Urogynecology is a subspecialty of gynecology that focuses on the diagnosis and treatments of disorders of the female pelvic floor.
The pelvic floor consists of several muscles, connective tissue, nerves, tendons, and ligaments that:
- Provide support to our organs (bladder, uterus, and colon)
- Aid in sexual function
- Help maintain continence
Pelvic floor disorders can result from pregnancy, childbirth, heavy lifting, chronic straining or coughing, and exercise.
Types of Pelvic Floor Disorders
Disorders or diseases of the pelvic floor may include:
- Pelvic organ prolapse
- Urinary and fecal incontinence
- Painful bladder syndrome
What Is Pelvic Organ Prolapse?
Pelvic organ prolapse occurs when the pelvic organs (uterus, bladder, rectum) fall downward into the vagina from weak connective tissue and muscles. It is a common problem that may or may not be show symptoms. Some may have a feeling of fullness in the vagina, be able to touch a bulge of tissue at the vaginal opening, have dryness or irritation from the tissue rubbing on their clothing, or have to push the tissue up in order to have a bowel movement or empty their bladder completely. The diagnosis is made on a pelvic exam.
“In its most severe form, pelvic floor disorders can involve incontinence or loss of control of urine, the bowels, or both,” says John Reilly, MD, a UPMC colorectal surgeon at Colon & Rectal Surgeons of Erie.
Treatment options
Treatment options can include watchful waiting if the prolapse is not bothersome, a pessary which is a device placed in the vagina to hold up the prolapsing tissue, physical therapy in certain stages, and surgery.
What Is Urinary Incontinence?
Urinary incontinence is the involuntary loss of urine. Different types include stress urinary incontinence, urgency incontinence, and overflow incontinence. A condition referred to as overactive bladder involves urgency, frequency (day and night), and urgency incontinence. Stress urinary incontinence affects approximately 30% of women over age 45. Causes include childbearing, strenuous exercise, chronic cough conditions, smoking, obesity, and genetics. Stress incontinence occurs when you cough, sneeze, or jump. Pressure on the bladder and the urethra create the loss of urine.
Treatment options
Luckily, treatments designed to hold the pelvic organs comfortably in position have very good cure rates. The first recommended treatment is a low risk midurethral sling. This 15- to 20-minute outpatient surgical procedure has a 90% cure rate. Instead of surgery, your doctor may recommend a vaginal pessary or Impressa® bladder support. With physical therapy, you can learn to contract the pelvic floor when coughing or sneezing.
Urgency incontinence and overactive bladder affects 15% of all women and increases with age. A sudden or strong urge to urinate may result in incontinence if women don’t get to a restroom fast enough. They may void only small amounts of urine more frequently. They also may get up to urinate more than once during the night.
The cause is usually the brain and the bladder not communicating well. Treatment includes behavior and dietary changes like decreasing or eliminating soda, coffee, tea, and alcohol and avoiding triggers like running water, or putting the key in your door when you get home. We often recommend bladder training — voiding by the clock — to increase the amount of urine your bladder can hold and to help the bladder muscles adjust to larger volumes. Other treatment options include medicines, Botox injections, or neuromodulation to control the nerves that send messages between the bladder and brain.
What Is Painful Bladder Syndrome?
This condition, previously known as interstitial cystitis, can cause painful bladder symptoms. It affects 3 to 7% of women age 40 and older, but often goes undiagnosed. Symptoms can include discomfort, pressure, tenderness, or pain in the bladder, lower abdomen, and pelvic area. These vary from person to person, may come and go, and can chance over time. Many women also experience migraine headaches, fibromyalgia, painful intercourse, depression, or irritable bowel syndrome. The cause of painful bladder syndrome is unknown.
Treatment options
Treatments vary widely but should include education, stress management, and dietary modifications. Depending on the severity of your symptoms, the doctor may suggest other treatment options.
For more information, visit UPMC.com/MageeCentralPa.
Editor's Note: This article was originally published on , and was last reviewed on .