Urogynecology: A new service to support patients with pelvic floor disorders

Parkview Health is proud to introduce a new Urogynecology clinic, located on the Parkview Hospital Randallia campus. Austin Hill, MD, PPG - Urogynecology, discusses the role of this new specialty service and how it will further support patients with pelvic floor disorders.

What is urogynecology?

Urogynecology is a subspecialty of urology and gynecology that focuses on pelvic floor disorders. A urogynecologist receives specialized training in the treatment of conditions that affect the female pelvic organs and the muscles that support them. A urogynecologist will have completed medical school and a residency in obstetrics and gynecology or urology. Then, rather than going into practice, they undergo three additional years of fellowship training in female pelvic medicine and reconstructive surgery.

What medical conditions does a urogynecologist treat?

The three most common disorders of the pelvic floor are urinary incontinence, pelvic organ prolapse, and fecal incontinence. Let’s take a closer look at each one:

• Pelvic organ prolapse: When the muscles and tissues supporting pelvic organs like the uterus, bladder or rectum become weak/loose allowing the organs to fall out of their normal positions.
• Urinary incontinence: There are two main types of urinary incontinence: urge and stress. Urge urinary incontinence occurs when the muscle of the bladder contract too often or spasm, causing a sudden and intense urge to urinate, sometimes associated with leakage. Stress urinary incontinence occurs when someone coughs, sneezes, jumps or laughs, and is due to loss of support to the urethra or poor sphincter contractility, which can cause an involuntary leak.
• Defecatory disorders and fecal incontinence: When someone has difficulty with bowel movements and the inability to control bowel movements. These conditions are more common in individuals who already have urinary incontinence.

We do treat a variety of other things, both medically and surgically, in addition to these three main pelvic disorders. Urogynecologists also specialize in pelvic mesh placement and excision, bladder pain syndrome, birth trauma, recurrent urinary tract infections, vaginal dryness, vulvar irritation, vaginal and periurethral cysts, urethral diverticulum, fistula repair and other pelvic disorders. 

What can someone expect at their first visit or treatment?

For a patient’s first visit, we want to make sure, as a subspecialty, that we’re getting the full story. To do that, we send patient packets out beforehand, which go over a patient’s medical history and including questions on their pelvic health and the conditions we treat like incontinence and prolapses. Then, upon the first visit, we take the time to evaluate the patient, discuss what they’re hoping to get out of their visit, what their options are, and then we create a treatment plan together.  

When should I seek help or treatment from a urogynecologist, and will I need a referral?

Patients can self-refer, but most of the time they’ve mentioned their symptoms to their primary care provider who then refers them to us. Unfortunately, many women wait a long time, even years, before seeking help because they’re uncomfortable talking about their condition, or they don’t think something can be done and are unaware of the options that are available to them.

Some women also feel embarrassed that they have a pelvic floor disorder, but we want you to know you are not alone in your symptoms and challenges. We want all patients to know that our office is a safe place. A place where everyone coming in has similar problems that we will help find solutions for. 

We want to empower women to bring up any concerns, pelvic symptoms or discomfort you may be experiencing. We’re are always happy to help and remain committed to providing you the best care possible, so you can get back to living your best life.

Why is it necessary to seek treatment and not ignore problems with my pelvic health?

It’s just like anything else. If you take care of your car, getting routine oil changes and maintenance done, generally, it’s going to last for a while. Your body and your health are the same. Pelvic floor disorders are symptom-based and, if ignored, they will start to impact your daily life. So, if something is bothering you, it’s in your best interests to address the condition and seek treatment.

With that said, we will never obligate a patient into any form of therapy or treatment. Management is based solely on a patient’s symptoms and goals. If their condition bothers them, we will address it. If they aren’t bothered, then we will make sure there are no medical indications for treatment and let the patient guide our next steps and treatment strategies. However, we make these plans with the understanding that over time, their condition could progress and become more bothersome.

What role does stigma play in women seeking treatment?

Stigma plays a huge role in women taking the initiative to seek out available treatment. About 70% of women will wait, on average, one year to speak with a physician. 1 in 5 women will wait five years or longer. However, once they do find the courage and make an appointment, they may still feel uncomfortable. Pelvic health is a subject that can be uncomfortable to talk about, leaving many people unwilling to admit they’re having issues. While it can be embarrassing, it’s important to know that our office is a safe environment and we will do everything we can to make our patients feel comfortable.

So, how can we correct this stigma? Through awareness and understanding that pelvic floor disorders are not normal. It may surprise you to know that 1 in 4 women over the age of 20 have a pelvic floor disorder, and that number only goes up as you age. Additionally, 60% of women who are 65 or older will have some form of urinary incontinence. By the time they’re 80, 1 in 5 women will have had surgery for a pelvic floor disorder. But just because your grandmother or mother told you this would be an issue doesn’t mean something can’t be done. You don’t have to live with the discomfort that infringes on your daily life. We have a variety of options with excellent results that will help patients improve and feel better with lasting results.

How would you describe your approach to treatment?

Our philosophy and approach to treatment are to explore the least invasive option. Most of our therapies start with behavioral change. Initially, we want to focus on how to change diet, mindset and assist patients without the use of medication or surgery. Then, we look at the options that are going to benefit the patient most. Maybe that’s physical therapy, medication or a procedure. We discuss all of the options, benefits, risks and anticipated outcomes with the patient, making it a joint decision on the best path forward. But, no matter the treatment plan, our goal is to get patients back to their normal activities and doing the things they enjoy.

It’s rewarding for us to see someone come into our office with an issue that’s impacting their daily life, go through the clinic and therapies, then leave being able to resume activity again. It’s so fulfilling to know we were able to help them.

Why is it so beneficial for our community to have this specialty available?

Under the umbrella of women’s health and understanding the number of people that are impacted by pelvic floor disorders, it makes sense that we have this specialty here in Fort Wayne. We haven’t had a fellowship-trained urogynecologist in the community until now. Having a doctor specifically trained in pelvic health and pelvic floor disorders allows for more understanding of available treatments and surgeries along with their associated benefits, outcomes and historical relevance. Additionally, this wider breadth of training provides uniquely designed care tailored specifically to each patient’s needs and situation.

How does this specialty correlate to others within the gynecology field?

Again, this is a subspecialty of gynecology and urology. So, if you have a gynecologist or urologist you love seeing and there’s an issue, they would most likely refer you to us. We take pride in developing relationships with other physicians from other departments to make sure we’re taking excellent care of one another’s patients. Additionally, when there is a more challenging condition that isn’t clear cut, we will collaborate and create a plan together to make sure that patient is receiving the best care possible.

Where is the new urogynecology office located?

Our office is on the Parkview Hospital Randallia campus at 2231 Carew St., entrance 4. If you’re looking for more information or want to schedule an appointment, please visit our Women’s Pelvic Health page or call 260-425-5240.