Who's on Your Team

Which type of doctor should you seek out to treat those little leaks when you laugh, cough or sneeze - a generalist or a specialist? This article explains the difference.

When it comes to treating those little leaks when you laugh, cough or sneeze, there are several different types of doctors and medical professionals whose advice you can seek. The list includes generalists, such as urologists and gynecologists, as well as specialists, such as urogynecologists or physical therapists that specialize in pelvic floor muscles.

To find out just what each type of professional does and how they are different, we consulted Neeraj Kohli, MD, MBA, who is director of the Division of Urogynecology at Brigham and Women's Hospital in Boston, Mass.

Let's start with some simple definitions. A urologist is a doctor who treats diseases of both male and female urinary tracts, as well as the male reproductive system. A gynecologist, on the other hand, treats the female reproductive system, including the uterus, vagina, and ovaries.

Dr. Kohli defines both urologists and gynecologists as generalists. "Generalists do a good job at the initial screening or basic treatment for bladder weakness problems," he says. "Generalists are good for screening, for teaching people how to do pelvic floor exercises, or for handling simple surgeries," . These types of medical professionals usually develop and implement a treatment plan for bladder leaks based on symptoms, rather than the results of diagnostic tests, he notes.

A female urologist, on the other hand, is a doctor who specializes in the female urinary tract. This type of doctor is very similar to an urogynecologist, or a gynecologist who specializes in pelvic floor dysfunction. The pelvic floor contains the muscles, ligaments, connective tissue, and nerves that help control the rectum, uterus, vagina, and bladder, according the American Urogynecologic Society.

These specialists "bring a lot of special knowledge to the patient and the treatment plan," says Dr. Kohli. "Patients who fail the first-line treatments [typically prescribed by generalists] are better served by these specialists," he explains, as these types of doctors have experience with 10 to 20 different medicines versus 2 or 3, they have access to pelvic floor physical therapists, and they can perform more complicated surgical procedures."

Specialists such as urogynecologists also use more extensive testing in order to diagnose a patient's problem, Kohli notes. The most commonly used diagnostics tests include a urodynamic profile, which involves filling the bladder with water and measuring how it behaves. This test might be used to determine how much urine the bladder can hold or if any urine is left behind once urination is complete. Another test often used by specialists is a cystoscopy, which lets a doctor examine the inside of the urethra and bladder for infection, bleeding, or tumors.

A urogynecologist may also refer a patient to a physical therapist who specializes in the pelvic floor muscles. These medical professionals also bring a highly focused knowledge to their treatment plans. They can teach patients how to do their physical therapy exercises at home, for instance, how to become more aware of the need to urinate, or how to control the bladder and muscles during urination.

"Specialists do a full testing gamut before treatment," Dr. Kohli says, while generalists usually start a treatment based on symptoms. "At the end of the day, if you have access to a specialist, that's usually the fastest and most effective method for successful treatment. I use the analogy of treating chest pain. Who would you want to see? Your primary care physician? Or a cardiologist?"

How to Talk to Your Doctor about Your Bladder Weakness Problem

Bladder control is a medical problem that can be treated. That's why it's important to open the lines of communication with your doctor. The more your doctor knows about you and your situation, the easier it will be for him or her to diagnose and treat your bladder control problem.

Still feeling tongue-tied? We'll start the conversation for you. To make it even easier to talk, you can print out a copy of this page and take it along on your next doctor's visit. And remember, your doctor has "seen it all" and "heard it all" before. They certainly aren't squeamish talking about medical concerns so you shouldn't be either. They just want to help you lead the best life you can.

Before You Go...to the Doctor

To help your doctor diagnose your bladder control problem, it's a good idea to keep a diary for one week of what you eat and drink, how often you go to the bathroom, and how often you leak urine.

How to Tell Your Doctor that You Have a Bladder Control Problem

What do you say to your doctor when you're describing your bladder control problem? Just fill in the blanks to the following questions:

  • When does the problem occur?
  • How long has bladder control been a problem?
  • How much of a problem has this become?
  • How many times do you have a bladder control problem each day?
  • Are you aware of the need to urinate before you leak urine?
  • Are you aware right away that you have leaked urine?
  • Are you wet most of the day?
  • Do you wear absorbent pads in case of accidents? Occasionally? All the time?
  • Do you avoid social situations in case of accidents?
  • Is it more difficult to control your urine when you cough, sneeze, strain, or laugh?
  • Is it more difficult to control your urine when running, jumping or walking?
  • Is the problem worse when sitting up or standing?
  • Do you suffer from constipation?
  • Is there anything you do to reduce or prevent accidents?
  • Have you ever been treated for this condition before? When? What was the treatment? Did it help?

Questions To Ask Your Doctor

Now that you've described your bladder control problem, make sure the following questions are answered during your visit:

  • Can you help me? If not, can you give me the name of a specialist I should see instead?
  • Could my usual food or drinks cause bladder problems?
  • Could my prescription or over-the-counter medications contribute to my bladder weakness problem?
  • Could other medical conditions cause loss of bladder control, including a past surgery or injury? Could an illness or disease I have be the cause of my bladder control problem, and will the leakage stop with treatment?
  • Is menopause affecting my ability to control my urine? Will losing weight help me?
  • What tests should I have, if any, to determine the cause of my bladder control problem?
  • Is my bladder weakness temporary or long-term? What kind of problem do you suspect I have?
  • What are the treatments to regain bladder control? Which one is best for me?
  • What are the benefits and side effects of the treatments? If you suggest I be treated with a medicine, will it interact with any other prescriptions or over-the-counter medicines I'm taking?
  • What can I do about the odor and rash caused by urine?

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