Urogynecology and Reconstructive Pelvic Surgery (URPS) is the marriage between urology and gynecology. It focuses on treating conditions that affect a woman's quality of life.
Below, Dr. Angel Marie Johnson, our Director of Women's Health, provides an overview of the top conditions she sees as a urogynecologist. From there, you can read in-depth articles about each one.
As with all content on our blog, the following is meant to be educational, not medical advice. Always consult your physician regarding your unique healthcare needs.
What is overactive bladder (OAB) in women?
JOHNSON: Millions of Americans suffer from overactive bladder. It impacts one in four women over the age of 18. Women, on average, wait six and a half years before they ever seek treatment, and less than half ever do. We also know that urinary incontinence decreases a woman's quality of life, similar to that of chronic diseases like heart disease and diabetes.
But here's the good news: overactive bladder is treatable.
Further reading on the GBU blog:
- Overactive Bladder in Women: Symptoms & Treatment Options
- 10 Things We Wish Everyone Understood about Overactive Bladder
- Axonics vs. Medtronic for Bladder and Bowel Dysfunction
- Introducing eCoin for Treating Urinary Incontinence in Women & Men
- MRI-Compatible Sacral Neuromodulation for Bladder Dysfunction
- What Does an OAB Nurse Navigator Do?
What is pelvic organ prolapse?
JOHNSON: Pelvic organ prolapse is when the vagina loses support, and that can involve three areas:- The top vaginal wall, which we call bladder prolapse or officially a cystocele. However, that's a simplification because it's the anterior vaginal wall that the bladder sits on that is prolapsing.
- Uterine prolapse occurs when the uterus has come through the opening. I commonly compare it to a sock that's turned inside out. Prolapse can happen after the uterus is removed (hysterectomy) as well.
- Posterior vaginal prolapse or what's called a rectocele. It occurs when the vaginal wall weakens, causing it to bulge. The bulge often affects patients with constipation. Chronic constipation can cause and exacerbate the prolapse, creating a vicious cycle.
Prolapse is more common post-menopause, and approximately 15% of women will undergo prolapse surgery. Thirty percent of the women who undergo prolapse surgery will end up having more than one procedure because, unfortunately, no matter what we do, sometimes the prolapse can recur even after surgery.
Prolapse treatments include pelvic floor physical therapy, a non-surgical option called a pessary, and surgery. The surgeries tend to be outpatient procedures with a short recovery and minimal interruption in your overall daily life.
Further reading on the GBU blog:
- Pelvic Organ Prolapse 101
- Understanding Native Tissue vs. Mesh-Augmented Surgery for Pelvic Organ Prolapse
- Lefort Colpocleisis for the Treatment of Pelvic Organ Prolapse (POP)
- What is a Rectocele (Posterior Vaginal Wall Prolapse)?
What is stress incontinence in women?
JOHNSON: Stress incontinence impacts up to 50% of women. The majority of women believe, "Oh, I had children. So, it's common to leak urine when I cough, laugh, or sneeze." Although it might be common, it's never normal to have bladder accidents once you're potty-trained.
I urge any woman who leaks urine with a cough, laugh, or sneeze not to live that way. They shouldn't alter their activity because they're afraid of peeing their pants. Women, we don't need to be a joke in our family! I don't want your kids trying to make you laugh so you pee your pants.
Instead, make sure you seek care because there are options. Treatments range from physical therapy to a procedure called Bulkamid or a mid-urethral sling.
Further reading on the GBU blog:
- Stress Urinary Incontinence in Women: Symptoms & Treatment Options
- Bulkamid for Female Stress Urinary Incontinence
What is pelvic pain?
JOHNSON: Pelvic pain is among the top chief complaints I see as a urogynecologist. This condition can be very debilitating yet challenging to treat. Pain is unique to the individual impacted by it, and it's tough for a physician to understand what a patient means when they describe pelvic pain. Is it bladder pain? Is it vaginal pain? Is it hip pain? Is it joint pain, or do they have tight hamstrings, which happen after the age of 30?
So when it comes to pelvic pain, the urogynecologist is the doctor of choice to start unpackaging those symptoms.
However, I urge patients to understand that it can be a long process to narrow down the cause. Treatments range from pelvic floor physical therapy to pelvic relaxation stretches. Trigger point injections can sometimes help. Also, creams, both pain relief creams as well as vaginal estrogen, can help alleviate pain from various sources.
Further reading on the GBU blog:
- Trigger Point Injections for Pelvic Pain
- Chronic Pelvic Pain Caused by Myofascial Pelvic Pain Syndrome
What is hypoactive sexual desire disorder (HSDD)?
JOHNSON: Hypoactive sexual desire disorder is the most common sexual disorder impacting women. It's more common after menopause, and it only becomes a disorder when it is distressing. Meaning if a woman doesn't have an interest in sex, it doesn't bother her, and it doesn't impact her life, then it's not a disorder and doesn’t warrant treatment.
It's only a disorder if she's distressed by it or it's affecting her life in a way that's causing harm, whether that's her overall self-image or her intimate relationships.
Various treatments are available. The first one I recommend is sex therapy, and it could be individual therapy or couples therapy, where you discuss all the dynamics in the relationship.
For women, sexual desire starts in our mind. It's not as physical as it is for men, where it's more about blood supply and physical changes. Women have to address the emotional barriers first, things like stress and relationship dynamics, before we even get to the physical—the chemical and body structures when it comes to sexual desire and arousal in women are different from men.
Two FDA-approved medications are currently available in the U.S. to treat hyposexual desire disorder: Addyi, which is a daily oral pill, and Vyleesi, which is a weekly injection.
Further reading on the GBU blog:
- Understanding Hypoactive Sexual Desire Disorder in Women
- Vyleesi for Hypoactive Sexual Desire Disorder (HSDD)
What is fecal incontinence?
JOHNSON: Fecal incontinence is an involuntary loss of solid, liquid, or mucus stool. It's a condition that is widely under-reported. Some women will never vocalize that it happens to them. They won't even acknowledge it because of how isolating and somewhat humiliating the condition can be. Yet it's as common as asthma, and it's not something that only happens to older people. It's common in women in their 40s. So, it's crucial to address.
We take a collaborative approach to treating fecal incontinence, meaning your gastrointestinal or GI physicians will often work with your urogynecologist. Sometimes we even bring in our colorectal colleagues due to birth trauma or lacerations from a complicated vaginal delivery.
Sacral neuromodulation is the number one treatment for fecal incontinence after behavioral modification, which means fiber, trying to bulk the stool, and addressing any dietary allergies or intolerances.
Further reading on the GBU blog:
- Fecal Incontinence: Symptoms and Treatment Options
- Axonics vs. Medtronic for Bladder and Bowel Dysfunction
- MRI-Compatible Sacral Neuromodulation Available for Bowel Dysfunction
What are urinary tract infections (UTIs)?
JOHNSON: Urinary tract infections are the plague of the post-menopausal woman. Recurrent UTIs are when a woman has more than two UTIs in six months or more than three in a year. UTIs are incredibly common and can rob women of their quality of life.
The reasons you should see a doctor for recurrent UTIs are twofold. One is to make sure that there's nothing structural going on. The workup starts by first getting a renal bladder ultrasound to make sure there are no stones, no masses, or structural reasons causing infections, and no scarring or renal changes resulting from them.
I also perform an office cystoscopy where I look inside the bladder and confirm there are no bladder masses, tumors, or cancer that's causing the infections.
Fortunately, for the majority of women, it's not structural. More often, the reason for the recurrent UTIs is due to menopause.
Many prevention strategies focus on boosting a person's natural immunity and ability to fight infections. Various evidence-based ways to boost immunity exist, from natural supplements to hormonal creams. Other strategies to help prevent UTIs are also available.
I want women to understand that UTIs aren't connected to hygiene. It's shocking how many women come to my office frustrated because they say, "I clean, and I bathe, and I wipe front to back; I do all of these things."
You're not dirty! You haven't gotten to where you are without knowing how to clean yourself. Do yourself a favor and see a urogynecologist to find the underlying cause of your UTIs.