Urogynecology Services for Women's Bladder and Pelvic Health

As you get older, the muscles that help you control when and how you pee may weaken. Having children can worsen this problem, which can be frustrating, embarrassing, and even painful.

We offer many treatments for bladder, bowel, and other problems involving the organs in your pelvic area. From therapy and medicine to surgery, urogynecology has solutions for many pelvic floor issues.

UPMC has urogynecologists who see people throughout Pa. UPMC Magee-Womens Hospital in Pittsburgh also has a special center for pelvic health.

What Is Urogynecology?

Urogynecology, or urogyn, is a combination of urology and gynecology.

Your bladder and your female reproductive organs have a unique relationship, which urogynecologists are experts at understanding. They have special training in diagnosing and treating pelvic floor disorders in people with these organs.

Urogynecology is a newer specialty. The first urogynecologists became board-certified in 2013. Urogynecologists see people of all ages, and offer everything from medicine to surgery.

What does pelvic floor mean?

Your pelvic floor is the support system for all of the organs around your pelvis.

The muscles in your pelvic floor work hard to keep your bowel, bladder, uterus, vagina, and rectum where they should be. It’s the called the “floor” because it’s the low part of your pelvis. It’s literally what keeps organs from falling out.

What’s the difference between gynecology and urogynecology?

A gynecologist is a doctor with expertise in the female reproductive system. They see people for well-visits and screen for various diseases. They can also help with issues related to your period, birth control, and menopause.

If they’re also an obstetrician (an ob-gyn), they’ll see you through pregnancy and deliver your baby. They may also be able to do certain types of gynecological surgery. They sometimes treat pelvic floor disorders, but it’s not their focus.

By contrast, pelvic floor disorders are the main focus of an urogyn. Urogynecologists don’t do the same type of well-visit care that gynecologists do. They're more narrowly focused and more specialized.

What’s the difference between a urogyn and a urologist?

Urologists treat a wide range of conditions that affect your bladder and kidneys. They diagnose infections and other problems unrelated to the pelvic floor.

Urogynecologists have training in urology, but their focus is narrower. They deal with urological conditions as they relate to your pelvic floor. They also only see people with female reproductive organs.

Why Would I Need to See a Urogynecologist?

Your gynecologist might refer you to a urogyn, or you might come on your own.

You might see a urogyn if you:

• Leak urine when you run, walk, jump, laugh, sneeze, or cough.
• Get sudden urges to pee or poop, and sometimes have accidents.
• Keep getting UTIs.
• Have pain during sex.
• Feel pain, pressure, or general discomfort in your pelvic area, and/or have a feeling that your vagina is falling out.

What conditions does a urogynecologist treat?

A urogyn treats the full range of pelvic floor disorders, including:

• Incontinence — Urine leaks that happen with activity (stress incontinence) and at random (urge incontinence).
• Overactive bladder — When the muscles that control your bladder start to squeeze at the wrong time, causing leaks.
• Excessive nighttime peeing — Called nocturia, this is when you often wake up several times a night to urinate.
• Bowel movement problems — Having sudden urges to poop and not being able to make it to the bathroom or being constantly constipated.
• Pelvic organ prolapse — Sometimes also called dropped bladder or dropped uterus, this is when your bladder or uterus drops and starts pushing against your vagina.
• Recurring urinary tract infections — Frequent UTIs that can happen in any part of the urinary system (bladder, kidneys, ureters, or urethra).
• Painful bladder syndrome — A chronic condition where the walls of the bladder become inflamed, causing pain and irritation.
• Urinary retention — When urine doesn't completely empty from your bladder.
• Pain during sex — Pelvic floor problems like UTIs or pelvic organ prolapse can cause pain during sex.

What Urogynecology Procedures Do You Offer?

Urogynecologists are problem-solvers.

We work to understand your problems and how they’re affecting your life. We start with the simplest ways to help solve them, and if that doesn’t work, we try more advanced treatments.

Every treatment or procedure we offer is based on the most current research. This field has exploded over the last decade, and we stay up to date so we can bring you the latest and best treatments.

Your urogyn will talk with you about which tests or procedures you might need, which may include the following.

Bladder testing

This includes tests like:

• Urodynamic testing — This test helps your urogyn determine if your bladder is functioning as it should.
• Cystoscopy — This procedure lets your urogyn examine the lining of your bladder and your urinary tract.

Lifestyle changes

Changes in diet and exercise can have an impact on pelvic floor problems. For example, losing weight can help take pressure off your pelvic floor.

We can work with you to make lifestyle changes like:

• Start an exercise program.
• Learn about eating healthier.
• Start doing specific pelvic floor exercises, like Kegel exercises (squeezing your “pushing” muscles).

Medication

Certain medicines can help some people with pelvic floor issues. For example, muscle-relaxing drugs can help with muscle spasms that cause incontinence.

We also do Botox® injections for overactive bladder. An injection can help calm the nerves in the bladder, decreasing the feeling of urgency you get.

Physical therapy

A pelvic floor physical therapist (PT) can work with you to strengthen weakened pelvic muscles. They also have techniques to help you relax or stretch tight pelvic floor muscles. A pelvic floor PT can design the right therapy program for your goals.

Medical devices

For some people, a pessary can help with incontinence and other symptoms of pelvic organ prolapse. This small, removable device goes inside your vagina.

We also offer sacral nerve modulation (SNM) for incontinence. This small, surgically implanted device sends mild electrical stimulation to the nerves at the end of your tailbone, improving communication between your pelvic floor muscles and your brain.

Surgery

If all other treatments have failed, our urogynecologists offer minimally invasive surgeries that can be life-changing, including:

• Sling surgery — We use a piece of body tissue or synthetic material to create a hammock-like cradle to support the urethra. It supports your bladder neck and helps prevent involuntary urine leakage when coughing, sneezing, laughing, or exercising.
• Sacral colpopexy — This surgery repairs pelvic organ prolapse and is less invasive than vaginal repair. We can do it robotically, which adds even more precision.

What are the risks and complications of urogynecology procedures?

Not every person with incontinence and/or prolapse issues will need surgery. But for those with severe problems, the benefits nearly always outweigh the risks.

This is because pelvic floor disorders greatly compromise the quality of people's lives. This can lead to depression, social isolation, and avoiding physical and sexual activity because of discomfort and embarrassment.

Your doctor will talk to you about specific risks associated with any procedure they do. For example, surgery can cause some mild nerve damage. And all surgeries carry a risk of bleeding or infection.

Your care team can help you manage risks.

What Should I Expect at a Urogynecology Appointment?

First appointment

It can be helpful to write everything down that you want to talk about before your appointment. If you’ve been keeping a diary or record of bladder or bowel problems, bring it with you.

Your urogyn will ask you about your symptoms. They'll also take a medical history to get a sense of what life is like for you now and what things in your past might be related to the problems you’re currently having.

They’ll want to know about:

• Pregnancies and births.
• Your periods and any menstrual problems.
• Your sexual function.

If you’ve had a sexual assault or trauma, this may feel like an overwhelming, even invasive conversation. Considering that half of women have experienced sexual violence during their lifetimes, urogyns deal with these topics frequently. While you don’t need to share specific details, letting your urogyn know about your experience can be helpful.

Know that everything we do at UPMC is private and confidential. We understand these can be uncomfortable issues to talk about, no matter your history.

Exams and tests

Your urogyn will start by doing a pelvic exam to see the organs of your pelvic floor.

They may use a speculum to examine your vagina and see if it’s prolapsing. If it is, they’ll try to determine which part is prolapsing. They may also use a Pelvic Organ Prolapse Quantification, or POP-Q, to assess how severe your prolapse is.

The urogyn may then do bladder testing to learn about any incontinence you’re having.

They might also order imaging tests:

• Pelvic ultrasound — To see your bladder and pelvic floor muscles.
• MRI of pelvic floor — To assess what’s happening with your pelvic floor and what happens when you strain.
• CT scan of your pelvis and abdomen — To rule out other things that might be happening.

Depending on your symptoms, your urogyn may order other tests as well, including:

• Colonoscopy — Looking at your entire colon can help rule out other issues causing bowel problems.
• Nerve testing — To understand if your bowel is getting the right signals. Is it filling as it should? Are your muscles getting the signals and working as they should?
• Defecography — To assess how you're pooping. You sit on a toilet and have a bowel movement, and there’s a special way of visualizing it via x-ray or MRI.

Diagnosis and treatment

Your urogyn will review all of your test results and offer a diagnosis. Having the right diagnosis matters because it lets us know what to do next.

Sometimes, small changes can make a big difference. We start with conservative treatment and add more as needed.

The goal is to help you live the life you want to live. This means doing the activities you enjoy and not having to live with pain or worry about accidents.

Although your treatment will be unique to you, your urogynecologist will be with you each step of the way.

Do I Need a Referral to See a Urogynecologist?

While many ob-gyns refer people to a urogyn, you don’t need a referral to schedule an appointment with a urogynecologist at UPMC.

---

Last reviewed by a Jocelyn Jane Fitzgerald, MD on 2024-09-05.