Take 5: Five Questions with Dr. Wittenberg on Urogynecology

Wittenberg121115-094Urogynecology is a field of medicine which specifically treats women experiencing pelvic floor disorders. Unlike gynecology, it is possible that many women are unfamiliar with urogynecology, when a urogynecologist is needed, and what kind of treatment they can expect.

At the Urogynecology Center of San Francisco (UGCSF), we realize that although the field of urogynecology may not be well known, the issues that women face that require the care of a urogynecologist are known. We asked Dr. Heidi Wittenberg some of the more common questions our patients have when seeking treatment for a pelvic floor disorder.

What is a pelvic floor?

Your pelvic floor is the muscles, ligaments and tissues that support your pelvic organs. The uterus, bladder, rectum and bowel comprise the pelvic base. This base, or floor, helps keep everything supported and in place even though gravity is constantly pushing on this area, plus activities like lifting and jogging, or any action like sneezing or coughing. The pelvic floor has to be strong enough to take daily and long term insults, and the bulk of physical force lands on this area rather than any other area of the body. Unlike other support muscles, such as ligaments and tissue, the pelvic floor has to be strong, but flexible. Flexibility allows bowel movements, emptying the bladder, having intercourse, and of course, having a baby.

What are some examples of a pelvic floor disorder?

Urinary incontinence, fecal incontinence, urinary retention due to bladder prolapse, bladder prolapse by itself, uterine prolapse or descent, rectal prolapse into the vagina, urethral prolapse.

Can a gynecologist treat a pelvic floor disorder?

Gynecologists can treat simple or mild cases of pelvic floor disorders with procedures called cystocele repair or rectocele repair, or by fitting a pessary.

How is a urogynecologist different from a gynecologist?

A urogynecologist has had the same training as a gynecologist or urologist, but then pursues additional specialized training. They have experience in treating more complicated and severe cases of pelvic floor disorders — ranging from functional issues of urinary or fecal incontinence, painful bladder syndromes, pelvic pain to anatomical issues of prolapse, scarring, nerve damage, benign gynecological conditions (like bleeding, fibroids, ovarian cysts) requiring minimally invasive surgery/advanced laparoscopic and/or robotic surgery.

Treatments urogynecologists provide include physical therapy, medications, urethral or vaginal support procedures, urethral bulking, anal sphincter bulking, laparoscopic or vaginal hysterectomies, removal of fibroids or ovarian cysts, removal of ovaries for cancer prevention in high risk patients, treatment of endometriosis, hysteroscopic procedures for fibroids, polyps or bleeding, bladder neuromodulation, and rectal neuromodulaiton.

Can my urogynecologist also be my gynecologist?

Depending on the practice, some urogynecologists can also provide gynecological care, other practices are strictly urogynecologic care and refer basic gynecological care to a gynecologist.