When to Refer Your Patients to a Urogynecologist

Urogynecology, also known as female pelvic medicine and reconstructive surgery (FPMRS), is a subspecialty for OB/GYNs focused on non-malignant pelvic floor dysfunctions, such as urinary incontinence. While it’s usually clear when to refer your patients to an OB/GYN or a urologist, urogynecology is an often-misunderstood subspecialty when it comes to patient referrals. 

We recently spoke with a urogynecologist at Inspira Medical Centers Vineland and Mullica Hill, to get an inside look at her specialty, find out the right time to refer patients and learn how to talk to patients about urinary incontinence.  

Misconceptions About Urogynecology

Urogynecologists often receive patient referrals that aren’t quite aligned with their specialty. “There are a few misconceptions about urogynecology—we will sometimes get referrals for patients with malignancies, like bladder cancer. But, we treat non-malignant pelvic floor dysfunctions, so these patients are better off being referred to urologic oncologists,” said an IMG urogynecologist.

In addition, urogynecologists focus on those with pelvic floor conditions including, but not limited to, pelvic organ prolapse, genitourinary tract fistula and lower urinary tract disorders, so patients with upper urinary tract disorders, such as kidney stones, should be referred to a urologist. Gynecologic concerns that are not associated with pelvic floor dysfunction, such as fibroid uterus, abnormal vaginal bleeding and ovarian cysts, should be referred to an OB/GYN. 

When to Refer to a Urogynecologist

The right time to refer a patient to a urogynecologist is when they have lower urinary tract conditions or pelvic floor dysfunction concerns. Urogynecologists treat patients with conditions including:

• Pelvic organ prolapse
• Pelvic floor pain
• Vulvovaginal concerns (such as vulva skin dystrophy, Gartner’s duct cyst, Bartholin’s cyst, vestibulitis, vaginal atrophy or dyspareunia)
• Urinary tract infection
• Urethral or bladder dysfunction (such as interstitial cystitis, overactive bladder, urinary leakage, urethral diverticulum or Skene’s gland cyst) 
• Complications from childbirth (such as genitourinary tract fistulas)

How to Talk to Patients About Incontinence

One of the most common reasons to refer patients to a urogynecologist is if they’re having urinary leakage. It may not always be easy to talk about, but it’s important to communicate to patients that they don’t have to live with incontinence—it’s a treatable condition.

When discussing urologic concerns with your patients, start with three questions: 

1.  Are you experiencing urinary leakage? 

2.  When do you experience it? 

3.  Do you want to do something about it? 

If your patients are experiencing urinary leakage and are ready for treatment, it’s time to refer them to a urogynecologist. By asking when they experience leakage, you may be able to determine the cause of the incontinence. There are a few different categories of urinary incontinence to be aware of: 

• Stress urinary incontinence: leakage when coughing, laughing or sneezing 
• Urge urinary incontinence: leakage due to frequent urgency to urinate
• Mixed urinary incontinence: a combination of stress and urge incontinence 
• Neurogenic bladder: leakage due to a neurological condition such as Parkinson’s disease or multiple sclerosis 
• Functional incontinence: leakage due to mental status, many times is accompanied by fecal incontinence 

If your patients are suffering from incontinence of any kind, it’s important to listen to their concerns and educate them on behavioral and lifestyle changes they can make to help lessen their symptoms. “It’s best to start with conservative management when addressing urinary incontinence,” said an IMG urogynecologist. “Ask them questions about how often they visit the bathroom, how much water they drink and if they ingest any bladder irritants. Depending on their responses, you can advise patients to empty their bladder more frequently, drink less water, avoid irritants and perform pelvic floor muscle exercises, so they’re less likely to leak.”

Treatments for urinary incontinence depend on the cause, severity, patient preferences and medical status. “Along with behavioral modifications, medical management, as well as surgical and non-surgical procedures, are available to manage patients with urinary leakage,” said a urogynecologist. “Really, we focus on individualized care according to each specific patient and their needs.”