Monday, March 3, 2014

Q & A About Urogynecology

Diagnoses that contribute to pelvic pain, such as interstitial cystitis and vulvodynia are challenging to manage. A collaborative approach among healthcare providers is in the best interest of patients. It is important to find not only a skilled physical therapist, but other skilled providers as well. In keeping with the recent theme of Q & A, here's an interview with Audrey Baum, Certified Women’s Health Care Nurse Practitioner, working with Dr. Tomas Antonini at Central Texas Urogynecology and Continence Center. Audrey has been a great resource and great collaborator with our clinic and here is a little peek into her practice.

What's Up Down There (WUDT): What diagnoses does your practice treat the most?
Audrey Baum, WHNP

AB: We primarily treat urinary incontinence and pelvic organ prolapse. We also treat fecal incontinence, interstitial cystitis, recurrent UTIs, recurrent vaginal infections, most types of sexual dysfunction and vulvar vestibulitis/vulvodynia.

WUDT: What are the different treatment options available to patients for IC?

AB: Treatments center on diet modification, stress management, pain management and medication. All treatment plans are customized to fit individual patient needs. Diet modification includes instruction on IC-friendly diets, identifying personal dietary triggers and developing a diet that fits with the patient’s lifestyle.

Stress management is essential and we focus on finding exercise or meditative programs that work for the patient, as well as counseling when needed. We stress non-narcotic management of pain and focus on flare/trigger control and physical therapy with experienced therapists. Mild non-narcotic pain relievers are prescribed infrequently (we refer to pain management specialists if stronger pain relief is needed).

We also offer in-office bladder installations for times when immediate pain relief is required and can instruct the patient on how to do these at home, if needed. Cystoscopy with hydrodistention is a procedure done in the OR that can sometimes relieve pain symptoms for several weeks or months.

Medication includes Elmiron and other aids to control bothersome IC bladder symptoms, including overactive bladder medications. Patients with severe symptoms unrelieved by these measures can try InterStim, an implanted nerve modulator, or Botox.

WUDT: Does your practice treat vulvar vestibulitis, and if so what treatments are available?

AB: Yes. Treatment is individualized and includes many of the same areas as IC. We focus on non-narcotic pain relief, including commercial and compounded topical medications or suppositories and hot/cold therapy. We refer to physical therapy as appropriate.

WUDT: What do you like best about practicing in urogynecology?

AB: Changing people’s lives! We give patients back their ability to sit through a movie, walk without pain, exercise without wearing a pad, shop without memorizing bathroom locations and have sex without discomfort. It is very rewarding to hear how happy people are (we see lots of joyful tears).

WUDT: What is the most challenging part of practicing in urogynecology?

AB: Managing chronic pain. It is a frustrating problem for both us and our patients.

WUDT: What started your interested in urogynecology?

AB: I stepped in to help out a urogynecologist for six weeks while her physician's assistant was in China adopting a baby and I fell in love with the specialty. That was eight years ago and I haven’t looked back.
Thanks to Audrey Baum, WHNP and Sara Sauder, PT, DPT for their collaboration on this article!