A Urogynaecologist is an obstetrician and gynaecologist who has a special interest in pelvic floor problems such as urinary and bowel weakness/incontinence and vaginal/pelvic organ prolapse, as well as bladder and vaginal pain and other conditions e.g. urinary infections/recurrent cystitis.
Many, although not all, are subspecialists and have undertaken a two-three year training programme on top of their basic training in obstetrics and gynaecology and spend most of their time managing women with these problems – in particular doing investigations for bladder weakness such as urodynamics and offering a wide range of treatments within a multi-disciplinary team of nurses, physiotherapists, midwives, pain specialists, colorectal surgeons and urologists.
Urogynaecologists are also involved in teaching how to prevent birth injuries such as the ‘OASI Care Bundle’ www.rcog.org to midwives and obstetricians.
Many are involved in research to try and improve the results of treatment as well as prevention.
How a Urogynaecologist can help after birth injury:
Many Urogynaecologists will have dedicated clinics for women who have suffered a birth injury often with colleagues from the multi-disciplinary team. Many are with a colorectal surgeon, but there are also nurse/midwife clinics where a physiotherapist attends too.
Here time can be given to go through all the aspects of how the injury might have arisen and what can be done to treat the symptoms. The clinicians can also give advice on how to prevent another injury in a future pregnancy.
Treatments include physiotherapy, and advice on vaginal pessaries which can be worn to prevent leakage and prolapse.
In some cases, if these treatments don’t work, then surgery can be considered and the ‘pros and cons’ discussed.
The team can arrange support and counselling for women with mental health issues as a result of their birth injury.
How can I access my local Urogynaecology service?
The MASIC map shows centres around the UK where services can be accessed. This is for women who have had an OASI (obstetric anal sphincter injury) but will usually involve a Urogynaecologist too; a referral from your GP is best.
In addition there is much information for women via the British Society of Urogynaecology https://bsug.org.uk/pages/information-for-patients/111 and the International Urogynecological Association patient website www.yourpelvicfloor.org where there is a ‘Find a Provider’ service.
All should usually be able to provide you with information about the results of their surgery and feedback from women. You might also be invited to take part in clinical trials which might not just help you, but other women in the future too.
What questions should I ask my Urogynaecologist?
- It’s best to ask what is the problem and how has it happened, and what can your Consultant, and you, do to help.
- Explain how your symptoms affect your everyday life and which one troubles you the most. There are numerous relatively simple ‘self-help’ measures including avoiding drinks which might aggravate the condition (e.g. tea, coffee, fizzy drinks), weight loss and pelvic floor exercises (with a physiotherapist or specialist nurse), vaginal pessaries and medications.
- Ask what to do if that doesn’t work; what else is available, and how successful that is e.g. surgery outcomes and what are the risks?
- What if I do nothing?
- If planning another pregnancy, will it get worse? What can be done to prevent that?
- Are there support groups/other organisations that might help?
- Are there any clinical trials I can take part in?