Exploring the Basics of Urogynecological Evaluation and Treatments: A Talk with the Doc

The most important lesson physical therapists can take away from the Section on Women’s Health’s new video course on “Urogynecological Clinical Evaluation and Treatments” is to “to understand the variety of assessment and office procedures,” says creator Daniel Gruber, MS, MD, FACOG, FPMRS, Lt Col, USAF, MC, of Walter Reed National Military Medical Center.

“I really believe in visual learning such as videos, which are an efficient method to understanding physical findings and procedures,” he adds. “Having basic knowledge of the urogynecologic clinic can be very useful in explaining expectations to patients and knowing when to consult.”

Gruber is the chief and fellowship director of Female Pelvic Medicine and Reconstructive Surgery, as well as an associate professor for the Uniformed Services University at Walter Reed. Here, he shares his opinions on some of the issues covered in the SOWH video.

SOWH: What are the most common issues addressed during urogynecological examinations, and how do findings relate to the physical therapist?

Gruber: “The most common diagnoses a urogynecologist encounters are pelvic organ prolapse and urinary incontinence. Prolapse encompasses the anterior, posterior and apical compartments and can occur in any or all of these areas. For prolapse that is above the hymen, pelvic floor physical therapy (PFPT) can be helpful.

Urinary incontinence consists of stress incontinence and overactive bladder.  Both of these bladder problems are treated in many different ways, to include PFPT.  PFPT is often a first or second line treatment for these conditions.”

SOWH: Is it important to practice from an individualized perspective for the patient, and what are some suggestions on how to do so?

Gruber: “Each patient has unique circumstances that require individualized treatment plans. Doing a detailed history and listening to the patient are the most important ways to learn his or her specific situation. Many patients have been dealing with their issues for a long time, and learning their unique symptoms can be key in maximizing treatments.”

SOWH: How do you ensure that the patient is an active participant in her plan of care? 

Gruber: “Getting patients to be an active participant is often a difficulty. Reading the patient and seeing what motivates them are important. People who have severely suffered from their condition tend to be more motivated.

Additionally, I give limited instructions for patients at each visit to not overwhelm them. I think the more items they are given, the less likely they are to be compliant. I try to pick the most beneficial method for their condition and focus on that.”

SOWH: What are your suggestions to facilitate collaboration between the physical therapist and physician?

Gruber: “Like any other relationship, it’s important to establish communication and trust at the beginning. If either the physician or physical therapist is consulted, it’s vital to make a good impression and establish credibility. Make the other party’s life easier by taking ownership of the patient, and give feedback to the consulting party, so he or she knows the patient is in good hands.”