Some of your patients may not realize the importance of pelvic floor health until they experience a pelvic floor disorder. Urogynecologists, who are specially trained to treat pelvic floor problems, tend to see patients with these concerns. Yet traditional gynecologists can and do see patients with pelvic floor conditions. In fact, you may be the first clinician your patient will encounter when seeking help. Whether you provide care yourself or refer them to subspecialists, it helps to deepen your understanding of the disorders that affect this aspect of their anatomy.
Discussing Pelvic Floor Disorders
A number of conditions can affect a woman's pelvic floor — the group of muscles, ligaments and connective tissue that helps support internal organs such as the bladder, bowel, uterus, vagina and rectum. The most common forms of urogynecology pelvic floor conditions include urinary or fecal incontinence, overactive bladder, organ prolapse and fistulas. There are many causes for these problems, including childbirth, surgery, menopause, chronic disease and heavy lifting — most of which can result in weakened or torn pelvic floor muscles.
As you might imagine, pelvic floor disorders can be embarrassing for patients when they occur and can be difficult for them to discuss, even with physicians. Gynecologists may need to take the lead in starting conversations about these conditions with patients rather than waiting for them to raise the subject. Getting started can be as simple as asking certain questions during a routine appointment: "Have your bathroom habits changed at all?" or "Have you noticed any leakage or pelvic pain?" Even if the answer is no, you leave the door open for patients to come to you with concerns in the future.
When to Refer to a Specialist
How you treat a pelvic floor disorder depends on the particular condition. Some problems may respond to treatment such as dietary changes, behavior modifications, pelvic floor exercises like Kegel exercises, medication or devices like vaginal pessaries. However, more serious cases will likely require consultation with or referral to a urogynecologist. These specialists have additional years of fellowship training and certification in female pelvic medicine and reconstructive surgery and are skilled in the evaluation and treatment of disorders that affect the pelvic floor.
Depending on your patient's specific concern, a urogynecologist may suggest therapies like biofeedback or electric stimulation, or they might recommend certain surgical procedures. Whatever the treatment, gynecologists play an important role in helping these patients get treatment. Clinicians have the opportunity to work closely with urogynecology specialists to provide women with the best possible care for pelvic floor disorders.
Urogynecology ultrasound
