
Limit lifting to under 10 pounds (about a 1 gallon container) for 4-6 weeks.
Don't shower the first 24 hours after surgery. And don't take baths for at least 1 week. Sitz baths are permitted.
Get back to driving 3-5 days after surgery. But be cautious if taking prescription pain medications.
Resume sex 2-3 months after surgery.
Return to work in 3-4 weeks after surgery. Some patients may have fatigue for a few weeks.
No dietary restrictions unless diabetic.
Take medications to help ease pain and prevent constipation. We'll guide you in the days after surgery on the best medicines for you.
Can I bring someone with me to my procedure?
Yes, you are welcome to bring someone.
Can I drive myself home?
You can drive yourself to and from the office where procedures are performed. Though, you’ll need someone to drive you if you’ve been given an oral sedative before the procedure.
Does insurance cover pelvic floor surgery?
Most all procedures and surgeries are covered by insurance as long as you have both:
- Completed a pelvic floor and/or bladder or bowel evaluation
- Documentation of other prior therapies
Do I need a referral from my doctor to see a urogynecologist?
No referral is necessary to make an appointment to see a pelvic floor specialist at UVA Health. Call us at 434.424.5440 in Charlottesville or 540.640.6831 in Culpeper to request a consultation.