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.