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If you have bladder leaks, a prolapsed uterus, or other pelvic floor problems, you may need to see a urogynecologist. And if you’re asking, “What is a urogynecologist?” you’re not alone.

Because the specialty is new, many people feel confused about what a urogynecologist does. Here’s a look at the health issues a urogynecologist treats and what to expect at a urogynecology appointment.

What Is Urogynecology?

Urogynecology is a medical specialty that deals with pelvic floor issues in women. Urogynecologists are surgeons with advanced training. They treat problems like incontinence, pelvic organ prolapse, and other pelvic floor health issues.

A urogynecologist completes medical school. Then, they have a residency in gynecology or urology. After that, they have three more years of training in female pelvic medicine and surgery.

The American Board of Medical Specialties approved female pelvic medicine and reconstructive surgery (urogynecology) as a subspecialty in 2011. The first urogynecologists became board certified in 2013 and as of 2023 the specialty is now called Urogynecology and Reconstructive Pelvic Surgery (URPS).

Urologist, Gynecologist, and Urogynecologist: What’s the Difference?

Urologists receive training in health issues of the urinary tract. They test, diagnose, and treat the urinary system in men, women, and kids.

Gynecologists specialize in female reproductive health. They diagnose and treat problems of the female reproductive system. That includes the uterus, fallopian tubes, ovaries, vagina, and breasts.

Urogynecologists have knowledge of both specialties. They primarily treat women. A urogynecologist is an expert in pelvic floor problems.

If you have problems with your pelvic floor, your doctor may refer you to a urogynecologist. Some insurance companies may allow you to plan a visit with a urogynecologist without a referral.

What Is the Pelvic Floor?

The pelvic floor is the muscles and connective tissue in the lower part of the pelvis. Both men and women have a pelvic floor. It acts as a hammock or sling to support the pelvic organs.

In women, the pelvic floor supports the bladder, bowel, uterus, vagina, and rectum. Over time, hormonal changes can cause pelvic floor muscles to loosen. Many women have pelvic floor problems in menopause, but they can also happen to younger women.

The strains of pregnancy and birth can also weaken the pelvic floor muscles. Other risk factors for pelvic floor problems include:

• Becoming overweight
• Chronic coughing
• Constipation
• Pelvic surgery
• Smoking

Conditions Urogynecologists Treat

Urogynecologists have deep knowledge of pelvic floor dysfunction. Some health issues they treat include:

• Fecal incontinence. Accidental bowel leakage. Causes include injury or weak pelvic floor muscles.
• Fistulas. Abnormal openings that develop between the bowel and vagina or the bladder and vagina.
• Overactive bladder or urge incontinence. The sudden urge to pee. If you have an overactive bladder, you might get up several times at night to pee.
• Pelvic organ prolapse. When one or more pelvic organs slip out of place and bulge into the vagina.
• Stress incontinence. When urine leaks when you cough, sneeze, laugh, or move suddenly.
• Urinary tract infections. When bacterial infections happen in the bladder and cause symptoms like burning with urination.
• Pelvic pain. When you have pain associated with pelvic area or during intercourse.

What to Expect at a Urogynecology Appointment

At your first office visit, your doctor will ask about your medical history. They’ll perform a pelvic exam and ask for a urine sample. They may test the urine for infection or inflammation in the urinary tract.

Based on your health issue, your doctor may run one or more tests:

• Cystometry. This test shows problems in the emptying and filling of the bladder.
• Cystoscopy. This test looks inside the bladder through a small camera inserted in the urethra.
• Pelvic ultrasound. This test helps the doctor look at the bladder and uterus.
• Urodynamic testing. This test shows how well the bladder can hold and empty urine.

Urogynecology Treatments

Your treatment will depend on your specific needs. Your doctor may suggest a variety of treatment options for pelvic floor issues. These therapies might cure pelvic floor issues or just relieve symptoms.

Your outcome may depend on how severe your problem is. Some mild pelvic floor issues respond well to lifestyle changes and physical therapy. Others need more aggressive treatment, like surgery.

Lifestyle changes

Your doctor may ask you to try some lifestyle changes first. They may suggest that you:

• Achieve and maintain a healthy weight. Becoming overweight puts stress on the pelvic floor. Even dropping 5% to 10% of your body weight can reduce incontinence.
• Pay attention to when and what you’re drinking. Too much water close to bedtime can increase nighttime trips to the bathroom. Caffeine can irritate the bladder and increase urination.
• Quit smoking. Women who smoke are at a higher risk for pelvic floor issues.
• Stay active to maintain a healthy weight and help keep bowel movements regular. (Constipation can put pressure on the pelvic floor.)

Physical therapy

Urogynecologists work closely with physical therapists trained in issues of the pelvic floors. They may suggest:

• Biofeedback. Devices that reveal how well the pelvic muscles contract. You can gain awareness and control of the muscles. Biofeedback can also improve sensation in the pelvic floor.
• Bladder retraining. Learning how to pee on a schedule to help decrease bladder leaks.
• Kegels. Exercises that may help women with mild to moderate pelvic floor issues. They involve contracting and relaxing the pelvic floor muscles.

Pessaries

A pessary is a plastic device that supports prolapsed organs by being inserted in the vagina. There are some pessaries you can manage yourself and others we can put in/take out in the office. A pessary can also help with bladder control by pressing against the urethra.

Office procedures and surgery

Your doctor may suggest one of these options:

• Botox: This well-known wrinkle treatment can also treat an overactive bladder.
• Bulking agents: These gels narrow the tube of the urethra to reduce leakage of urine.
• Pelvic floor electrical nerve stimulation: An implanted device that helps activate the nerves that control bladder or bowel function.
• Surgery is an option if other treatments don’t work or this is your preference for management. Your doctor may suggest surgery for pelvic organ prolapse, urge incontinence, or bowel control.