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Urogynecology refers to gynecologic disorders related to the bladder and pelvic floor support for the vagina and uterus. Examples of these disorders include:
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- Leakage of urine (incontinence)
- Overactive bladder (OAB), including frequent need to urinate, waking at night to urinate (nocturia), strong urge to urinate (urgency)
- Bulging, sagging or falling of pelvic organs (prolapse)
- Painful urination (dysuria)
- Difficulty urinating or having bowel movements (emptying disorders)
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These and other problems can result from childbirth, aging, disease, surgery, chronic constipation, medications, repeated heavy lifting or other causes. A medical history, physical examination and tests will help determine the cause of your problem and help you decide on an appropriate treatment.
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The kidneys filter waste products out of the bloodstream and make urine, which drains into the bladder. When the bladder fills, nerves send a message to the brain and you feel an urge to urinate. Sphincters and pelvic floor muscles keep urine inside the bladder until you reach a toilet. When you urinate, these muscles relax, the main bladder muscle contracts, and urine leaves the body through the urethra.
Certain diseases, medications, infections, chronic behaviors or other factors such as vaginal delivery and menopause can disrupt this process and make a person lose control of when they urinate. This group of conditions is called . The most common forms of UI are:
- – Leakage of urine during an activity, such as playing sports, laughing or lifting. Abdominal pressure forces the urethra open.
- , also known as – Leakage occurs after a sudden urge to urinate. Urine is squeezed out of the bladder before it has filled, too frequently and/or at inappropriate times.
- – Leakage of urine when the bladder fills beyond capacity.
- – A person experiences symptoms from more than one type of incontinence.
 The American Urogynecologic Society estimates that 15-20 million people in the U.S. suffer from urinary incontinence. Most of them are women. Many people with UI don't see a doctor for treatment, often because they are embarrassed or have been told that the condition is normal or that treatment is ineffective. On the contrary, UI is not normal in people of any age, and treatment is successful for 80-90% of patients.
Urinary incontinence is actually a symptom, not a disease. That means one or more other problems are causing the urine leakage. Some common bladder and pelvic floor disorders are:
- – The bulging, sagging or falling of pelvic organs (bladder, uterus, rectum, intestine). Prolapse develops slowly, so symptoms may be mild and vague at first, such as pain during sexual intercourse or inability to hold in a tampon. As prolapse progresses symptoms may develop into a feeling that something is protruding from the vagina, a heavy sensation in the vagina, or an inability to urinate or have a bowel movement without inserting the fingers into the vagina.
- – One in five women will have a urinary tract infection in her lifetime. Infections happen when E. coli bacteria grow in the urethra and travel to the bladder. Symptoms include burning when urinating, urge to urinate without much result, cloudy or reddish urine, smelly urine, a feeling of fullness or pressure above the pubic bone, and general malaise. A simple urine test can detect the presence of an infection, and a course of antibiotics are all that is needed to treat the problem.
- – Inflammation or irritation of the bladder wall, causing stiffening and scarring of the bladder and a decrease in the amount of urine the bladder can hold. Common symptoms included pelvic pain, painful sexual intercourse, urinary urgency and a frequent need to urinate. About 90% of people who get IC are women.
- – About 90% of bladder tumors are cancerous. The most telling sign of bladder cancer is blood in the urine. Other symptoms include pain when urinating, frequent need to urinate, and an unproductive urge to urinate.
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Try this quiz from BladderInfo.com:
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When you come in for your appointment, we will ask you many questions about your symptoms, bladder habits, diet, medical and family history, any surgeries you have had, any medications you are taking, and your general health. After this, we will perform an examination that may include these tests:
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Physical examination
- Gynecologic examination
- Neurologic examination
- Urinalysis – A urine sample undergoes chemical and cellular tests.
- Urine culture – A urine sample is tested for infection.
- Urodynamics – A small catheter is inserted into the bladder to test its function during filling and urination.
- Cystoscopy – A thin, lighted instrument called a cystoscope is inserted into the bladder.
- Electrodiagnostic testing (EMG) – Mild electrical stimulation tests the nerves and muscles that control the bladder.
- Intravenous pyelogram (IVP) – An x-ray is taken of the bladder, ureters and kidneys.
A comprehensive evaluation will help us figure out what the problem is and work with you to decide on the best treatment. If you have incontinence, the tests will determine what type(s) of incontinence you have. Testing can also predict whether you might develop or find relief from incontinence after being treated for another problem, such as prolapse.
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Despite what many people think, incontinence and other pelvic floor problems are not something patients have to "get used to" living with. Many non-surgical and surgical treatments are available to minimize discomfort or annoyance or cure the problem entirely.
Incontinence may be treated in many ways, depending on the severity of the problem and the person's health and preferences. No single treatment is effective for all patients.
First, we may advise the patient to practice Kegel exercises to strengthen the muscles that keep the urethra closed. Flexible plastic devices called may be fitted in the vagina for support. Medications, hormone replacement and diet changes can be helpful as well.
For stress incontinence specifically, treatments may include practicing Kegel exercises, Biofeedback with electric stimulation and finally modern minimally invasive surgical options such as (tension free vaginal tape) and (Obturator approach). These new procedures allow for safe, effective treatment without lengthy recovery. Most patients return to their normal activities within 4 to 7 days. Other treatments include urethral implants () a minimally invasive uretharal implant that restores continence and confidence without surgery, just a urethral injection.
For overactive bladder, treatments include, biofeedback and electric stimulation, medications and finally surgical options namely procedure.
Women who aren't negatively affected by prolapse may choose not to treat the problem, or to postpone treatment until they experience discomfort or other complications. With a few exceptions, prolapse tends to worsen when left alone. Although pessaries can help support the sagging organs, most patients opt for surgery to avoid having to change, clean and reinsert pesaaries for many years. Modern prolapse surgeries are safe and effective and often involve the insertion of a Mesh which allows good long term support and reduces recurrence of the prolapse.
Treatment for interstitial cystitis may include home care (diet modification, heat or ice packs), exercise, medication or electrical stimulation.
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