Urogynecology: Treatment, Procedure, Cost and Side Effects

Urogynecology is a subspecialty within general gynecology services, which focuses on disorders of the female pelvic floor such as pelvic organ prolapse (bulging out of the uterus and/or vagina), urinary incontinence, fecal incontinence and constipation.

Urogynecology is often confused with gynecology, but the two are completely different. Urogynecologists focus on the evaluation and treatment of non-cancerous conditions concerning the female pelvic organs and their supporting muscles and tissues, as well as pelvic reconstructive surgery. Urogynecologists treat urinary incontinence, fecal incontinence and pelvic floor disorders such as pelvic organ prolapse.

Because urogynecology is a specialty, it is very unlikely that you will ever have a need to simply walk in or call to make an appointment. Nearly all urogynecology visits are spurred on by a tentative diagnosis, either from your gynecologist, urologist or general practitioner.

There is some crossover with the subspecialty of female urology – urogynecologists are urologists who undergo additional training to be able to manage female urinary incontinence, pelvic organ prolapse and interstitial cystitis/PBS. Contemporary urogynecological practice encourages multidisciplinary teams working in the care of patients, with collaborative input from urogynecologists, urologists, colorectal surgeons, elderly care physicians, and physiotherapists. This is especially important in the care of patients with complex problems, e.g. those who have undergone previous surgery or who have combined incontinence and prolapse, or combined urinary and bowel problems. The clinical conditions that a urogynecologist may see include stress incontinence, overactive bladder, voiding difficulty, bladder pain, urethral pain, vaginal or uterine prolapse, obstructed defecation, anal incontinence, and perineal injury. They may also care for women with vesico-vaginal or rectovaginal fistulae with specialist training, and in conjunction with other specialties.

Urogynecology treats a few basic issues of the female pelvic floor, such as stress incontinence, overactive bladder, voiding difficulty, bladder pain, urethral pain, and vaginal or uterine prolapse.

The pelvic floor is a term used to refer to the muscles, ligaments, connective tissue and nerves that help support and control the functioning of your bladder, uterus, vagina and rectum. Loss of support may lead to loss of bladder or bowel control, difficulty emptying the bladder or bowels, and downward falling or bulging of the pelvic organs. The pelvic floor can be affected by many things, but common causes of damage include childbirth, repeated heavy lifting, straining for bowel movements, some chronic diseases, and surgery.

Urinary incontinence is one of the primary treatments that urogynecologists provide. Urinary incontinence can be caused either as a result of stress (referred to as stress urinary incontinence, or SUI), or an overactive bladder. Depending on the type of incontinence, your urogynecologist will offer you solutions such as surgical procedures, as well as certain exercises that you can do at home to strengthen your pelvic muscles. Most commonly, SUIs are managed by surgery while medication is generally used for urge incontinence.

In case of loss of support or prolapse of the pelvic organs, surgical options are generally recommended, which correct the issues with the pelvic organs. Non-surgical options are also available, but they are generally not as effective as surgery.

Women who suffer from issues of the pelvic floor are eligible to go in for urogynecology treatments.

Women who suffer from general issues of the reproductive organs need not go to urogynecologists, as their problems can be treated by general gynecologists.

Urogynecology treats a variety of issues, and different issues have different side effects. In case the treatment of bladder incontinence is done non-surgically via medication, side effects include dry mouth, nausea and constipation. Other issues that are solved via surgery generally do not have any side effects, but it also depends from person to person. In case a patient already suffers from diseases such as obesity, diabetes, or breathing problems, they may experience side effects that people who do not suffer from these diseases will not experience. Pelvic reconstructive surgery can cause side effects such as pelvic pain and pain during sex.

Urogynecology issues such as bladder incontinence that are generally solved via medication do not have any post-treatment guidelines. However, in cases of surgeries involving the pelvic floor (such as pelvic reconstructive surgery), there are certain guidelines that need to be followed after the surgery has been done. Healing takes around 3 months, so during this time you should avoid any task that can put pressure on the repair i.e. lifting, straining, vigorous exercise, coughing and constipation. You should be able to drive and be fit for light activities within 3-4 weeks of surgery. Patients are also advised to wait for at least 5-6 weeks before having sexual intercourse.

Surgeries for strengthening the pelvic muscles, as well as pelvic reconstructive surgery, can take a total of 6 to 8 weeks to heal completely. During this time period, it is very important to strictly follow the post-op regimen provided by your doctor.

Different issues of Urogynecology require different treatments, so the treatment can range from anywhere in between Rs. 20000 to over Rs. 1.5 lakhs.

Issues like bladder incontinence can be successfully cured either via medication, or via surgery. But issues such as pelvic organ prolapse might not be completely cured via surgery. Day-to-day activities can often put a lot of stress on the surgically repaired pelvic floor, as a result of which some women have a persistence or recurrence of their prolapse after surgery. Surgery may result in fewer symptoms, but all of your symptoms may not be relieved.

Alternative options to surgical Urogynecology remedies include OTC medications, and behavioral and dietary modifications. However, in case you suffer from a certain urogynecological issue that needs surgery, there is no alternative treatment.