Frequently Asked Questions
What is an Urogynecologist and When Would I Need One?
Although your primary care physician, OB/GYN, or urologist may have knowledge about pelvic floor problems, an urogynecologist has specialized training in pelvic floor disorders and can offer additional expertise. You should see an urogynecologist when you have problems of prolapse, and/or troublesome urinary or fecal incontinence, or when your primary doctor recommends consultation.
Additional problems for which you or your doctor might think about consulting an urogynecologist include: problems with emptying the bladder or rectum, fistulas, and the need for special expertise in vaginal surgery, including the need for a revision or repeat surgery.
What is Pelvic Prolapse?
Pelvic prolapse is the loss of pelvic support that occurs when the soft connective tissue that support the pelvic organs become stretched, weakened or torn. It is a very common disorder, particularly as women age. Treatments range from conservative measures, including pelvic floor exercises or the use of a support device (a pessary) that sits within the vagina to hold up the surrounding organs, to surgical treatments.
What are the types of incontinence?
There are five basic types of incontinence:
- Stress incontinence: Occurs when pelvic muscles are damaged, causing the bladder to leak during exercise, coughing, sneezing, laughing, or any body movement which puts pressure on the bladder.
- Urge incontinence: Urgent need to pass urine and the inability to get to the toilet in time. Occurs when nerve passages along the pathway from the bladder to the brain are damaged, causing a sudden bladder contraction that cannot be consciously inhibited.
- Overflow incontinence: Refers to leakage that occurs when the quantity of urine produced exceeds the bladder’s holding capacity.
- Surgery Incontinence: Follows such operations as hysterectomies, cesarean sections, lower intestinal surgery, or rectal surgery.
What are some common Bladder irritants?
- Alcoholic beverages
- Carbonated Beverages (with or without caffeine)
- Milk or milk products
- Coffee or Tea (even decaffeinated)
- Medicines with caffeine
- Citrus juice and fruits
- Tomatoes/Tomato-based products
- Highly spiced foods
- Sugar and artificial sweetener
- Corn Syrup
What is urodynamics testing?
Health professionals recommend patients undergo urodynamic testing so they gain a better understanding of how well the bladder is working and to better understand the cause of urinary incontinence or retention.
What are some of the risk factors for incontinence?
The likelihood of developing urinary incontinence increases with age, and incontinence in general is most common in women. The exact causes vary and are most often related to underlying conditions or diseases.
Are there any steps I can take to help prevent urinary incontinence?
- Start a regimen of Kegel exercises to strengthen pelvic muscles
- Maintain a healthy weight to reduce pressure in the abdomen
- Don’t smoke
- Stay physically active with moderate exercise
- Increase the fiber in your diet
- Avoid liquids that can be irritants, such as caffeine
What is an urogynecologist?
An urogynecologist is a physician who specializes in treating women with a variety of disorders to the pelvic floor. This specialist is also sometimes called a female urologist.
Before the urogynecology specialty was created, women with pelvic floor disorders typically visited multiple specialists and received separate treatment for problems in the urinary, gastrointestinal and reproductive systems. An urogynecologist comprehensively manages all these conditions.
In addition to completing medical school, an urogynecologist must complete a four- or five-year residency program in urology or obstetrics and gynecology, plus an intensive three-year fellowship in female pelvic medicine and reconstructive surgery.
What is the pelvic floor?
The pelvic floor is the muscles, ligaments, connective tissues and nerves that support the bladder, uterus, vagina and rectum and help these pelvic organs function.
What causes pelvic-floor disorders?
The National Institutes of Health estimate one-third of women in the United States will experience pelvic-floor disorders in their lifetime. Childbirth, repeated heavy lifting, chronic diseases and surgery can weaken the pelvic floor. Inherited factors also can contribute.
While pelvic-floor disorders become more common as you get older, they are not inevitable. Depending on the severity of your condition, a range of treatments are available to minimize the symptoms or repair the damage.
How are these conditions diagnosed?
In addition to a comprehensive history and physical examination, our physicians may also rely on several types of evaluations, including:
- Urodynamics: A small catheter is placed into the patient’s bladder to measure pressure in the bladder and urethra while the bladder is filled with water. The patient answers a series of questions to help determine how much her bladder can hold, after which she urinates, and the amount or urine is measured. The test is not painful and lasts approximately 20 minutes. The patient may stop the test at any time.
- Cystoscopy: A small tube-shaped camera is inserted through the urethra to view the bladder for details that are difficult to see with an X-ray. The cystoscope is no larger than a catheter. The camera is attached to a monitor so that the patient can view the inside of her bladder as well. The test is not painful and lasts approximately 5 minutes. The patient may stop the test at any time.
- Urinalysis: A patient’s urine is often checked at the time of the visit to ensure that she does not have an infection.
- Bladder ultrasound: An image of the patient’s bladder may be taken at the visit to ensure she is emptying it completely. This is not invasive or painful.
- Pelvic-muscle evaluation: A physical exam or an electronic monitoring device is used to measure the patient’s ability to contract her pelvic muscles.
What medical conditions do urogynecologists treat?
Urogynecologists treat urinary incontinence, fecal incontinence and pelvic floor disorders such as pelvic organ prolapse. Approximately one in three women will experience one of these conditions. Urinary and fecal incontinences involve a lack of control over those functions. The pelvic floor is the system of muscles, ligaments and tissues that support the bladder, urethra, uterus, vagina, small bowel and rectum in the pelvic area. Pelvic floor disorders are conditions involving a weakening of support for those organs, often leading to prolapse.
Can I do anything about incontinence on my own?
Depending on your particular circumstances, there are several things you can do to treat incontinence. Doing pelvic floor muscle exercises (Kegel exercises) to strengthen your pelvic floor muscles can help with your bladder control and can even prevent pelvic floor disorders from occurring. Eating foods that are high in fiber can ease the stress on bowels, and avoiding caffeine and certain other beverages can increase your bladder control. Behavior modification in the form of bladder training can help control the timing of urination.
Maintaining proper weight, not smoking and avoiding excessive stress in lifting can help reduce your risk of pelvic floor disorders.
Is it possible that my pelvic floor problem will just go away over time?
It is not likely that a pelvic floor disorder will go away on its own. In some cases of pelvic organ prolapse, an urogynecologist may suggest no immediate treatment and observing the situation over time, provided that the symptoms are not too unpleasant for the woman. Depending on the problem, it is also likely that if left untreated, incontinence or pelvic floor disorder will worsen. The result could be that a problem that might have responded to a simpler treatment early on requires a more complex treatment later.
If I need pelvic floor surgery, how long will it take to recover?
This is a reconstructive surgery, and the body should be given ample time to heal without undue physical stress. Many women return to work or their daily life soon after surgery, as long as they do not bend, lift, squat or otherwise stress their pelvic floor. This period of limited activity may last up to three months, depending on the surgical procedure. Your physician will prepare you with lifestyle changes that will protect your pelvic floor during recovery and afterward.
When I stand up, urine just leaks out and I cannot control it. How should I proceed?
There are treatments for this common and very frustrating urinary symptom. Sometimes this happens because of a bladder spasm, but sometimes it’s related to the sphincter muscle sitting at the top of the urethra is weakened and unable to help hold in the urine. Treatments for this problem may include exercises and bladder training, medication, a quick office procedure or outpatient surgery depending on your diagnosis.
Your next step should be to schedule an appointment with an urogynecologist to further discuss these problems, which will likely lead to bladder testing and a review of your treatment options.
What Is Bladder Training?
The goal of bladder training is to learn how to control the urge to empty the bladder and increase the times between urinating to normal intervals (every 3-4 hours during the day and every 4-8 hours at night). After a few weeks of this training, leakage may occur less often.
What Are Some of the Lifestyle Changes That Are Used To Manage Urinary Incontinence?
Making the following changes in your lifestyle, if they apply to you, may help the problem:
- 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.
Find a Physician
Looking for a physician in your area? By using our Physician Directory, you can search for a New Jersey physician by specialty, facility, town, and zip code right now.
For more information on any physician, call 1-800-560-9990