What is urogynecology?
Urogynecology is a field of medicine dedicated to the treatment of pelvic floor disorders in women. A urogynecologist is a doctor who specializes in the treatment of pelvic floor disorders in women.
Why should I see a urogynecologist?
Pelvic floor disorders such as urinary or fecal incontinence and pelvic organ prolapse can be quite disruptive to a woman's quality of life. In the past, these embarrassing problems were not reported and considered a normal nuisance of the aging process. As longevity and health care has improved steadily in the past several years, more attention and focus have been given to the evaluation of pelvic floor disorders. Women are far more likely to be affected and most pelvic floor disorders can be effectively managed. A urogynecologist is specialized in evaluating and treating pelvic floor disorders.
Pelvic Floor Disorders
The pelvic floor is comprised of muscles, ligaments and connective tissue and nerves that help support and control the organs within the pelvis - the rectum, uterus, vagina, and bladder. The pelvic floor plays a vitally important role in both excretory (urination and defecation) and reproductive functions. A pelvic floor disorder (PFD) occurs when there is a weakening or injury to the structures within the pelvic floor - nerves, muscles and connective tissues.
Pregnancy, childbirth, repetitive heavy lifting, chronic pulmonary disease, chronic constipation, radiation and pelvic surgery are the most common factors. Not surprisingly then, pelvic floor disorders occur more frequently and earlier in women than men, and prevalence increases with age.
There are a variety of pelvic floor disorders, the most common of which are:
- Urinary incontinence - accidental leakage of urine
- Anal incontinence - accidental leakage of stool or gas
- Abnormal bladder emptying - difficulty emptying the bladder
- Pelvic organ prolapse - bulging or protrusion ("prolapse") of the vagina or uterus through the vagina, due to loss of support of bladder, uterus and/or rectum
There are different types of incontinence:
- Stress incontinence is loss of urine during activities that put abdominal pressure on the bladder - such as coughing, sneezing, laughing, lifting or changing position.
- Urge incontinence is loss of urine following an overwhelming urge to urinate that cannot be suppressed. Urge incontinence may occur in patients with an "overactive bladder."
- Mixed incontinence occurs when symptoms of both stress and urge incontinence are present.
- Overflow incontinence is "dribbling" of urine and is usually associated with urinating frequently and in small amounts. Also referred to as chronic retention of urine, overflow incontinence occurs when the quantity of urine exceeds the capacity of the bladder.
Women are more prone to urinary incontinence as a result of pregnancy and childbirth, while in men urinary incontinence is more frequently a result of neurologic injury or prostate problems. Prevalence increases with advanced age.
The accidental leakage or stool or gas can vary from partial, in which a person loses only a small amount of waste, to complete loss of an entire bowel movement. Anal incontinence can result from chronic or severe constipation, damage to the anal sphincter muscles (the ring of muscles that keep the anus closed), rectal prolapse, spinal cord injury, stroke, diseases of the nervous system (e.g. Parkinson's disease) and chronic diarrhea. It is also commonly associated with advanced age, women with other pelvic floor disorders and irritable bowel syndrome. While anal incontinence affects both men and women, it occurs more frequently in women. The stress and pressure of childbirth on the pelvic floor may not evidence itself until decades later when the anal sphincter muscles weaken with aging.
Abnormal Bladder Emptying
Incomplete emptying of the bladder may result from neurological damage (any disease or disorder that interferes with neurological function of the muscles that contract the bladder) or abnormalities in the urinary structures. When neurological, it is often called neurogenic bladder. Neurological damage may by central (e.g. Alzheimer's, Parkinson's, multiple sclerosis or spinal cord injury), or peripheral (e.g. diabetes, pelvic injury from surgery or vaginal delivery). Abnormalities in urinary structures are most commonly "urethral stricture" (narrowing of the tube - urethra - that carries urine from the bladder when we urinate) and prostate gland enlargement in men.
Pelvic Organ Prolapse
Pelvic organ prolapse occurs when the muscles and tissue that support the pelvic organs weaken, and the pelvic organs "slip out of place" or start to sag. With loss of support, the uterus, bladder, urethra, cervix, rectum or small and large intestines may press down and cause a bulge through the vagina.
- Uterine prolapse: the uterus presses down on the vagina, protruding into it or through it.
- Vaginal prolapse, the top of the vagina collapses down protruding into or through the lower part.
- The suffix "-cele" means pouch or hernia.
- A cystocele (cyst means bladder) is protrusion of the bladder into the vagina.
- A rectocele (rect means rectum) is protrusion of the rectum into the vagina.
- An enterocele (enter means intestine) is protrusion of the small intestine into the vagina.
Loss of support may occur when any part of the pelvic floor is injured, such as with a vaginal delivery, surgery (e.g. hysterectomy), pelvic fracture, and pelvic radiation. Other factors that promote prolapse include heavy lifting, chronic constipation, chronic cough from pulmonary disease, and obesity. Aging and menopause, and various nerve and muscle diseases, also contribute to deterioration of the pelvic floor.
Symptoms may include:
- Feeling of a heavy sensation in the vagina that worsens as the day progresses
- Urinary frequency, difficulty starting the urine stream, spraying of the urine stream and difficulty emptying the bladder completely
- Urinary leakage with intercourse
- Difficulty evacuating bowel movements