Oct 14, 2024 Urogynecology: A Guide for Women

This important medical subspecialty treats common conditions that are often ignored.

When we think about women’s health care, the specialty of obstetrics and gynecology (OBGYN) probably springs to mind.

But while it’s important to see a gynecologist regularly starting around ages 13 to 15, women may need specialized care that goes beyond reproductive health for a variety of reasons:

• Women’s bodies are complex, and their intricate reproductive systems interact or connect with nearby organs and related bodily functions.
• Health care needs change throughout women’s lives—well past childbearing and menopausal years.
• Often, women develop problems in the pelvic area that are not solely gynecologic. The multifaceted nature of women’s health has given rise to a subspecialty called urogynecology that can address diverse issues related to female anatomy.

Here’s what you need to know about this important medical field and the conditions it treats.

The Field Is Growing

Urogynecology has been recognized as a discipline for decades but was only established as a certified subspecialty in 2011, with the first urogynecologists being board certified in 2013. The field doesn’t simply combine urology and gynecology but requires urogynecologists to undergo specialized education and training in an intensive fellowship on top of a general residency in either OBGYN or urology.

The Pelvic Floor Is Key

“Urogynecology is a subspecialty of both gynecology and urology that focuses on pelvic floor disorders [PFDs],” says Eric Liberman, DO, Director of Minimally Invasive Gynecologic Surgery at Cooperman Barnabas Medical Center (CBMC) and a member of RWJBarnabas Health Medical Group.

The pelvic floor is a funnel-shaped, sling-like area of muscles, ligaments and connective tissue between the coccyx (tailbone) and pubic bone that supports the bowel, bladder, uterus and vagina. Urogynecologists are experts at diagnosing and treating PFDs with a variety of methods, including medications, devices and surgery, often working with other providers.

“As a gynecologic surgeon, collaboration with urogynecologists is beneficial because a patient’s symptoms may have more than one underlying cause,” says Dr. Liberman. “To achieve optimal patient outcomes, it’s important to consider the interactions of all organ systems and their effects on the patient’s symptoms.”

For example, a patient undergoing a hysterectomy for a large fibroid uterus and heavy menstrual bleeding may also have urinary incontinence and/or frequency that have been attributed to the fibroids. However, fibroids are not always the cause. “The patient may also have an underlying bladder dysfunction that may benefit from a concomitant procedure,” Dr. Liberman says. “Conversely, patients may present to a urogynecologist with urinary frequency or incontinence complaints, and the root cause may be fibroids.”

Treatments Are Available

“About one in three women will experience at least one pelvic floor disorder in her lifetime,” says Katherine Shapiro, MD, a urogynecologist at Robert Wood Johnson University Hospital Somerset and a member of RWJBarnabas Health Medical Group. “Often, childbirth can lead to these disorders, and women may experience them immediately postpartum or even decades down the road.”

Among the most common PFDs are:

• Pelvic Organ Prolapse: One or more pelvic organs slip from their normal position and protrude into the vagina. Prolapse is often managed with a pessary—a silicone device inserted into the vagina to support the uterus or bladder and rectum,” says Megan Abrams, MD, a urogynecologist at Monmouth Medical Center and a member of RWJBarnabas Health Medical Group. Physical therapy may also be helpful as an adjunct or even a stand-alone treatment. Some cases may benefit from reconstructive surgery. “Surgery is minimally invasive and can be done laparoscopically or vaginally,” Dr. Shapiro says. “Recovery time is usually two to four weeks.”
• Stress Incontinence: Pressure on the bladder from movement or activities such as coughing, sneezing, laughing or heavy lifting causes urine to leak. Treatment options include physical therapy, a surgically placed urethral sling or urethral bulking agents that are injected into the walls of the urethra to help strengthen its sides, allowing tighter seals that prevent leakage.
• Overactive Bladder (OAB): Bladder muscles tighten involuntarily, triggering a need to urinate urgently or often. Treatments for OAB include physical therapy and medications that suppress involuntary bladder contractions or relax certain muscles, increasing bladder capacity. Procedures such as injecting the bladder with Botox or placing nerve-stimulating devices can also help.

You Don't Have to Suffer

“These problems are common, but that doesn’t mean they’re normal, and you shouldn’t have to live with them,” says Dr. Shapiro. Older patients in particular often believe that conditions such as incontinence and pelvic organ prolapse are normal consequences of childbirth or aging and that they must “deal with it.”

“A phrase I often hear from patients is ‘I wish I had known about treatment sooner,’” Dr. Abrams says.

Collaboration Is Crucial

PFDs often accompany or mimic gynecologic, urologic, gastrointestinal or other conditions, making collaboration between urogynecologists and other health care professionals important.

“For example, pelvic pain or urinary symptoms such as OAB, incontinence or chronic pelvic pain may be caused by fibroids—or by a PFD or interstitial cystitis [a chronic inflammation of the bladder],” says Dr. Liberman. “If a postmenopausal patient has had fibroids for many years but later develops increased urinary frequency or urgency, it’s important to investigate causes other than just fibroids.”

Dr. Liberman may refer such cases to a urogynecologist for urodynamic testing, which evaluates how well the bladder, sphincters and urethra store and release urine. A multidisciplinary collaboration helps determine the best treatment.

Surgeries are sometimes performed jointly by a gynecologic surgeon and a urogynecologist, which can spare patients from multiple procedures. “For instance, if a patient is having a hysterectomy and also has severe pelvic floor prolapse or urinary incontinence, a urogynecologist may work collaboratively to address the PFD or urinary incontinence,” Dr. Liberman says. “This way, the patient only has to undergo surgery and anesthesia once. Collaboration is key for the best patient outcomes.”

A Minimally Invasive Solution

For several years, Bette Uhrmacher, a retired superior court judge, had lived with what she assumed was a prolapsed bladder. She also assumed that correcting her uncomfortable bladder and bowel problems would require invasive surgery and a lengthy recovery.

“My husband was ill, and I didn’t want to be unable to drive,” Bette says. “I also remembered my mother’s hysterectomy and thought, ‘I can’t do this.’”

Bette tried using a pessary, a vaginal device that supports the uterus or bladder/rectum, but it didn’t provide much relief. Then, during an unrelated appointment, Propa Ghosh, MD, a urologist at Monmouth Medical Center (MMC), told Bette that her prolapse could readily be addressed by a urogynecologist.

In March 2024, she saw Megan Abrams, MD, a urogynecologist at MMC, who diagnosed a uterine and bladder prolapse and reviewed minimally invasive treatments. “I chose the option that offered the fastest recovery and would allow me to return to the gym soonest,” says Bette.

The procedure consisted of a vaginal hysterectomy and uterosacral suspension, which restores support of the top of the vagina after hysterectomy. “The procedure is entirely vaginal, so no incisions are made in the abdomen,” Dr. Abrams says. Bette spent one night in the hospital, was driving in 10 days and went back to the gym in six weeks. “Dr. Abrams and her team were very good and very reassuring,” she says. “I felt like I got my life back.”

Learn more about comprehensive women’s health services available at RWJBarnabas Health.