Formally referred to as Female Pelvic Medicine/Reconstructive Surgery, urogynecology focuses exclusively on the care of women with pelvic floor dysfunction such as bladder and bowel incontinence, vaginal prolapse, trouble urinating or passing bowel movements, and pelvic pain. To insure quality training for urogynecologists, the American Board of OB/GYN and the American Board of Urology have joined to accredit the strict fellowship programs. The requirements are a two-year fellowship for urologists and a three-year fellowship for Ob/Gyns.
The specialty was formed to address a need, says James Head, MD of Shelby OBGYN in Alabaster. “It can be frustrating and time-consuming for patients who have to see five or six different doctors for evaluation for one of these problems, and often the give up,” he says. “We can make most people better, and it makes a huge difference in their social function and interactions. We have seen a lot of success which is one of the reasons I enjoy working in this field. We offer a service that a lot of others may not have an interest in or may not know how to treat.”
Brent A. Parnell, MD, also became an urogynecologist to help these women. “Urogynecology gives me the opportunity to provide life-changing therapies and surgeries for women who, many times, suffer in silence for years before seeking treatment,” says Parnell, who will join Ob-Gyn South at Brookwood Hospital in July. “As Ob/Gyns, we are trained to take care of women. I enjoy working with them to design treatment plans to meet their goals, and my training in urogynecology allows me to provide the highest level of care available for women who have pelvic floor disorders.”
Pelvic floor disorders can occur when the pelvic floor is weakened or stretched from damage caused by childbirth, obesity, surgery, or disease. Depending on the severity of symptoms and patient health, conservative, non-surgical therapies often are the initial approach in treatment. Medications, exercises, lifestyle and dietary changes, and support devices are among such treatments.
“When a patient comes to us with incontinence, the first thing we do is evaluate them to check function and form. Incontinence is not a disease, it is a symptom, and there are several things that can cause the problem,” Head says. “The cause of the problem determines what treatment is right for each patient.”
Many physicians are knowledgeable about pelvic floor disorders, but an urogynecologist has a higher level of expertise in treating these issues. “Ob/Gyns focus only on women’s health, so we are uniquely qualified to take care of pelvic floor disorders. Urologists are specialists for genitourinary disorders and approach things with a different skill set and perspective,” Parnell says. “The training in OB/GYN provides the basic skills necessary to take care of female pelvic floor disorders, and the additional training in urogynecology builds on that skill set and expands it to cover the entirety of pelvic floor disorders that women may experience.”
Head points out that an urogynecologist can offer simple solutions that many patients don’t realize are available. “For women with bowel leakage, increasing fiber intake can help, and there also are medical therapies for both bowel and bladder problems. There are so many possibilities, it’s hard to list them all,” he says. “One of the advanced therapies we use is sacral neuromodulation, to try and reset the nerves that go to the colon or bladder. It’s like putting a pacemaker in the lower back area, and is a successful procedure on the right patient.”
During the 20 years that the specialty has been around, it has grown and become more widely recognized, Parnell says. “Urogynecology has provided a mechanism to continue improving women’s health through advancements in treatment and a singular focus on pelvic floor disorders. It also has provided a forum for education through initiatives such as ‘Voices for PFD’ and ‘Take the Floor,’” he says.
Head says there are currently only a few urogynecologists practicing in Birmingham. He expects those numbers to increase as the specialty becomes more widely practiced. “It is a rewarding field, because if you realize the impact these problems can have on people and you can make them better, you have some grateful patients,” he says. “The trend of this specialty has started to increase in other cities, and I think Birmingham will catch up quickly. There is a big potential to make a difference in the lives of many women.”