Urogynecology - women's pelvic floor medicine

The field of urogynecology and women's pelvic floor medicine is a relatively new field that has emerged from gynecology and gained momentum over the past decade, and urogynecology centers now exist in almost every hospital.

The urogynecologist is a physician specializing in obstetrics and gynecology who has undergone further training in the field of pelvic floor disorders in women, and aims to provide a response for women suffering from problems related to weakness of the pelvic floor (incontinence, feces, uterine prolapse, etc.).

The reason that this sector has especially grown out from the field of gynecology probably stems from the frequent need of the physician to meet and address other problems related to women's health. For example, there is a need to relate to other pathological conditions in the pelvis (ovarian cysts, uterine fibroids, etc.), to discuss the need for preservation of the ovaries versus oophorectomy at menopause, and of course to relate to the reproductive plans of the woman - whether she is interested in further pregnancies, whether to delay surgery until after births or whether to recommend a Cesarean section after treatment, and more.

Pelvic floor

The woman's pelvic floor is an organ with a very important role both in supporting the pelvic organs especially the uterus and bladder, and in urinary and fecal control. The pelvic floor is a complex structure from both an anatomical and functional point of view, consisting of muscles, ligaments and nerves.

Injury to this organ is very common in women and pelvic floor problems exist at an incidence rate of more than 50% of women with a significant increase in incidence in older age. These problems can seriously affect the quality and functioning of daily life to the point of stopping work, avoiding social activities, severe harm to body image and self-esteem, damage to relationships and more.

How do I know if I am suffering from a pelvic floor problem?

Damage to the pelvic floor is usually accompanied by various symptoms that harm a woman's quality of life. Typical symptoms are many and varied and include:

  • involuntary urination, including stress and urge urinary incontinence
  • urgency and frequency of urination
  • the need for urination during the night
  • difficulty in urinating
  • feeling of discomfort and vaginal pressure resulting from prolapse of the pelvic organs (uterus or bladder)
  • disturbance in having sexual relations

The frequency of the problem and the "Bond of Silence"

The phenomenon of stress urinary incontinence is very common and could reach up to 50% of the elderly population. In primitive societies, the subject is taboo from the point of view of a woman's ability to contact a physician and present her problem. Unfortunately, even in modern society the false myth prevails that the problem is typical of the aging population and so we have difficulty in obtaining accurate data regarding the extent of the problem. Many women walk around with damage to the pelvic floor and refrain from complaining both due to shame and to a lack of knowledge and understanding that the process can be fixed and usually very simply; sadly awareness is low even among physicians who interact with the women on a day to day basis. In many cases a doctor who proactively asks about the problem will come across a woman opposite him who is suffering and crying out for help.

In recent years we have witnessed two important phenomena in this field. On the one hand, the medical ability to help with different situations of injury to the pelvic floor has increased. On the other and no less important hand, there is increasing awareness of these issues among both the medical community and among women, more women are being referred or turn of their own initiative to ask for help.

Why is this happening to us?

First, from a structural point of view, a woman's pelvic floor is fundamentally different from the structure of a man. The structure of the vagina and the birth canal in women creates a continuous "fault" in the pelvic floor; anatomically and physiologically this part constitutes a point of weakness, and most injuries involve this region.

Many studies have shown that in many cases vaginal birth and the transition of the baby in the birth canal causes damage to ligaments, muscles and nerves. Additional risk factors are related to the genetic-hereditary component and increase in intra-abdominal pressure (obesity, chronic constipation, smoking with chronic cough, lifting, etc.). Age also has an important role in the formation of the injury: the more advanced the age, the more common the phenomenon because of the cumulative damage over the years.

The urogynecology clinic

The urogynecology and pelvic floor clinic at Hadassah is a multi-system clinic that aims to provide a response for women suffering from problems related to weakness of the pelvic floor (incontinence, feces, uterine prolapse, etc.). The clinic is staffed by a doctor - a urogynecologist, and a physiotherapist specializing in the pelvic floor as well as a nurse coordinator.

A process of general evaluation of complaints related to pelvic floor problems and a full assessment of the woman is performed in one visit to the clinic. The evaluation includes taking a medical history, specific questions to identify the problem, physical examination, and urodynamic testing. If necessary various imaging tests can be performed and the woman can be referred to a colorectal surgeon or gastroenterologist according to the findings.

This processing provides data on properties of the bladder and the functioning of the pelvic floor. At the end of the process, using the data collected, the team will sit together with the woman and treatment options will be reviewed.

What is the treatment?

To determine the type of treatment, the urogynecological assessment should of course be completed. The treatments for pelvic floor injuries are diverse and can be adapted to each woman according to her needs and the assessment findings.

The treatment approach is holistic and involves a variety of approaches: lifestyle change, changing eating and drinking habits, re-evaluation of the medication a woman takes for other diseases, exercises to strengthen the pelvic floor, drug treatment and surgical operations. Treatment usually includes a combination of different options.

In recent years there has been a breakthrough in treating women with complaints of involuntary incontinence or prolapsed pelvic organs. The recent introduction of minimally invasive surgical techniques provides an excellent solution to the problem with minimum surgery, short duration with excellent results and a short and easy recovery.