Tips on When to See a Urogynecologist from Intermountain Health

When a woman is pregnant and gives birth, the muscles inside her pelvis must stretch and support the increasing size of the baby. During the delivery, the baby’s head can put excessive pressure on the nerves, stretch ligaments or the tissue that connects everything, and/or stretch and tear muscles.

After childbirth, those pelvic floor muscles and surrounding tissue can be weakened, over-worked or damaged. Other factors that contribute to pelvic floor disorders include aging, obesity, genetics, and behavioral things like chronic coughing, lifting, constipation, and pelvic surgery.

“The pelvic floor muscles function as a basket that supports and holds a woman’s internal organs in her lower abdomen such as the bladder, bowel, uterus, vagina and rectum. It’s very common to have weakened pelvic floor muscles at any age, or not know how to use them. You can still develop problems and need treatment even, with good muscles,” said Sara Diaz Valentin, MD, a urogynecologist with Intermountain Health Avenues Obstetrics and Gynecology in Salt Lake City.

A weakened pelvic floor can lead to symptoms such as:

• Difficulty controlling the bladder, leaking urine or urinary incontinence, especially if it happens when coughing, sneezing, or laughing.
• Pain during sex
• Difficulty controlling your bowels, leaking bowel or fecal incontinence.

Intermountain Health offers pelvic floor physical therapy, which is a great option for less severe symptoms. There are 17 Intermountain locations in Utah that offer pelvic floor physical therapy.

“For more severe symptoms, or if you tried therapy and still struggle with symptoms, you may need to see a urogynecologist. A urogynecologist is an obstetrician and gynecologist who has completed a three-year fellowship that includes additional specialized training and board certification in the field of urogynecology and reconstructive pelvic surgery,” said Dr. Diaz Valentin.

Although a primary care physician, OB/GYN, or urologist may have knowledge about these problems, a urogynecologist can offer additional expertise and perform surgery if needed.

“The bladder, rectum and vagina are like neighbors housed close together, and one affects the other. About one in six women have urinary incontinence and one in 12 women have fecal incontinence. And after age 50, about 50 percent of women have some degree of pelvic organ prolapse,” said Dr. Diaz Valentin.

Pelvic organ prolapse happens when the pelvic floor muscles are weak enough that one or more pelvic organs (vagina, uterus, bladder, urethra, rectum) drop from their normal position.

“Pelvic organ prolapse can feel like pressure, or heaviness in the pelvic area. Bulging or protruding of the vagina or uterus can also occur. You may feel or see something coming out of the vagina, in the shower, or when wiping after using the toilet,” she added.

Common misconceptions about pelvic floor disorders

1. It’s a normal process of aging, and you must live with it.
2. A hysterectomy is always necessary.
3. Thinking one person’s experience is how it is for everyone.
4. Not understanding the difference between anatomy and function

“If the frequency or degree of pelvic symptoms are holding you back from doing things you enjoy, start with your primary care or women’s health provider and ask for a referral to a specialist for an evaluation. Be observant and do a self-exam and have a provider validate where the problem is coming from so you can get to the right kind of specialist at the right time,” said Dr. Diaz Valentin.

Dr. Sara Diaz Valentin is a urogynecologist with the Intermountain OB/GYN and Urogynecology Avenues Clinic. For up-to-date information and announcements please see the Intermountain Health newsroom at https://news.intermountainhealth.org.

For more information or to find a provider visit the urogynecology page at intermountainhealth.org or call the Intermountain physical therapy location line at 801-507-1270 and ask about pelvic floor physical therapy.

About Intermountain Health

Headquartered in Utah with locations in six states and additional operations across the western U.S., Intermountain Health is a not-for-profit system of 34 hospitals, approximately 400 clinics, medical groups with some 4,600 employed physicians and advanced care providers, a health plans division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is committed to improving community health and is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes at sustainable costs. For up-to-date information and announcements, please see the Intermountain Health newsroom at https://intermountainhealthcare.org/news.