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Urogynecology, also known as Female Pelvic Medicine and Reconstructive Surgery, is a subspecialty of gynecology and urology. Urogynecologists specialize in the care of women with pelvic floor disorders including vaginal wall prolapse, urine leakage, and stool leakage.
The pelvic organs include the vagina, cervix, uterus, bladder, urethra, small intestines, and rectum. These organs are held in place by muscles of the pelvic floor and layers of connective tissue called fascia. These supporting muscles and fascia may become torn or stretched, or they may weaken because of aging. In this condition, the tissue and muscles can no longer support the pelvic organs. As a result, the organs can drop downward.
The main cause of pelvic organ prolapse is having had children. Women who have had a vaginal delivery have a slightly increased risk of pelvic support problems than those who have had a cesarean delivery. Other causes of pelvic support problems include the following:
- Prior pelvic surgery
- Intense physical activity
- Factors that increase pressure in the abdomen, such as being overweight or obese, constipation and straining to have a bowel movement, and chronic coughing
- Genetic factors
One of the most common pelvic floor disorders is urinary incontinence (UI). An estimated 20 million people in the United States have bladder control problems. UI affects both men and women, although it is nearly twice as common in women. Involuntary loss of urine is experienced by more than 95 percent of females at some time during their lives. There are several types of urinary incontinence:
- Stress urinary incontinence—Loss of urine when a woman coughs, laughs, or sneezes. Leaks also can happen when a woman walks, runs, or exercises. It is caused by a weakening of the tissues that support the bladder or the muscles of the urethra.
- Urge incontinence—Leakage of urine caused by overactive bladder muscles that contract too often or problems with the nerves that send signals to the bladder.
- Mixed incontinence—A combination of both stress and urge incontinence symptoms.
- Overflow incontinence—Steady loss of small amounts of urine when the bladder does not empty all the way during voiding. It can be caused by an under active bladder muscle or blockage of the urethra.
Though common, UI should not be accepted as a normal result of aging. The choice to seek treatment is usually based on how bothersome the leakage is and how it affects a woman’s quality of life. There are lifestyle changes that can be used to help manage urinary incontinence. If any of these apply to you, you may want to consider making one or more of these changes.
- Lose weight. In overweight women, losing weight has been shown to decrease the frequency of urine leakage.
- Avoid constipation. Repeated straining may damage the pelvic floor.
- Drink less fluids and limit intake of caffeine, which is a diuretic.
- Seek treatment for chronic coughing.
- Stop smoking.
When to See a Urogynecologist
You should see a urogynecologist when you have symptoms of prolapse, troublesome urinary or bowel incontinence, sexual dysfunction, or when your primary care physician or obstetrician/gynecologist recommends consultation with a specialist. Other issues that may prompt you to consult a urogynecologist include problems with emptying the bladder or rectum, pelvic pain, and the need for special expertise in vaginal surgery. Although your primary care physician or obstetrician/gynecologist may have knowledge about these problems, a urogynecologist can offer additional expertise. We do not require a physician referral to schedule an appointment with one of our providers. If you have insurance, you may want to check with your insurance provider to see if they require a referral to ensure optimal coverage.
Symptoms of pelvic floor dysfunction
- Incontinence (Loss of bladder or bowel control, leakage of urine or feces)
- Prolapse (Descent of pelvic organs, causing a bulge and/or pressure in the pelvic region brought on by a “dropped” 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)
- Overactive Bladder (Frequent need to urinate, bladder pressure, urgency incontinence or difficulty holding back a full bladder)
Your urogynecologist can recommend a variety of therapies to cure or relieve symptoms of prolapse, urinary or fecal incontinence and other pelvic floor problems. He or she may advise nonsurgical or surgical therapy, depending on your wishes, the severity of your condition and your general health. We offer the full range of treatments for pelvic floor disorders and are experienced in vaginal and abdominal approaches to treatment. Some common examples include robotic sacrocolpopexy, transvaginal suspensions, Interstim, slings, periurethral injections and Botox. Conservative (nonsurgical) options include medications, pelvic exercises, behavioral and/or dietary modifications and use of vaginal devices called pessaries. Biofeedback and electric stimulation may also be recommended as treatment by our pelvic floor physical therapist.
What is a pelvic floor physical therapist?
We often recommend our patients have follow-up consultations and evaluations with a pelvic floor physical therapist. We partner with a team of physical therapists at ATI Physical Therapy who specialize in working with women experiencing urinary, bowel and/or sexual dysfunction. Pelvic floor physical therapists have advanced training in working with the musculoskeletal aspects of these diagnoses and are skilled in evaluating and treating the pelvic floor muscles as well as other musculoskeletal structures around the pelvis. Treatment often includes manual therapy (including myofascial release), specific therapeutic exercise, EMG biofeedback and is individualized to the patient’s needs.
Your pelvic floor therapy may include Kegel exercises to help strengthen the pelvic muscles. Kegel exercises, along with bladder training and modifying fluid intake, are often very successful in treating stress incontinence and urge incontinence. Here is how they are done:
- Squeeze the muscles that you use to stop the flow of urine (but do not do these exercises while you are urinating).
- Hold for up to 10 seconds, then release.
- Do this 10–20 times in a row at least 3 times a day.
Be careful not to squeeze the muscles of the leg, buttock, or abdomen. Do these exercises on a regular basis. It may take 4–6 weeks to notice an improvement in urinary incontinence symptoms.
In addition, pelvic floor physical therapists provide behavioral education to help women understand how to develop healthy habits for bladder, bowel and sexual function. Often times, we find that making small changes in daily routine, nutrition and fluid intake can create significant improvements in function.
What to expect during your first visit to our office
Before your initial visit, you will receive a packet of materials from our office in the mail. This packet will contain questionnaires for you to complete. The information you provide will help us in making a diagnosis. For patients with urinary complaints, you may be asked to include a “voiding diary”. This is a logbook for recording when you urinate, how much and at what time. It is important for you to complete all questionnaires before your arrival at our office. We also ask that you to bring any medical records you have to your first appointment.
After making a diagnosis related to your individual situation, your urogynecologist will propose a treatment plan, including observation, nonsurgical options (such as medication and physical therapy), surgery or some combination of these choices.
Locations & Contact Information
890 W. Faris Road, Suite 510
Greenville, SC 29605
2000 E. Greenville St., Suite 4600
Anderson, SC 29621
333 S. Pine St.
Spartanburg, SC 29302
Please call (864) 455-1600 to schedule an appointment at any of these locations.