Urogynecology and female pelvic floor medicine are relatively new fields that developed from gynecology and have expanded in the past decade. These days, there are urogynecology centers in almost every hospital. A urogynecologist is a specialist in obstetrics and gynecology who has completed advanced study in female pelvic floor problems.
Urogynecology most likely became a specialty because physicians were required to deal with women's other medical problems such as pathological conditions in the pelvis (ovarian cyst, muscular uterus and so on), conserving or dissecting ovaries in old age and of course, fertility. Some of the other issues involve additional pregnancies, surgical procedures and childbirth, and delivery by cesarean section.
The Pelvic Floor. The most important function of the female pelvic floor is supporting the pelvic organs – especially the uterus and the bladder – and controlling the secretion of urine and feces. From an anatomic and functional point of view, the pelvic floor is a complex structure composed of muscles, ligaments and nerves. Injury to the pelvic floor is very common among women. It is well known that over 50 percent of women experience pelvic floor problems, which increase as they age. These problems can seriously damage a woman’s quality of life, sometimes causing her to stop working, avoid social activity, and affect her body image, self esteem and relationship problems.
Symptoms. Pelvic floor injury is usually accompanied by symptoms that seriously impact a woman’s quality of life. The typical and classic symptoms include:
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Involuntary urine leakage, including leaking during effort
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Frequent urination
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Need to urinate during the night
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Difficulty in urinating
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Inconvenience and vaginal pressure cause by prolapsed pelvic organs (the uterus or the bladder).
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Difficulty in engaging intercourse.
The Sound of Silence. Uncontrollable urination during effort is very common and can affect up to 50 percent of adult females. In primitive societies the subject is a taboo and women are embarrassed to seek treatment. Unfortunately, the myth that this problem is only common among the elderly also exists in modern society. Consequently, doctors are finding it difficult to collect exact data about the extent of the problem. Many women suffer from pelvic floor injuries and don't see a doctor because they are too embarrassed, or don't know that the problem can be fixed, often with a simple procedure. Unfortunately, gynecologists also suffer from a lack of awareness. In many cases, if doctors initiate a conversation about the problem with their patients they will discover women crying for help.
Two important phenomena in this field have occurred in the past few years: the medical ability to treat pelvic injuries is increasing; and there is a growing awareness of these problems in the medical community and among women. More women are referred for help or seek help themselves.
Why does this happen to women? Biologically, a woman's pelvis is different than a man's. The vagina and birth canal create a "fault" in the pelvic floor. Anatomically and physiologically this creates a weak point where most injuries occur.
Research has demonstrated that in many cases, vaginal birth and the passage of the baby through the birth canal damages the ligaments, nerves and muscles. Other risk factors are connected to genetics. These factors relate to the increase of pressure on the abdomen, such as excessive weight, chronic constipation, smoking with a chronic cough and weight lifting. Age also plays an important part: as we get older, the phenomenon is more common because of accumulated damage throughout the years.
The Urogynecology Clinic. The urogynecology clinic provides answers to women's pelvic problems. Hadassah’s urogynecology clinic is staffed by a urogynecologist, a physical therapist who specializes in the pelvis and a certified nurse.
A full assessment is performed in one visit. It includes medical history and specific questions about the problem, a medical exam and a urodynamic exam. The assessment reveals information about how the bladder and pelvic floor are functioning. Based on their findings, doctors can recommend imaging or refer the woman to a colorectal surgeon or gastroenterologist, if needed. At the end of the visit, the staff reviews the information and discusses treatment options with the patient.
The treatment. There are a number of treatments for pelvic floor injuries. Based on the woman’s needs and the data collected, the most appropriate is suggested. The therapeutic method is holistic and involves various approaches: a change of lifestyle; a change of diet; reassessment of the woman's medication; exercises to strengthen the pelvic floor; medications and surgical procedures. The treatment usually combines a few of the options.
In the past few years there has been a breakthrough in the treatment of women with leaking bladders or prolapsed pelvic organs – in medications and surgical procedures. Lately, minimally invasive surgery was introduced with wonderful results and an easy and short healing process.
This Health Tip courtesy of Dr. Yuval Lavy Director of the Urogynecology Service, Department of Obstetrics and Gynecology, Hadassah-Mt. Scopus.