Pelvic pain is an excruciating and often life-altering condition. It leaves many people desperately seeking answers for months or even years. As the primary medical specialist responsible for the bladder, urinary tract and reproductive system, urologists are often the first line of defense when patients experience pain in the pelvic region. But for too many, these visits lead to dead ends, misdiagnoses, and worsening symptoms.
It’s time for urologists to do better.
The Referral Maze
When pelvic pain begins, many people turn to their primary care doctor. These physicians, unfamiliar with the complexities of pelvic pain, often refer patients to a urologist, believing the issue may be related to an infection or other issue of the bladder, prostate, or urinary system. It’s a logical step. After all, symptoms like urinary urgency and frequency, burning, stabbing or aching pain in the penis or vagina, fall under the urology umbrella.
It’s at this point that urologists have a golden opportunity to help their patients. Instead, they rely on a narrow and outdated playbook that leaves patients even more frustrated and confused. The playbook includes:
- Testing for urinary tract infections or sexually transmitted infections
- Conducting imaging studies like CT scans or ultrasounds
- A uroflow test to measure the speed of urine flow, amount of urine and bladder emptiness
- Performing a cystoscopy to examine the bladder itself
When all these tests come back normal, and they almost always do for patients with pelvic pain, the patient is left in limbo. Some are told, “There’s nothing physically or structurally wrong with you.” Others are told to take Flomax, for months on end, despite the fact that it doesn’t help their symptoms. Still other patients are handed vague diagnoses, like interstitial cystitis (IC), and left to search the internet for further help.
The IC Diet and Other Dead Ends
One common piece of advice patients receive from urologists is to try the IC diet—a restrictive eating plan meant to reduce bladder irritation. This advice comes despite the urologist’s own tests revealing no inflammation or irritation to the bladder.
In reality, many patients with pelvic pain don’t have bladder issues at all. Instead, their symptoms stem from pelvic floor dysfunction—a condition where the muscles, nerves, and connective tissues of the pelvic floor are overly tight, weak, or imbalanced. Telling a patient with muscular issues in the pelvic floor to try the IC diet is like telling someone with a broken leg to try a neck brace. It’s completely irrelevant and asinine, and it results in the patient needlessly worrying about whether the food they eat will flare up their symptoms. Unfortunately, this is the type of advice we’re currently getting from many urologists.
This lack of awareness causes significant harm. Patients waste months or even years trying ineffective treatments. The feedback loop of continuous pain causes more tension and fear, and as a result, more pain. By the time the patient finally discovers the role of the pelvic floor and the root cause of their symptoms, if they ever do, they’ve endured unnecessary suffering, and lost precious time that could have been spent healing rather than making their symptoms worse.
Why This Matters
Pelvic pain is not just a physical problem—it’s a mental and emotional one. The uncertainty and lack of answers are deeply distressing, leaving patients anxious, lonely, and hopeless. As specialists, urologists have a responsibility to provide clarity and guidance, not more confusion.
The healthcare system already makes it difficult for pelvic pain sufferers to get help. From the stigma of seeking help and talking about issues in the pelvic region, to a lack of awareness among general practitioners, patients face numerous barriers. Urologists should be a beacon of hope in this system, offering expertise and actionable solutions. Instead, too often, they contribute to the problem.
What Needs to Change
For urologists to better serve their patients, systemic changes are needed:
- Education on Pelvic Floor Dysfunction: Urologists must receive training to recognize and understand the role of the pelvic floor in conditions like pelvic pain, urinary symptoms, and sexual dysfunction.
- Avoiding the “Nothing’s Wrong” Diagnosis: Just because imaging and lab tests come back normal doesn’t mean a patient’s pain isn’t real. Urologists should approach these cases with curiosity and empathy, seeking alternative explanations instead of dismissing symptoms. If patients are in pain and all urological tests come back normal, it’s a urologist’s duty to educate the patient about pelvic floor physical therapy.
- Collaboration with Other Specialists: Pelvic pain is a multidisciplinary issue. Urologists should work closely with pelvic floor physical therapists, gynecologists, pain specialists, and mental health professionals to provide comprehensive care.
A Call to Action
Pelvic pain sufferers deserve better. They deserve specialists who understand the complexities of their condition and are equipped to guide them toward healing. Urologists are in a unique position to lead the charge, but doing so requires a commitment to education, empathy, and collaboration.
For every patient who has endured the frustration of fruitless tests, for every person who has been told their pain isn’t real, and for every life that has been derailed by pelvic pain, it’s time to say: Dear Urologists, Do Better. The people who rely on you deserve nothing less.
If you’ve suffered from pelvic pain or pelvic floor dysfunction and a urologist failed to recognize your symptoms, diagnose or refer you to pelvic floor therapy, leave them a Google review letting them know. Link to this article if you’d like. You can be part of the solution and help ensure other patients get the help they need.