Who are urogynecologists, and what do they do?
Urogynecology is a subspecialty of obstetrics and gynecology that focuses on female pelvic care and reconstructive surgery. Doctors who specialize in diagnosing and treating pelvic floor problems, such as weak bladders and pelvic organ prolapses, are known as urogynecologists.
The field of urogynecology is relatively new. It did not exist before 2011, and doctors began receiving board certification for it only in 2013. A variety of specialists handled these health conditions previously. Women frequently had to see multiple doctors for pelvic floor issues.
What conditions do urogynecologists treat?
Female pelvic medicine and reconstructive surgery (FPMRS) is another name for urogynecology. Urogynecologists treat pelvic floor disorders and bladder issues. They handle every aspect of the treatment, from evaluation and diagnosis to treatment and management. These issues include:
- Weak pelvic muscles: Weak pelvic muscles often lead to a condition called pelvic floor dysfunction. In this condition, a person is unable to correctly relax and coordinate their pelvic floor muscles to urinate or have a bowel movement. Some symptoms that may indicate a pelvic floor dysfunction can be frequent bathroom visits, having to frequently begin and stop when you're trying to urinate, constipation, having to change positions on the toilet to eliminate stool, leaking stool, leaking urine, painful urination, unexplained low back pain, and recurrent pain in your pelvic region — with or without a bowel movement.
- Reproductive problems: These may include concerns such as congenital conditions of the lower reproductive tract like imperforate hymen, vaginal septum, uterine anomalies, and vaginal fistulas, dyspareunia, etc. Dyspareunia (pain during sex) is a condition that affects around 28% of all people in the United States. The estimates are believed to be low as many people don't seek help for the condition because it's a sensitive topic. Hence, awareness is important as timely medical intervention can prevent severe consequences in the future. Symptoms of dyspareunia include sharp pain during penetration or at entry (even when using a tampon), deep pain during thrusting, throbbing or aching after intercourse, pelvic cramping, muscle tightness or spasms, and bladder pain.
- Bladder or rectal incontinence (losing control when going to the bathroom): Bladder and rectal incontinence means having a hard time holding in urine or stool. This usually happens when you may have unwanted passage of stool or urine that you can't control. Causes for bladder incontinence may include damaged sphincter muscles, urine retention, and overactive bladder. On the other hand, bowel incontinence may be caused due to nervous system damage from a disease or injury, vaginal childbirth, rectal prolapse, rectocele, Crohn's disease, or ulcerative colitis. Meanwhile, diarrhea and constipation are common causes of both problems. Additionally, either type of incontinence can be caused by things such as medicine side effects, stress, multiple sclerosis, stroke, Alzheimer's disease, diabetes, infections, hemorrhoids, and other problems with the pelvic floor.
Treatment for pelvic floor disorders includes:
- Behavioral therapy: Regular pelvic muscle (Kegel) exercises to aid muscular control and leakage management and lengthen the interval between bathroom visits.
- Pessaries: A pessary is a device that, when inserted into the vagina, supports the bladder, uterus, and other organs. You can remove it for cleaning and reinsert it based on the doctor's guidance on proper use.
- Medication: Depending on the disorder, this may be a treatment option.
- Surgery: Surgical treatments range from minimally invasive and laparoscopic to reconstructive surgery.
What kind of education and training do urogynecologists receive?
A urogynecologist is a doctor who has completed a four-year residency in obstetrics and gynecology after attending medical school. They may receive additional, highly specialized training in treating pelvic floor disorders, both surgical and non-surgical. That degree of education, however, is not required to become a urogynecologist. Following residency, they may seek a fellowship to become experts in diagnosing and treating issues in women's pelvic organs, such as the uterus, vagina, rectum, and bladder.
After completing their fellowship, urogynecologists must pass an exam to become FPMRS certified. They must also complete at least seven years of post-medical school training.
Urogynecologists can also provide the highly specialized care required by patients with pelvic issues because they have additional fellowship training or competence in the field. While an OB-GYN or a family doctor can give an initial diagnosis and rudimentary treatment for pelvic floor issues, urogynecologists have the experience and surgical expertise to provide complete care. Urogynecologists occasionally consult after earlier therapies have failed or when the patient requires specialized surgery.
What is the difference between gynecologists and urogynecologists?
If you already have a gynecologist you trust, you may dismiss the idea of seeing a urogynecologist. But wait a minute. Women experiencing pelvic floor health difficulties may benefit significantly from obtaining the advice of a urogynecologist.
Gynecologists are female reproductive health specialists. They typically see patients once a year for a wellness check and screening. Furthermore, they work with women more frequently if they are pregnant, have fertility or menstrual concerns, or require more frequent medical treatment.
Women frequently form relationships with a gynecologist they trust, and that doctor often sees them throughout their lives. A gynecologist can give you information on general women's health issues such as family planning, menstruation, sexual health, and hormone imbalances.
However, in complex pelvic floor cases, your gynecologist may refer you to a urogynecologist near you who can provide the necessary expertise about your condition.
Urogynecologists complete a course in either urology or gynecology before specializing in female pelvic medicine and reconstructive surgery. This training qualifies urogynecologists to treat women with pelvic floor diseases such as prolapse, incontinence, an overactive bladder, and emptying abnormalities.
Since female pelvic medicine is their primary focus, urogynecologists are highly specialized and current on the most recent advances. On the other hand, gynecologists handle a wide range of women's health disorders. Therefore, they are more likely to be excellent generalists. However, unlike urogynecologists, they do not specialize in pelvic floor conditions.
However, you are not required to select a gynecologist or a urogynecologist. Your gynecologist is still the best person to help you with your overall health, labor, and delivery. Urogynecologists are another option if you have an ongoing problem such as an overactive bladder, prolapse, or fecal leaks. Urogynecologists can also aid with postpartum recovery by teaching you how to strengthen your pelvic floor to reduce urine leakage, which many women suffer when they laugh or sneeze after giving birth.
What is a pelvic organ prolapse?
Pelvic organ prolapse happens when the organs in your pelvis, like your uterus or bladder, drop down because the muscles in your vagina are weak. Things that can make it more likely for you to have this problem include having babies through your vagina, a genetic history of pelvic organ prolapse, and hurting your pelvic floor. Women who are obese are 40 to 75 percent more likely to have pelvic organ prolapse.
What causes pelvic floor disorders such as incontinence?
Pelvic floor disorders, like incontinence, happen for different reasons. Doctors are still learning more about what causes them.
Some things that might make you more likely to have these problems include:
- Past surgeries: If you've had surgery to fix prolapse or remove your uterus (hysterectomy), you might have a higher chance of getting pelvic floor disorders.
- Weak tissue: Genes can affect the strength of muscles and tissues. Some medical conditions can also make tissue weaker, leading to issues like pelvic organ prolapse.
- Childbirth: Having babies, especially through vaginal delivery, could increase your risk. The more babies you have, the higher the risk might be. Some studies suggest that using tools like forceps during delivery might also raise the risk.
- Aging: Like other muscles, your pelvic floor muscles can weaken as you age. Menopause and aging can also worsen pelvic problems.
- Pressure on your pelvic floor: Smoking, chronic coughing, constipation, straining during bowel movements, or lifting heavy things can all put pressure on your pelvic floor. This pressure might cause accidents or discomfort with urine or bowel movements.
What to expect from a visit to a urogynecologist?
When you visit a urogynecologist, expect the doctor to review your medical history thoroughly. The doctor will inquire about past events that might have impacted your pelvic floor, including family history, previous births, pelvic surgeries, lifestyle, and dietary habits. Sharing this information is crucial as it aids the doctor in diagnosing your condition and devising an appropriate treatment plan.
The doctor will want you to discuss your symptoms openly during the appointment. The doctor will ask for the specifics of your symptoms, including their occurrence and how they affect you. Although it may be uncomfortable, providing as many details as possible will enable the doctor to promptly diagnose your condition and determine the most effective treatment options. The doctor may ask you to elaborate on symptoms such as incontinence, pelvic pain, vaginal bulges, constipation, and diarrhea.
The next step involves the doctor performing a physical examination, similar to what you undergo during a regular gynecological check-up. The doctor may deem further testing necessary to confirm the diagnosis based on your condition and symptoms. For instance, if bladder leakage is a concern, the urogynecologist might suggest a cystoscopy, where he will insert a tiny camera to visualize the inside of your bladder. Additionally, the doctor may recommend urodynamic testing to assess your bladder function more comprehensively.
The doctor will work with you to develop a thorough treatment plan that addresses both the symptoms and the underlying cause of your disease after making a diagnosis. This plan could involve various options, such as lifestyle adjustments, physical therapy, vaginal devices, or surgical intervention. The doctor will support your decision and work with you to choose the best course of treatment, even if it means opting for no intervention.
Here are some tips to prepare for when you seek a consultation with a urogynecologist:
- Arrive a few minutes early to fill out the mandatory forms.
- Make a list of your queries and the medications you are on. Keep this list handy to ensure effective communication and resolution.
- If you are complaining about a bladder leak, carry an extra pair of underwear as you might urinate yourself.
Where can you find a good urogynecologist near you in New York?
Finding a urogynecologist in New York City can be difficult. However, with the help of Zocdoc, you can rapidly find one from the comfort of your own home in a matter of minutes. To arrange a video consultation or an in-person appointment, go to the Zocdoc website and enter your ailment or symptoms, insurance information, location, and the day you wish to see a clinician. Choose "find" to get a list of the specialists in urogynecology near you. You can also delimit your search results by the time of day, gender, languages spoken, hospital affiliation, and whether or not the practitioner treats children.
In the drop-down option at the top of the page, enter your insurance carrier and plan to filter for the providers you can view to those who accept your insurance. This will only show in-network providers. Though adding your insurance information to your Zocdoc account simplifies finding in-network providers, do not forget to take your insurance card to your appointment, as many offices still ask for it for official purposes. For any insurance-related queries, visit Zocdoc's patient help center.
Zocdoc provides information on each healthcare provider's educational history, including clinical experience, certifications, specialties, awards, licenses, and accreditations, to help you discover the best treatment for yourself and your family. Furthermore, you can validate your decision by reading honest and trustworthy reviews by past patients.
Depending on the doctor's availability, you can book appointments before, during, and after office hours with Zocdoc. If the doctor's schedule permits, you can also book appointments on weekends and holidays. You can also book online appointments if you cannot visit in person. Look for the purple icon on doctors' profiles allowing such video consultations.
Booking appointments with the ideal urogynecologist near you on Zocdoc is quick, free, and completely safe.
Urogynecologists and female pelvic health in New York
The National Center for Biotechnology Information conducted a cross-sectional survey after a retrospective evaluation of all urogynecology telemedicine consultations at a tertiary care center from March 1, 2020, to March 31, 2021. The poll used a Likert scale to assess patient satisfaction. Descriptive statistics, as well as Fisher's exact analysis, were used.
As a result, around 256 telemedicine visits occurred at a private health institution during the study period, with almost 88 patients (roughly 34% unadjusted response rate) completing the survey. The participants in the study were nearly 55 (SD 17; 24, 84) years old on average. The majority of patients (almost 69% were white) lived in New York City's five boroughs (approximately 81%) and had a higher level of education (nearly 72% had a bachelor's or professional degree).
Most visits (around 68%) were for urine problems, with those patients reporting greater satisfaction with urogynecology demands than those with pelvic complaints. Other demographics showed no significant variations in satisfaction. Overall, scheduling (almost 99%), technology (around 90%), provider engagement (nearly 96%), fulfillment of personal needs (approximately 91%), and overall satisfaction (close to 94%) were all rated highly.
The study also found that telemedicine visits at a tertiary urogynecology clinic during the COVID-19 epidemic resulted in reasonable patient satisfaction across all demographics and visit types. Visits for urinary problems, which may not require an in-person evaluation, resulted in greater fulfillment of urogynecology demands. Future research must standardize and validate a telemedicine satisfaction survey for urogynecology and establish which patients will benefit from this technology.
Sources
WebMD
Penn Medicine
Drugwatch
National Center for Biotechnology Information
Inspira Health
Healthline
Johns Hopkins Medicine
Mayo Clinic
Cleveland Clinic[1]
Cleveland Clinic[2]
Cleveland Clinic [3]
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