Urogynecology

At Overlake Clinics – Pelvic Health, we provide innovative female pelvic medicine and reconstructive surgery, urology, and physical therapy services for women at any stage of life. Our providers take a holistic approach to each individual, with the ultimate goal of comprehensively restoring her pelvic function.

What is a urogynecologist?

Urogynecologists specialize 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 even surgeries.

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?

After medical school, urogynecologists complete a full residency training in either obstetrics and gynecology (four years) or urology (five to six years), followed by two to three years of specialized female pelvic medicine and reconstructive surgery fellowship training. 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.

Accredited urogynecology fellowship training assures urogynecologists have had comprehensive, complete training in female pelvic medicine and surgical reconstruction.

When should I see a urogynecologist?

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

• Vaginal prolapse.
• Difficulty emptying the bladder or rectum.
• Some types of pelvic pain.
• Urethral masses.
• Sexual dysfunction.
• Prior pelvic surgeries with recurrent problems or complications.
• Obstetrical or surgical fistula 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 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 pelvic reconstructive surgery, you may want to request a consultation with a urogynecologist so you are able to make an informed decision about your options.

What treatment options are available from a urogynecologist?

Urogynecologists 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:

• Pelvic exercises.
• Behavioral and/or dietary modifications.
• Vaginal support devices.

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. The most common causes of fistulas are post-surgical (i.e., after a hysterectomy) or due to obstetrical tears.