Urogynecology is one of the emerging subspeciality nurse practitioners’ (NP’s) roles focusing on the treatment and prevention of the fecal and urinary incontinence also referred to as dual incontinence. The specialty also focuses on the pelvic floor disorders (PFDs) and bladder pain, and vaginal prolapse. Currently, there is an increasing demand for NPs with expertise and knowledge in urogynecology. The demand for these services is expected to grow significantly in future considering the current shortage of physicians trained to handle such conditions, the expansive prevalence of these conditions, and the gradually ageing population prompting a higher disease burden. Based on the 2021 report of the U.S. Census Bureau, the demand for urogynecology services is anticipated to rise by 35% by 2030 (Brown et al., 2022). There is a specialist deficit in the U.S. despite the AMA’s (American Nurses Association) projection showing a substantial increase in physicians, urologists, female pelvic medicine and reconstructive surgeons, and gynecologists (Cera, 2021). The current patient/physician ration is projected to remain steady at the current level. The role of nurses in urogynecology is vital in the effort to address pelvic floor dysfunctions.
Pelvic Floor Physical Therapy
The dysfunction of pelvic floor is a common health issue for women; hence, its prevalence is significantly high not only in the United States but also across the world. According to Tuli (2021), 25% of women manifest symptomatic gynecological problems in their lifetime. This means that the issues of the pelvic floor muscle functions and dysfunctions, and other related morbidities affecting the women’s quality of life have escalated significantly (Tuli, 2021). Also known as physiotherapy, physical therapy focuses on human functionality and movement. Therefore, pelvic floor physical therapy bases its interventions on thorough assessment of the symptoms as well as the specific functions of the pelvic floor muscle.
Working in conjunction with physiotherapists and/or doctors, nurses undertake an active role in assessing the pelvic floor muscle dysfunctions as well as the pain and weaknesses associated with the pelvic floor. As affirmed by Cera (2021), for instance, Advanced Practice Nurses (APNs) are coming in the forefront to provide critical services such as assessment of the pelvic floor operations and providing non-surgical treatment for any abnormalities. Nurses undertake evidence-based rehabilitation of the pelvic floor to remedy physical and cognitive impairments resulting from distorted pelvic floor functionality caused by urinary infections (Quallich & Lajiness, 2022). Pelvic muscles may be affected adversely by pregnancy, surgery, drugs, childbirth, estrogen deficiency, or even accidents that distort their working efficiency. Hence, symptoms that could be enhanced with pelvic floor exercises include urinary problems like urinary incontinence and frequency, painful urination and difficulties in fully emptying the bladder (Lo et al., 2022); bowel problems such as bowel incontinence and painful bowel movements, as well as unexplained pain in the pelvic, genital and rectal areas.
To address such symptoms, nurses, with the guidance of expert therapists, focus on multiple physical therapy techniques or procedures. They include external physical therapy procedures such as joint mobilization, nerve release, deep tissue massage, trigger point therapy, and skin rolling, and internal physical therapy methods that involve sliding a finger or a special device inside the vagina to perform a trigger point therapy. Carried out by a nurse practitioner or doctor instead of a physical therapist, trigger point therapy is executed by applying pressure on a definite spot. Besides, nurses can also do it by injecting anesthesia into specific trigger points. An early initiation of the physiotherapy and pelvic floor rehabilitation procedures are deemed vital in enhancing the health of women (McKibben, 2016). Overall, the provision of care to individuals with urinary incontinence and bowel problems is becoming a primary nursing responsibility for continence nursing specialists.
Pediatric Nursing Care
Advanced practice nurses and/or registered nursing practitioners who pursue training in pediatric specialty also play an important role in urogynecology. Whereas pediatric nurses work in pediatric departments within hospitals and clinics, as well as in private pediatric practices, they also work with women during pregnancy during which they advise them about the effective ways to diminish mother-to-child transmission of infections associated with urinary incontinence (Kok et al., 2021). Notably, infants are highly susceptible to infections arising from vaginal yeast infections which are common among pregnant women. Also, children are more susceptible to such infections because of their weakened immunity. This is because of their devastating impact on the health of the infant. Pediatric nurses will assess the behavior of the infant checking on the signs and symptoms that the mother and the child may not be able to understand. Because of their advanced understanding of childhood development and issues that affect babies and toddlers, registered pediatric nurses are able to collaborate with the parents in administering age-appropriate medications and treatments (Quallich, 2021). More importantly, they are able to identify incontinence-related problems in newborns and address them swiftly.
Bladder Training
Nurses undertake bladder training, an important behavioral therapy aimed at treating urinary incontinence. The primary goal of this intervention is increasing the fluids that the bladder can hold and the time it takes to empty these fluids. Bladder training is done by scheduling periods to use the lavatory and controlling the overwhelming urge to urinate. Nurses undertaking bladder training prepares a fixed voiding schedule depending on the health of the patient (Gupta & Rane, 2021). Urge suppression techniques are used to address deterioration in bladder health as a result of infections, old age, or side effects associated with pregnancy, menopause, and the process of giving birth. Bladder problems are becoming a common phenomenon in United States. According to a 2021 report by the America’s CDC (Centers for the Disease Control and Prevention), for instance, 60% of the people in the U.S. are affected by bladder-related infections in their lifetime (Verma et al., 2021). More so, the CDC reports that urinary catheters account for around 80% of the overall catheter-related infections in the U.S. (Verma et al., 2021). Therefore, this makes bladder training an emergent role for nursing practitioners today.
Pathophysiology
As previously mentioned, urinary incontinence is a distressing problem that makes one experience involuntary urine leakages. According to Caliskan et al. (2019), urinary incontinence affects 25% and 40% of premenopausal and postmenopausal women respectively. Nurses undertake micturition and continence aimed at creating a balance between the detrusor muscle activity and urethral closure (Paterson et al., 2017). It is important to underscore the fact that in a normal health situation, urethral closure often exceeds bladder pressure. This makes it possible to maintain urine in the bladder. The bladder and proximal urethra are both held within the pelvis. In cases where the bladder pressure rises beyond normal levels, medical attention should be sought (Bavendam et al., 2016). A corrective surgical procedure may also be sought depending on the magnitude of the problem and wishes of the patient. Nurses may conduct assessments after the patient raises complaints relating to pelvic pains and even refer them to urology specialists for further attention. It is important that a careful examination and history is undertaken to establish any issues triggering incontinence (Rantell, 2017). For instance, there could be tumors blocking the urinary tract. The issue may also arise from sensations, poor reflexes, and stool implication. These are common problems evident among pregnant women and lactating mothers who are in the journey of recovery after giving birth.
Role in Diet and Management of Postpartum Patients
Nursing practitioners play an important role of guiding pregnant or new mothers on appropriate nutrition or dietary intake. Pregnant or recently delivered women require proper nutrition to restore their health and address essential dietary requirements of the mother and child. Such interventions occur mostly in inpatient settings. However, following the current advancements in health care technology, mothers and their breastfeeding infants may receive homecare through online interactions with the nurses (Geissbuhler et al., 2020). Nurses may also collaborate with the nearest daycare centers and other community setting to provide the necessary care to the mothers and their newborns. Parents suffering dual incontinence require special nutrition to remedy bacterial and fungal infections. It is hence in the best interest of the women’s health that the intervention of a nurse is sought to ensure bacterial and fungal infections are treated. In a nutshell, diet is a key factor in the recovery of people suffering from Urinary Tract Infections (UTIs).
Besides facing dietary problems, mothers also face numerous other complications after delivery. They might experience significant maternal physiological changes on their way to returning to non-pregnant state. Nurses undertake the medical issues and physiological needs arising during this particular period. However, it is important that nurses are sensitive to the cultural differences surrounding childbirth so as to advise on certain restricted activities and give direction on the consumption of particular foods. According to Tamanini et al. (2022), between 25% and 50% of women experience postpartum issues such as shivering; hence, the need for proper nursing care. Sometimes unprecedented body temperatures are experienced following labor. More so, fetal-maternal bleeding, administration of drugs such as misoprostol, and bacteremia containment could be addressed adequately with proper nursing care in place (O’Dell et al, 2016). Vaginal soreness could also be an issue of concern as extensive tears experienced during birth could take some time before they completely heal. Nurses could provide vital care to reduce this discomfort and alleviate ensuing infections. According to Lajiness & Quallich, (2016), nurses should perform routine tests to establish the cause of different vital signs witnessed in both the mother and child after birth. More often emergencies occur after birth and mothers could develop feelings of inadequacy and anxiety. Hence, they must remain calm during such changing circumstances and accord mothers the requisite assistance.
Performing Nerve Stimulation Acupuncture
Nerve stimulation acupuncture is widely used to treat different disorders of internal organs. The process involves the stimulation of an acupuncture point commonly referred to as acupoint. The primary goal of doing this is to relieve pain and discomfort by refurbishing the flow or qi, a critical force that influences the energy channel to different parts of the body (Geissbuehler et al., 2021). Nerve stimulation acupuncture is done by inserting needles into the pressure points of the patient’s body to stimulate the nervous system. In effect, the body releases its natural sedatives called endorphins into the brain, spine, and muscles; thus, altering how the body responds to pain. In a nutshell, acupuncture is widely used in pain management and addressing the broader symptoms of urinary incontinence. Therefore, besides relieving chronic pain in the bladder, nerve stimulation acupuncture also arouses blood flow; hence, restoring the bladder’s damaged nerves.
Nurses can effectively perform nerve stimulation acupuncture because they have an extensive understanding of the automatic nervous system. Hence, apart from using the procedure to treat different overactive bladder symptoms, nursing practitioners also apply it to effect the somatic and autonomic nervous systems. This is especially conducted in the lumbosacral region which is actively involved in micturition.
Management of Prolapse and Pessary Fitting
A nurse may undertake a uterine prolapse assessment after childbirth or any other related medical procedure. According to Langston et al. (2017), the primary goal of doing this is to ensure the uterus does not slip to dangerous levels into the vagina. The pelvic exam is necessary in testing the strength of the pelvic muscles (Doumouchtsis et al., 2022). It follows that if severe incontinence is detected, the nurse may recommend further tests regarding the impact of uterine prolapse (Hayward, 2022). The ultimate goal of this procedure is to ensure the quality of life is enhanced and patients do not suffer unprecedented pain during pregnancy and after child birth.
Nurses in conjunction with multidisciplinary teams may also undertake pessary treatment on the affected people. Essentially, pessary fitting is done to reduce urogenital bother indications that adversely life quality (Langston et al., 2017). The stress urinary incontinence (SUI) and pelvic organ prolapse (POP) are serious health issues affecting millions of people across the world. It hence follows that a pessary is used as a supporting device providing a non-surgical remedy to the symptoms associated with these disorders (Tuli, 2021). Pessaries are commonly used among the women suffering from POP. According to Pereira et al. (2020), pessaries are used by 98% of urogynecologists and 86% of gynecologists in avoiding dysfunction. Upon recovery, pessaries are removed and patients can conduct urogenital functions without necessarily having to get such artificial support.
Promotion of Primary Care to Address Diverse Women Needs
The role of nurse practitioners extends the breadth and depth of skills and knowledge adequate to offer primary care that addresses the distinct needs of women. Nurses’ education encompasses complicated and normal obstetrical care such as prenatal, intrapartum, and postpartum, complicated and normal gynecological conditions, and fatal well-being (Zeiger et al., 2021). More so, there is emphasis on the fertility, use of contraception, sexual, and reproductive health of both men and women. In a nutshell, the primary content of this awareness includes primary care promotion and meeting of common women’s healthcare needs throughout their lifespan. Such issues range from the heart disease, menopause, genitourinary complains, and osteoporosis as exemplars (Fisher et al., 2022). Further focus is put on creating awareness to the needs of the adolescents undergoing significant body changes during puberty. The ultimate goal is to ensure they understand their daily healthcare needs to differentiate between normal and abnormal changes as well as the psychosocial and physical determinants of healthy ageing (Quallich, 2017).
Proactive Participation in Urogynecology MDT Meetings
Management plans are vital when treating urinary incontinence. Urogynecology multidisciplinary meetings (MDT) are vital before embarking on invasive urinary incontinence treatments (Norton et al., 2017). Nurses are part of the multidisciplinary clinical teams and their presence in MDT meetings is of critical importance. It is during these meetings that the care team discusses different patients’ conditions and proposes the most effective remedies for the same (Bretschneider et al., 2016). This is done in compliance with the provisions of the evidence-based and patient-centered care concepts. It is important that MDT meetings take into consideration of the preferences, views, and circumstances of the patients as much as possible (Soysal et al., 2022). This should correspond to the care plan that is the most appropriate depending on the patient’s condition. Notably, MDT discussions should give rise to a comprehensive treatment plan for every patient’s condition discussed. Nurses act as custodians of these plans because they ensure the plans are followed to the letter and the patient adheres to the proposed practices and medications to hasten the recovery process.
In summary, the role of nurses in urogynecology are numerous and diverse. The rise in demand for nursing services in urogynecology is triggered by the ever-rising issues and dynamics in women’s health. Complexities continue to rise as issues of rectal dysfunction, urinary tract malfunctioning, and loss of pelvic structure support continues to intensify. Pelvic disorders are on many occasions embarrassing. If left untreated for a long time, they could trigger greater medical complications. Some symptoms such as urine or feces leakages and vaginal budges do not constitute a normal aging process. People experiencing such symptoms should see an urogynecologist for assessment and advice.
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