When is it time to see a specialist?
When patients first experience signs of urinary incontinence they will usually discuss it with their primary care physician. According to Dr. Hari Tunguntla, assistant professor in the Department of Urology at Robert Wood Johnson Medical School, "patients are initially seen by their primary care physician who treats the condition with lifestyle modifications that may include dietary changes, weight loss, and/or pelvic muscle exercises." When a patient is not seeing improvement after three or more months or the symptoms continue, a primary care physician may refer the patient to a urologist, urogynecologist, nurse specialist, physical therapist, or occupational therapist. A patient should also consider seeing a specialist if they become frustrated that their primary care physician is not engaging in multiple remedies as a behavioral strategy, with or without medication depending on the diagnosis, or not listening altogether and giving it priority. A separate office visit to discuss the bladder control problems is suggested. Some individuals who may desire surgery for their problem might go directly to a specialist from the beginning.
Types of Specialists:
Urologist - a surgeon who specializes in the urinary conditions of men and women.
Gynecologist - a doctor specializing in the reproductive health of women, some have special interest and training in urinary incontinence and pelvic organ prolapse.
Urogynecologist - a gynecologist who has advanced training in treating both surgically and non-surgically pelvic floor disorders in women; including pelvic organ prolapse and incontinence.
Physical Therapists (CAPP-Pelvic) - a physical therapist who has a certificate of achievement in pelvic physical therapy from the American Physical Therapy Association (APTA) in standardized courses.
Occupational Therapists - an occupational therapist who has advanced training in pelvic floor rehabilitation and may also have a certification in biofeedback from the Biofeedback Certification International Alliance (BCIA). The BCIA offers board certification in biofeedback, neurofeedback, and pelvic muscle dysfunction biofeedback.
Nurse Specialist - a nurse or nurse practitioner that has received urology certification from the Certification Board for Urologic Nurses and Associates (CBUNA) may be able to perform urodynamics, urinalysis, provide biofeedback, pessary fitting, pelvic floor muscle exercise instruction, and urethral catheterization. Other advanced practice nurse specialists may include those with a certification of study as a continence nurse offered as a standardized track of the Wound, Ostomy, and Continence Nurses Society (WOCN). These nurses are trained in the management of chronic incontinence, both urinary and fecal, including skin care.
Should I get a second opinion? When?
A patient may consider getting a second opinion once a diagnosis and treatment plan has been determined. Dr. Anthony Komaroff, a practicing physician, professor of medicine at Harvard Medical School, and editor-in-chief of Harvard Health Publications, states that, "a second opinion may simply confirm your first diagnosis or treatment recommendation. Sometimes a second opinion can actually improve or refine the advice you get." Getting a second opinion can help improve your confidence that your doctor has determined the best treatment plan. It also gives you more options in selecting which healthcare professional you will choose for treatment.
Where should I get a second opinion from?
Dr. Komaroff agrees that, "asking your doctor, nurses, family, and friends for recommendations is a good place to start," when looking for a second opinion. Your doctor may have another specialist within the practice or clinic that could review your history and chart. Patient education organizations, like the National Association For Continence (NAFC), often offer a service to help patients find specialists in their area. NAFC can help you find a urologist, urogynecologist, nurse specialist, physical therapist, or occupational therapist in your area. Another good resource for finding physicians, who are considred experts in continence care for women, is to schedule a visit at a NAFC designated "Center of Excellence." NAFC's Centers of Excellence: Continence Care designation means that the care administered in such a location is performed by appropriately trained, experienced, and credentialed experts and such centers have demonstrated satisfaction in outcomes and care by a majority of their peers.
Will my doctor be offended that I want a second opinion?
"Your doctor shouldn't be offened or mad if you get a second opinion. If your doctor is put out that you want a second opinion - one that could improve your health care - perhaps they're not the right doctor for you," says Dr. Komaroff.
Are you interested in having NAFC locate a specialist for you?
Visit NAFC's Find An Expert Database.