You may be wondering: “Isn’t that why I see my ob-gyn?” The answer is yes—at first, but if your problem exceeds a gynecologist’s level of expertise or if it escalates or becomes chronic—as these issues increasingly do as we age—a urologist is the specialist your gynecologistwill call. Here’s what these next-level docs want you to know.
1. Below-the-belt problems get more common around menopause.
When hormones start dipping and spiking and sputtering to a halt, expect to see changes to your private parts. “The pelvic floor, bladder, urethra, and vagina are all very sensitive to declining estrogen,” Rosenblum says. “Pelvic floor problems like urinary tract infections, incontinence, and prolapse of pelvic organs become more common.” A urologist can help with prevention, which can involve using things like cranberry extract supplements, vaginal replacement estrogen, lactobacillus (a particular strain of probiotic), and even low-dose antibiotics after a higher-risk activity (like travel, which can alter your natural flora). Urologists also help with treatment, including medications, physical therapy, and surgery as needed. And if UTIs become really frequent or really problematic, a urologist will do a more extensive evaluation to rule out a possible underlying condition like a kidney stone, polyp, or tumor.
2. It’s not normal to pee on the hour or make mad dashes to the restroom.
But many women do it every day and don’t think twice about it. If you have “overactive bladder,” as some 40% of women do, according to the Urology Care Foundation, there may be an easy lifestyle fix—like cutting back on caffeine or alcohol, which stimulate the bladder; drinking less in general; scheduling bathroom visits, and doing pelvic muscle exercises. For more acute cases, there’s also medication, electrical stimulation therapy, collagen implants, and minimally invasive surgery. See a urologist if you have urgency or urgency incontinence (where you have a sudden urge to go and can’t make it to the bathroom in time).
3. Half of women with incontinence never bring it up to their doctor.
Maybe we’re embarrassed to admit it, or we think leaking pee is a normal part of getting older, or perhaps we think nothing can be done. It’s true that up to 57% of women between 40 and 60 suffer some degree of urinary incontinence, according to the American College of Physicians, even if it just happens when we laugh, cough, or sneeze (stress incontinence) or when we have to go really badly (urgency incontinence). (Here are 8 solutions for a leaky bladder.) Rosenblum says she’s seeing more patients with incontinence as women choose to have kids later because there’s a greater risk of damage to the pelvic floor—that group of muscles that supports the uterus, bladder, small intestine, and rectum. Pregnancy and delivery certainly ups your risk for urinary incontinence, but other risk factors include menopause, hysterectomy, obesity, urinary tract infections, functional and/or cognitive impairment, chronic cough, and constipation, according to the American College of Physicians. “Incontinence is very common, but it’s not something you have to live with,” Rosenblum says. “A lot of women have the false belief that it’s only treatable through surgery, but there are many non-invasive or less-invasive treatment options.” They can include pelvic floor physical therapy, medications such as anticholinergics, botulinum toxin (Botox), and several types of nerve stimulation.
4. Your next therapist should specialize in lady parts.
Yes, kegel exercises can tighten and tone the pelvic floor muscles, but studies show that most of us don’t do them right. So if you really want to prevent or treat incontinence, urologists recommend getting trained in how to perform kegels, and that means seeing a pelvic floor therapist. (As a bonus, it will also enhance your orgasms—because the pelvic floor muscle will contract more robustly). To find a practitioner near you, go online to the American Physical Therapy Association’s PT Locator. If you don’t have access to a practitioner, check out the handful of new devices that are like Fitbits for your vagina, stimulating pelvic floor muscles and providing feedback on your progress. Try Intone, a prescription device proven to treat incontinence, or PeriCoach, recently FDA approved. Pericoach works with an app on your phone to guide you through training sessions and monitor your progress. There’s also a new non-invasive treatment called the FemiLift Laser (you might have heard it called vaginal rejuvenation) that supposedly treats urinary incontinence, as well as laxity, but there are no good scientific studies yet to show how well it works, according to Rosenblum. (Here are four moves you can do to strengthen your pelvic floor.)
5. Pelvic pain can be a puzzle.
When you have pain in the general pelvic region—which includes the bowel, bladder, uterus, and ovaries—you’ll want to bring it up with your gynecologist first. “A good percentage of pelvic pain problems can be gynecologic in nature,” Rosenblum says. Common gynecological culprits include menstrual cramps, mittelschmerz (ovulation pain), endometriosis, ectopic pregnancy, ovarian cysts, uterine fibroids, and pelvic inflammatory disease. But if there doesn’t seem to be a gynecologic cause, cue the urologist. “We’ll look at the timing of symptoms, whether they’re related to your menstrual cycle, or whether they’re urinary or bowel-related,” Rosenblum says. Non-gynecologic sources of pelvic pain can include chronic constipation, UTI, pelvic floor spasms, irritable bowel syndrome, Crohn’s disease, ulcerative colitis, and more serious stuff like colon cancer.
6. UTIs and STIs get misdiagnosed—a lot.
A 2015 study in the Journal of Clinical Microbiology found that emergency departments majorly overdiagnose urinary tract infections and fail to recognize sexually transmitted infections. “The symptoms can cross over and be confusing,” Rosenblum says. STIs such as genital herpes, gonorrhea, chlamydia, and trichomoniasis can also cause burning pee—the hallmark of UTIs. The upshot: You could easily wind up on the wrong meds, including unnecessary antibiotics, and not get the treatment you actually need. Rosenblum’s tip for telling the difference: With a UTI, you’ll have frequent urination or pain in the vaginal or pelvic area during urination, but if the pain is more vague, it could be related to an STI or a simple bacterial infection of the vagina, which may also cause vaginal discharge or odor. If you suspect that you have a UTI, make sure your doc does a urine culture to confirm the diagnosis.
7. You may have pelvic organ prolapse and not know it.
You might think you’d notice a bit of bladder, rectal, or uterine tissue bulging into your vagina—a condition called pelvic organ prolapse, which comes from weakness in your pelvic floor muscles—but you actually might not. “Mild or even more advanced pelvic organ prolapse can be relatively asymptomatic,” Rosenblum says, adding that it’s very common after childbirth and after menopause. It’s estimated that half of women over age 50 have some degree of prolapse, according to the NYU Langone Medical Center, and by age 80, more than 1 in 10 women will have undergone surgery to fix it. Symptoms can include pressure and pain (including leg fatigue and low back pain), stress incontinence, difficulty peeing or pooping, constipation, irritated vaginal tissues, or pain during sex. If you’ve got any of these symptoms, get a thorough pelvic exam to confirm the diagnosis, and talk to a urologist about treatment. Surgery is the most definitive way to put things back in their place, but non-surgical options include pelvic floor therapy and a vaginal pessary, a device like a diaphragm that helps support the pelvic area.
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8. Kidney stones rise with the temperature.
A 2016 study shows that more US women (also teens and African-Americans) are developing kidney stones, a painful condition that historically strikes mainly middle-aged white men. Between 1997 and 2012, there was a 45% jump in the lifetime risk of kidney stones for women, the findings show. One possible explanation is higher temperatures. “We call the southern part of the US ‘the stone belt,'” Rosenblum says, “because in those warmer climates, people get more dehydrated, which makes it more likely that crystals will form in the urine and those crystals will turn into stones.” It can also be genetic. To minimize your risk, stay hydrated (you’re hydrated if your pee is light yellow, like lemonade), especially in hotter temps and when you’re being physically active. If you’ve already passed a kidney stone, Rosenblum advises drinking 2 liters of fluid a day. (Here are more ways to prevent kidney stones.)
9. Pain in the sack? Urologists treat that.
It’s no secret that sexual dysfunction gets more common as we age. We’re talking lower libido, difficulty reaching orgasm, pain during sex, and vaginal dryness. (Here are 8 reasons it hurts during sex and how to fix it.) Whether it’s because of lower estrogen and testosterone, medications you’re taking, stress, depression, or some other reason, urologists can help ID the most pressing issues and offer treatment. “We’re not just about popping pills,” Rosenblum says. “We work with therapists to treat the whole person.”