When Should You See a Urogynecologist?

Do you notice pee leaking when you sneeze, cough, or do a jumping jack?

Do you feel like you can’t empty your bladder all the way? Are you constantly running to the bathroom to go yet again?

Do you have persistent pain or pressure around your pelvis, lower back, and abdomen?

Are you feeling the effects of these things in your sex life, work life, or home life?

These are all reasons to see a urogynecologist, meaning a specialist in gynecology with urology.

What’s a Urogynecologist?

Urogynecologists, or urogyns, are doctors with special training in diagnosing and treating pelvic floor disorders in women.

People usually end up seeing a urogyn when their issues involve both the urinary system and reproductive organs. Your bladder, uterus, and rectum all rely on the same group of muscles for support (the pelvic floor). A urogyn understands how those systems interact and affect each other.

A board-certified specialty, urogynecology has only been around for a little over 10 years. Its official name is Urogynecology and Reconstructive Pelvic Surgery.

But that doesn’t mean that everyone who sees a urogynecologist needs surgery. There is a wide range of treatments between non-surgical options and surgery, but you do not need to suffer in silence.

Why Would I See a Urogynecologist?

If you see a urogyn, it’s often because of one or more of these pelvic floor problems:

• Bowel movement issues, including chronic constipation or accidents.
• The feeling that your vagina is falling out, which can also feel like pain and pressure.
• Pain during sex.
• Pelvic pain, which may come and go or feel constant.
• Stress incontinence, meaning you leak urine when you do things like cough, sneeze, run, or jump.
• Urge incontinence, meaning you get uncontrollable urges to pee with very little warning.
• Urinary tract infections

You might start with your primary care doctor or ob-gyn for any one of these problems. They'll likely send you to a urogyn to help figure out exactly what’s going on.

You can also see a urogynecologist on your own, without a referral. At UPMC, you can find a urogyn and schedule directly with them.

People of any age can see a urogynecologist. It’s more common to have these problems as you age, if you have given birth, or struggle with other medical issues. Regardless of the reason, if you have bothersome symptoms, we urge you to see urogynecology to talk about options.

What’s the difference between gynecology, urogynecology, and urology?

When it comes to urogynecologist versus gynecologist versus urologist versus ob-gyn, here’s a quick explanation:

• Gynecologist — An expert on the female reproductive system. Sees you for well-visits and screens for diseases. Can treat painful periods and prescribe birth control and hormone therapy.
• Ob-gyn — The same as above, plus expertise in pregnancy, labor, and delivery. They may treat pelvic floor disorders, but it’s not their focus.
• Urologist — Experts in the urinary system (bladder, kidney, urethra). They treat both men and women for a wide range of urinary problems.
• Urogynecologist — A pelvic floor disorder expert. They focus only on problems affecting the organs of the pelvic floor, including bladder problems, but do not usually care for people who suffer from kidney stones.

What Happens During a Urogynecology Exam?

Going to the urogynecologist is similar to seeing your gynecologist — the focus is just a bit different.

First, you’ll talk to the urogyn about the problems you’re having. They’ll ask about your symptoms and how they affect your life, but they'll also want to understand the whole picture. Learning about the mental or emotional toll your symptoms are taking will help guide their treatment recommendations.

For example, leaking urine may keep you from running, rock climbing, or some other pursuit. Your treatment plan might differ from what they prescribe to someone who's older and more sedentary.

Your urogyn will conduct a physical exam and then a pelvic exam. During the pelvic exam, they’ll focus on your pelvic muscle strength and function.

They might order tests to check other functions. This may include bladder testing.

What Kind of Treatment Do Urogynecologists Offer?

Urogynecologists offer a wide range of treatments.

First, your urogyn may talk to you about what's in your control. For example, eating more fiber and drinking more water might help alleviate constipation. They’ll also try to understand things like your diet and your sleep patterns to see if minor tweaks can help.

But chances are that if you’ve gotten to the place where you’re seeing a urogyn, you need symptom relief.

Some medicines can help with bladder problems. You might need something to help the muscles of your bladder relax. Botox injections also work for some people.

There are also options including pelvic floor physical therapy and pessaries. Some people may need more intervention, including surgery.

You can choose what options, if any, make sense for you and your symptoms.

How pelvic floor physical therapy works

Pelvic floor physical therapy helps you learn how to stretch, strengthen, or relax the muscles of your pelvic floor.

A pelvic floor physical therapist (PT) will start by checking how much strength and control you have in your core support muscles. When they've identified weaknesses or areas of stress, they’ll create a plan for you.

Bladder retraining is a possible part of this. With this training, you learn to identify which muscles need to contract or relax. You can even “see” them on a screen and watch them react when you tighten or loosen.

Pelvic floor PTs may also use different types of nerve stimulation, which can help with bladder control. They also use techniques to help you strengthen your vaginal muscles.

A pelvic floor PT will always get your consent before touching you or conducting an internal exam. Remember, pelvic floor PTs and urogynecologists often talk about and treat these issues. They’ll work to make you comfortable and feel in control.

Don’t Wait to Get Help From a Urogynecologist

Women with pelvic floor disorders tend to keep it to themselves. Either they’re embarrassed or they think it’s a normal part of aging.

But pelvic floor disorder isn’t just a matter of aging. There are ways to help ease pelvic floor problems, and a urogynecologist is a great resource.

See how we approach urogynecology at UPMC.