A urogynecologist is a specialist physician who treats women’s pelvic floor disorders and develops appropriate treatments and interventions such as exercises and surgeries. After medical school, urogynecologists complete their residency in either Urology or Obstetrics and Gynecology. Their continuing studies focus on the muscles and organs in the female pelvis. They study how these structures can be strengthened and healed from sudden or chronic injuries. Urogynecologists are often called in by oncologists treating female patients with uterine, bladder, and cervical cancers for surgical consultations.

Urogynecology is a relatively new specialty that came to be when The American Board of Medical Specialties saw a need for more gynecologists and urologists who were well-versed in female pelvic reconstructive surgery. The very first urogynecologists became board-certified in 2013. Since then, hundreds of urologists and gynecologists in the United States have underdone the certification process needed to become a urogynecologist.

Since organs in the female pelvis share connected tissue, when one of them is injured, the others are at risk of becoming damaged as well. This is why women who have recently given birth vaginally suffer from urinary and fecal incontinence, fistulas, tears, and an overactive bladder. Similarly, women who do a lot of heavy lifting over the course of their lives – whether it was gym weights or their own small children – often experience pelvic organ prolapse. This is a urogynecological condition in which an organ falls from its natural place within the pelvis. Following childbirth or surgery, the connective muscles around an organ can be stretched too far or severely weakened. After prolapsing, the organ presses against the vaginal wall until it can be fixed by a urogynecologist during surgery.

Women typically see urogynecologists after being referred to them by their gynecologist or urologist after complaints of specific lower abdominal pains and bladder and sphincter issues. In addition to surgical interventions, urogynecologists can recommend special (especially pre- and post-natal) exercises that strengthen the pelvic floor and prevent incontinence and other pelvic-related problems. If you have pelvic issues that still haven’t been resolved after seeing a urologist or gynecologist, it may be time to be examined by a urogynecologist.

Located in Agoura Hills, Dr. Sherry Thomas is a world-renowned gynecologist who specializes in women’s health and treating serious conditions that afflict her female patients. Contact Dr. Sherry Thomas today to schedule a consultation and find out how she can help you.

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The ideal treatment is primarily based on the overall cause of the incontinence itself as well as individual preferences. Some common treatments may include any of the following:

• Trained behaviors, including timed urination and bladder training
• Kegel exercises and lifestyle changes
• Certain medical devices or medications
• Surgical procedures

Medications as well as lifestyle changes, exercises, and behavioral training are generally tried first before exploring surgical procedures. If the problem persists, your doctor will likely try another type of treatment or perform additional tests. If there’s more than one reason that you’re experiencing incontinence issues, the primary cause is always treated first, subsequently followed by treatment for other less important causes, if necessary.

Ways Incontinence is Effectively Treated

Kegel Exercises

Kegel exercises, when performed correctly, are a very effective way to help incontinence issues. These exercises are designed to strengthen the pelvic floor muscles. These muscles are designed to control the flow of urine. As they get stronger, you’ll suffer less frequent leaks or accidents. These Kegel exercises are most helpful in treating urge and stress incontinence.

Bladder training or retraining is when you slowly increase the amount of time you can wait before going to the bathroom.

Key Vaginal Devices for Incontinence

One of the main reasons for incontinence may be due to weak pelvic muscles, which are the set of muscles that literally hold the urine inside the bladder and in place. Doctors sometimes use a pessary device in order to address female incontinence. This stiff ring is inserted into the vagina, and it’s used to press against the vaginal wall and urethra. This leads to less leakage overall since the pressure helps the urethra reposition itself.

Medicines for Incontinence

In the case of an overactive bladder, sometimes doctors prescribe certain medications in order to block the body’s nerve signals that primarily cause urination urgency and frequency. Many medicines known as ‘anticholinergics’ help the bladder muscles relax and therefore prevent sudden bladder spasms. However, they do have some side effects including constipation, flushing, rapid heartbeat, and blurred vision.

Many women are afraid or embarrassed to mention their incontinence issues. They often suffer in silence and resort to buying adult diapers or absorbent undergarments. This is very unfortunate since most incontinent issues can successfully be resolved by simply talking to your doctor about an effective treatment plan.

At our offices, Dr. Sherry Thomas is an experienced and skilled urogynecologist who specializes in treating women’s health issues. She offers surgical and non-surgical treatment options. Our team will work with you to determine the most effective treatment plan for your individual needs. Don’t settle for just living with urinary incontinence. Contact Dr. Sherry Thomas today to schedule your consultation. We’ll help you get your life back.

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Kidney or bladder stones

Kidney stones are crystals that form into calcified deposits that may remain in the kidney or work their way into the bladder or urinary tract. A UTI can develop when the stone blocks part or all of the urinary tract, as this leads to the formation of bacteria in the backed up urine. These stones can be diagnosed by blood, urine, or imaging tests.

Bladder stones, although much rarer, can cause the same symptoms that lead to recurrent UTIs as kidney stones. Both types of stones are treated with some type of destruction, often using a laser or sound waves, or removal via surgery.

Intercourse

Having sex, especially with a new partner, puts women at risk for developing a UTI. This occurs because the bacteria from the male present on the urethra comes into contact with the female genitalia, allowing the bacteria access to the urethra, urinary tract, and even the bladder.

While intercourse has the potential to keep UTIs coming back, there are steps that can be taken to minimize this risk. Urinating before and after sex, cleaning the genitals before and after sex, and avoiding use of a diaphragm or spermicide are all ways to decrease the risk.

Low estrogen

Decreased estrogen levels, especially those found in post-menopausal women, can lead to frequent UTIs. This is because estrogen has been found to increase the production of natural antimicrobial materials. Post-menopausal UTIs have traditionally been treated with antibiotics, but in many cases the infections recur after antibiotic therapy is completed.

Hormone replacement therapy may offer a reduced risk of infections, but this type of therapy has some risks associated with it and should be discussed with a physician. This is especially true in women with a history of breast cancer or heart disease.

Unusual urinary tract shape

When the urinary tract has an unusual shape there is the potential for the obstruction of urine and the development of bacteria behind the blockage. Depending upon the type of abnormality, treatment may range from catheterization to surgery. Regardless of the type of abnormality, it is important to know all the options available.

If UTIs are becoming a regular occurrence, it is time to look at treatments other than repeated courses of antibiotics. Talk to a professional to get a clear idea of the causes of the recurrences and the options available to treat them. Doctor Sherry Thomas is a seasoned urogynecologist who specializes in treating women’s health issues, including urinary tract infections.  Contact Dr. Sherry’s office today to schedule your consultation. We can answer any questions you may have, and we can help determine the best course of treatment for you and your needs.

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Dr. Sherry Thomas is world-renowned for her skill and expertise in women’s health. She can help with the treatment of female incontinence. To schedule your appointment, contact Dr. Sherry Thomas today to get all your questions answered and find out the best treatment options for you.

Causes of Female Incontinence

Females may be at higher risk for urinary incontinence because of a number of factors:

• Urinary tract infections – The short urethra in women makes them vulnerable to bacterial infections that can cause temporary incontinence problems.
• Constipation – The proximity of the rectum to urinary structures and nerves can create pressure that causes temporary incontinence.
• Pregnancy – The increased internal pressure of the growing fetus can cause stress incontinence.
• Childbirth – Delivery of a baby can damage muscles and ligaments that support the bladder and can also cause damage to nerves.
• Hysterectomy – Removal of the uterus can damage muscles involved in urinary function.
• Menopause – Menopause causes a reduction in estrogen in women’s bodies, a hormone that helps to keep the linings of the urethra and bladder in good condition.
• Aging – Natural aging causes the bladder to be less able to hold urine effectively.
• Obstruction – Blockages in the urinary system can cause disruptions in the normal flow of urine and may lead to incontinence.
• Neurological diseases – Conditions such as Parkinson’s, multiple sclerosis, brain tumor or stroke can damage nerve signals and can lead to incontinence.

Diagnosis of Incontinence Problems

In order to find an effective treatment for urinary incontinence, physicians must determine the underlying cause of the problem.

• A urine test can detect infection in the urinary system.
• Compiling a “bladder diary” can tell the physician how much the patient drinks, how frequently they void and under what circumstances incontinence occurs.
• Post-void residual measurement, measuring the amount of urine left in the bladder after voiding, can provide information about blockage or nerve damage to the bladder.
• Urodynamic testing uses a catheter inserted into the bladder to determine the strength of bladder walls and urinary sphincter condition.
• Cystoscopy insert a tiny lens into the urethra to detect abnormalities.
• Cystogram inserts a dye into the bladder to learn how the bladder empties.
• Pelvic ultrasound can detect any abnormalities within the urinary system.

Options for Treatment

After determining the source of the problem, the physicians may order any of a number of treatments for incontinence:

• Bladder training, such as urinating on a schedule, holding urine for longer periods of time or fluid management can help some patients.
• Pelvic floor exercises can help to strengthen the structures that hold the bladder.
• Anticholinergic drugs can help to calm overactive bladders.
• Topical estrogen creams can help to tone tissues in the urinary tract and genital areas.
• Mirobegron, a drug that relaxes the bladder, can help patients to hold more urine.
• Mechanical devices, such as pessaries or urethral inserts, can reduce stress incontinence.
• Bulking compounds can be injected into tissue around the urethra to reduce leakage.
• Botox, generic name botulinum toxin A, injected into bladder muscles can make reduce sensitivity that causes incontinence.
• Nerve stimulators can be surgically implanted under the skin to stimulate nerves and prevent incontinence.
• A number of surgical procedures can be done to increase support to the bladder and urethra to reduce incontinence.

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