Urogynecology is a subspecialty of obstetrics and gynecology that focuses on female pelvic medicine and reconstructive surgery.  Conditions that affect their pelvic health, such as urinary incontinence, overactive bladder, interstitial cystitis, chronic bladder discomfort, fistulas and pelvic organ prolapse, or painful intercourse, can be diagnosed and treated by a urogynecologist.

The pelvic floor is a group of muscles that surrounds the bladder, uterus, vagina, small bowel and rectum to keep these organs in place.  Conditions that affect the pelvic floor often are a result of aging, but also can be caused by pregnancy and childbirth, frequent or heavy lifting, or other strenuous activity.  Women may consider visiting a urogynecologist if they experience recurring symptoms such as pain during intercourse, pelvic discomfort or aching in the vagina, trouble emptying the bladder, leaking urine or feces, frequent urination, or recurring urinary tract infections.

Certain tests can be performed to diagnose and determine the severity of pelvic floor disorders.  A urinalysis may be taken to detect the presence of bacteria, white blood cells or blood to rule out the possibility of a urinary tract or kidney infection.  The patient may also undergo a post-void residual volume test, which checks if the bladder is emptying fully after urinating.  A bladder stress test can be performed to determine if the patient is leaking urine.

Treatments to correct these conditions may include behavioral techniques, such as pelvic floor muscle exercises, bladder training, scheduled toilet trips, or fluid and diet management.  Medication may also be prescribed to calm the bladder.  Physical therapy can rejuvenate and strengthen the muscles and tissues in the urethra and vagina.  Electrical stimulation also can assist with strengthening pelvic floor muscles.  Surgical procedures can be performed when other treatment methods do not improve the condition.

Symptoms of pelvic organ prolapse can vary depending on which organ is affected.  Low back pain and painful intercourse can indicate a prolapse of the uterus or small intestine, while leaking urine may be a symptom of bladder prolapse.  In most cases of pelvic organ prolapse, symptoms get progressively worse throughout the day.  Pelvic organ prolapses are commonly discovered during a routine pelvic exam, and a physician may order more tests or refer the patient to a urogynecologist for further treatment.

If a prolapse is discovered, further testing as appropriate will be performed to determine which organ is drooping and if there are other conditions related to the prolapse.  Treatment for pelvic organ prolapse can include a variety of therapies, including physical therapy that targets and strengthens the pelvic floor muscles, ligaments and connective tissue to support the pelvic organs and assist in bladder and bowel control.  A pessary, which is a small mechanical device that is inserted into the vagina, can help hold prolapsed organs in the correct position.  Surgery also is an option to repair tissues surrounding the pelvic organs and fix the prolapse.

Fistula repair is another procedure that a urogynecologist performs.  A fistula is a hole in the bladder or rectum that causes urine or stool to leak into the vagina or uterus.  It is commonly caused by childbirth trauma.  Most fistulas require corrective surgery that can be performed vaginally or abdominally, depending on the location of the fistula.

Women can take preventive measures to avoid pelvic organ prolapse and other urogynecological conditions.  Reducing body mass and maintaining a healthy weight can lessen the risk of pelvic floor problems.  Performing daily Kegel exercises can assist with strengthening pelvic floor muscles.  Women who smoke should consider quitting because the habit can lead to chronic cough, which puts stress on the pelvic floor muscles.  A high-fiber diet will reduce the risk of constipation, which can be a contributing factor to rectal prolapse.  Women who may be experiencing pelvic floor disorders should contact their gynecologist to schedule an appointment.

Curt Misko, M.D., is a urogynecologist who recently joined Licking Memorial Women’s Health in Newark.  Dr. Misko earned his Medical Degree from the Uniformed Services University of the Health Sciences, Edward F. Hebert School of Medicine in Bethesda, Maryland.  He completed an internship in obstetrics and gynecology at Tripler Army Medical Center in Honolulu, Hawaii, and completed a residency in obstetrics and gynecology at Madigan Army Medical Center in Tacoma, Washington.  He is board certified in obstetrics and gynecology, and female pelvic medicine and reconstructive surgery.